{"hospital_name":"Bayhealth Medical Center, Kent Campus","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Bayhealth Medical Center, Kent Campus","BayHealth Diabetes Wellness Center","BayHealth Emergency Center - Smyrna","BayHealth Women's Center - Kent"],"hospital_address":["640 S State Street, Dover, DE 19901","103 WOLF CREEK BLVD, STE 2, Dover, DE 19901","401 N CARTER RD, STE 101, Smyrna, DE 19977","540 S GOVERNORS AVE, STE 200, Dover, DE 19904"],"license_information":{"license_number":"HSPTL-005","state":"DE"},"type_2_npi":["1497178214","1992892848","1467546135"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Michael Tretina"},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"AmeriHealth Caritas","plan_name":"Next Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Highmark ACA Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Highmark Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Highmark Non-ACA All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VitalCore","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7800-09","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.68 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.78 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.84 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.889 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.92 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.95 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.96 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.98 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 170 ML"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 230 ML"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 230 ML"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 233 ML"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 236 ML"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 245 ML"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 247.5 ML"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 249 ML"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"},{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 440 ML"},{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 55 ML"},{"gross_charge":55.5,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"},{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 ML"},{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 ML"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 96 ML"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 98 ML"}]},{"description":"LEVOTHYROXINE 100 MCG TABLET [4423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-442-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 100 MCG TABLET [4423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-6624-19","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 100 MCG TABLET [4423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-6624-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION [113060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-468-10","type":"NDC"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":116.25,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":232.5,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":348.75,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION [113060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-451-10","type":"NDC"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":116.25,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":232.5,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":348.75,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION [113060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":519.5,"discounted_cash":436.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":130.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":259.75,"discounted_cash":218.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":389.75,"discounted_cash":327.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE 100 MCG TABLET [4423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-3284-46","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 100 MCG TABLET [4423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6953-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 100 MCG TABLET [4423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5184-92","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 100 MCG TABLET [4423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-442-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION [113060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-649-94","type":"NDC"}],"standard_charges":[{"gross_charge":434.5,"discounted_cash":364.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":108.75,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":217.25,"discounted_cash":182.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOFLOXACIN 750 MG TABLET [28964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6353-61","type":"NDC"}],"standard_charges":[{"gross_charge":55.5,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":166.5,"discounted_cash":139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG TABLET [28964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-483-11","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":192.25,"discounted_cash":161.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG TABLET [28964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-483-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":192.25,"discounted_cash":161.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG TABLET [28964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-538-20","type":"NDC"}],"standard_charges":[{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":130.75,"discounted_cash":109.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG TABLET [28964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-281-30","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":136.25,"discounted_cash":114.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG TABLET [28964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-930-20","type":"NDC"}],"standard_charges":[{"gross_charge":92.25,"discounted_cash":77.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":184.5,"discounted_cash":154.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":276.75,"discounted_cash":232.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000-295-24","type":"NDC"}],"standard_charges":[{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000-047-24","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0143-9721-24","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"63323-355-65","type":"NDC"}],"standard_charges":[{"gross_charge":155.5,"discounted_cash":130.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0143-9721-01","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021-132-82","type":"NDC"}],"standard_charges":[{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVOFLOXACIN 500 MG TABLET [18919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-722-50","type":"NDC"}],"standard_charges":[{"gross_charge":65.25,"discounted_cash":54.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":130.5,"discounted_cash":109.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":195.5,"discounted_cash":164.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 500 MG TABLET [18919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6352-61","type":"NDC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":113.75,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":170.5,"discounted_cash":143.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 500 MG TABLET [18919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-482-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":127.75,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":191.75,"discounted_cash":161.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021-132-83","type":"NDC"}],"standard_charges":[{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0143-9720-01","type":"NDC"}],"standard_charges":[{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION [113060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-649-07","type":"NDC"}],"standard_charges":[{"gross_charge":592.25,"discounted_cash":497.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":296.25,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":444.25,"discounted_cash":373.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVONORGESTREL 21 MCG/24 HR (UP TO 8 YEARS) 52 MG INTRAUTERINE DEVICE [29280]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7298","type":"HCPCS"},{"code":"50419-423-01","type":"NDC"}],"standard_charges":[{"gross_charge":4431.0,"discounted_cash":3722.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"LEVONORGESTREL 20.4 MCG/24 HR (UP TO 8 YRS) 52 MG INTRAUTERINE DEVICE [166050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7297","type":"HCPCS"},{"code":"0023-5858-01","type":"NDC"}],"standard_charges":[{"gross_charge":3399.0,"discounted_cash":2855.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"LEVONORGESTREL 17.5 MCG/24 HR (UP TO 5 YRS) 19.5MG INTRAUTERINE DEVICE [173622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7296","type":"HCPCS"},{"code":"50419-424-08","type":"NDC"}],"standard_charges":[{"gross_charge":3478.5,"discounted_cash":2921.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"LEVONORGESTREL 17.5 MCG/24 HR (UP TO 5 YRS) 19.5MG INTRAUTERINE DEVICE [173622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7296","type":"HCPCS"},{"code":"50419-424-01","type":"NDC"}],"standard_charges":[{"gross_charge":4431.0,"discounted_cash":3722.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"LEVONORGESTREL 14 MCG/24 HR (UP TO 3 YRS) 13.5 MG INTRAUTERINE DEVICE [119672]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7301","type":"HCPCS"},{"code":"50419-422-01","type":"NDC"}],"standard_charges":[{"gross_charge":3689.75,"discounted_cash":3099.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"LEVONORGESTREL 1.5 MG TABLET [99445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1142-63","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"LEVONORGESTREL 1.5 MG TABLET [99445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69536-162-88","type":"NDC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"LEVONORGESTREL 1.5 MG TABLET [99445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-809-01","type":"NDC"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":153.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"LEVONORGESTREL 1.5 MG TABLET [99445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-852-11","type":"NDC"}],"standard_charges":[{"gross_charge":198.75,"discounted_cash":166.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"LEVONORGESTREL 1.5 MG TABLET [99445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51285-162-88","type":"NDC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"LEVOFLOXACIN 25 MG/ML INTRAVENOUS SOLUTION [18925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"17478-107-20","type":"NDC"}],"standard_charges":[{"gross_charge":243.5,"discounted_cash":204.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":243.5,"discounted_cash":204.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":365.25,"discounted_cash":306.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0409-4444-24","type":"NDC"}],"standard_charges":[{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0409-4444-01","type":"NDC"}],"standard_charges":[{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0409-0528-35","type":"NDC"}],"standard_charges":[{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0409-0528-31","type":"NDC"}],"standard_charges":[{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567-437-24","type":"NDC"}],"standard_charges":[{"gross_charge":159.5,"discounted_cash":133.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000-048-24","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"63323-355-60","type":"NDC"}],"standard_charges":[{"gross_charge":159.5,"discounted_cash":133.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0143-9720-24","type":"NDC"}],"standard_charges":[{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOMILNACIPRAN ER 120 MG CAPSULE,24 HR,EXTENDED RELEASE [124469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-2212-30","type":"NDC"}],"standard_charges":[{"gross_charge":147.25,"discounted_cash":123.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"LEVOTHYROXINE 150 MCG TABLET [4425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1815-77","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 150 MCG TABLET [4425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-445-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 150 MCG TABLET [4425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5187-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 150 MCG TABLET [4425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-7069-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 150 MCG TABLET [4425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6956-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 25 MCG TABLET [4420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-4341-90","type":"NDC"}],"standard_charges":[{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 25 MCG TABLET [4420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-444-20","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 25 MCG TABLET [4420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-444-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 200 MCG INTRAVENOUS POWDER FOR SOLUTION [4418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-469-10","type":"NDC"}],"standard_charges":[{"gross_charge":407.75,"discounted_cash":342.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":815.5,"discounted_cash":685.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"LEVOTHYROXINE 200 MCG INTRAVENOUS POWDER FOR SOLUTION [4418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-452-10","type":"NDC"}],"standard_charges":[{"gross_charge":407.75,"discounted_cash":342.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":815.5,"discounted_cash":685.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"LEVOTHYROXINE 200 MCG INTRAVENOUS POWDER FOR SOLUTION [4418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-647-10","type":"NDC"}],"standard_charges":[{"gross_charge":515.75,"discounted_cash":433.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1031.25,"discounted_cash":866.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"LEVOTHYROXINE 112 MCG TABLET [10404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6954-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 112 MCG TABLET [10404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292-039-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 112 MCG TABLET [10404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292-039-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 112 MCG TABLET [10404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5185-92","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 112 MCG TABLET [10404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-9296-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 112 MCG TABLET [10404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-508-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 112 MCG TABLET [10404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-508-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 112 MCG TABLET [10404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-654-90","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOFLOXACIN 500 MG TABLET [18919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-537-50","type":"NDC"}],"standard_charges":[{"gross_charge":65.25,"discounted_cash":54.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":130.25,"discounted_cash":109.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":195.25,"discounted_cash":164.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-5615-05","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50474-595-40","type":"NDC"}],"standard_charges":[{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7123-61","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-472-15","type":"NDC"}],"standard_charges":[{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-472-11","type":"NDC"}],"standard_charges":[{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-795-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-859-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-859-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-354-01","type":"NDC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-536-12","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-820-20","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-5615-78","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-411-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-870-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-870-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-355-02","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-355-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-537-12","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-537-05","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-246-08","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6052-61","type":"NDC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG TABLET [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-821-20","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-820-01","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [24915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"0378-9691-52","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.63 MG"}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [24915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"0115-9931-78","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.63 MG"}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [24915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"0115-9931-76","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.63 MG"}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [24915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"76204-800-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.63 MG"}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [24915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"76204-800-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.63 MG"}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [24915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"43598-410-25","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.63 MG"}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [24915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"66993-022-27","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.63 MG"}]},{"description":"LEUPROLIDE ACETATE 45 MG (6 MONTH) SUBCUTANEOUS SYRINGE [40801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935-461-50","type":"NDC"}],"standard_charges":[{"gross_charge":8033.0,"discounted_cash":6747.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"LEUPROLIDE ACETATE 45 MG (6 MONTH) SUBCUTANEOUS SYRINGE [40801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935-454-44","type":"NDC"}],"standard_charges":[{"gross_charge":8033.0,"discounted_cash":6747.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"LEUPROLIDE ACETATE 45 MG (6 MONTH) SUBCUTANEOUS SYRINGE [40801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935-453-45","type":"NDC"}],"standard_charges":[{"gross_charge":8033.0,"discounted_cash":6747.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"LEUPROLIDE ACETATE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT [110751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"0074-3473-03","type":"NDC"}],"standard_charges":[{"gross_charge":1235.25,"discounted_cash":1037.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT [132981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"0074-3642-03","type":"NDC"}],"standard_charges":[{"gross_charge":6354.25,"discounted_cash":5337.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE [32893]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935-754-74","type":"NDC"}],"standard_charges":[{"gross_charge":1648.0,"discounted_cash":1384.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE [32893]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935-753-75","type":"NDC"}],"standard_charges":[{"gross_charge":1648.0,"discounted_cash":1384.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT [21108]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"0074-3683-03","type":"NDC"}],"standard_charges":[{"gross_charge":17616.5,"discounted_cash":14797.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT [13691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"0074-3641-03","type":"NDC"}],"standard_charges":[{"gross_charge":5338.5,"discounted_cash":4484.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"},{"gross_charge":10677.0,"discounted_cash":8968.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE [33669]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935-227-10","type":"NDC"}],"standard_charges":[{"gross_charge":4942.75,"discounted_cash":4151.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":9885.25,"discounted_cash":8303.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE [33669]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935-223-05","type":"NDC"}],"standard_charges":[{"gross_charge":4943.5,"discounted_cash":4152.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":9886.75,"discounted_cash":8304.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE [33669]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935-221-04","type":"NDC"}],"standard_charges":[{"gross_charge":4943.5,"discounted_cash":4152.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":9886.75,"discounted_cash":8304.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"LEUPROLIDE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21045]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"0074-3346-03","type":"NDC"}],"standard_charges":[{"gross_charge":13211.25,"discounted_cash":11097.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"}]},{"description":"LEUPROLIDE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"0074-3663-03","type":"NDC"}],"standard_charges":[{"gross_charge":11087.75,"discounted_cash":9313.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11.25 MG"},{"gross_charge":22175.5,"discounted_cash":18627.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"}]},{"description":"LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION [4392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457-528-10","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":648.0,"discounted_cash":544.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7922-09","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.76 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.95 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.98 ML"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":55.5,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 ML"}]},{"description":"LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION [23617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"70436-120-80","type":"NDC"}],"standard_charges":[{"gross_charge":424.25,"discounted_cash":356.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION [24915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"0378-9691-62","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.63 MG"}]},{"description":"LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [24916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"76204-900-15","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [24916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"76204-900-25","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [24916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7614","type":"HCPCS"},{"code":"0093-4148-45","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-5613-78","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 250 MG TABLET [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50474-594-40","type":"NDC"}],"standard_charges":[{"gross_charge":268.5,"discounted_cash":225.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":134.25,"discounted_cash":112.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 100 MG/ML ORAL SOLUTION [36590]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-358-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG/KG"},{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG/KG"}]},{"description":"LEVETIRACETAM 1,500 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-503-10","type":"NDC"}],"standard_charges":[{"gross_charge":175.75,"discounted_cash":147.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"LEVETIRACETAM 1,500 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-503-01","type":"NDC"}],"standard_charges":[{"gross_charge":175.75,"discounted_cash":147.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"LEVETIRACETAM 1,500 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"14789-330-15","type":"NDC"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":203.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"LEVETIRACETAM 1,500 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"14789-330-08","type":"NDC"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":203.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"LEVETIRACETAM 1,500 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-637-52","type":"NDC"}],"standard_charges":[{"gross_charge":315.25,"discounted_cash":264.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"LEVETIRACETAM 1,500 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-248-47","type":"NDC"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"LEVETIRACETAM 1,500 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-266-10","type":"NDC"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":203.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"LEVETIRACETAM 1,500 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-266-00","type":"NDC"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":203.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-603-41","type":"NDC"}],"standard_charges":[{"gross_charge":330.5,"discounted_cash":277.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-603-82","type":"NDC"}],"standard_charges":[{"gross_charge":330.5,"discounted_cash":277.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-636-52","type":"NDC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-636-10","type":"NDC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-265-10","type":"NDC"}],"standard_charges":[{"gross_charge":194.5,"discounted_cash":163.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-265-00","type":"NDC"}],"standard_charges":[{"gross_charge":194.5,"discounted_cash":163.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION [39278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7612","type":"HCPCS"},{"code":"0378-6993-31","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION [39278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7612","type":"HCPCS"},{"code":"0093-4147-19","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION [39278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7612","type":"HCPCS"},{"code":"17478-171-30","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION [39278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7612","type":"HCPCS"},{"code":"17478-171-01","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION [39278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7612","type":"HCPCS"},{"code":"0378-6993-93","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVETIRACETAM 1,500 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [113477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-637-10","type":"NDC"}],"standard_charges":[{"gross_charge":315.25,"discounted_cash":264.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK [113475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457-255-10","type":"NDC"}],"standard_charges":[{"gross_charge":167.75,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"0143-9673-25","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9673-25","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-400-01","type":"NDC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323-400-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"72485-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-106-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"72485-106-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-400-44","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323-400-44","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-400-41","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323-400-41","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1886-15","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"0409-1886-15","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOBUNOLOL 0.5 % EYE DROPS [10394]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-505-05","type":"NDC"}],"standard_charges":[{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION [20954]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1955","type":"HCPCS"},{"code":"54482-147-01","type":"NDC"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":213.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVOFLOXACIN 500 MG TABLET [18919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-280-50","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":135.75,"discounted_cash":114.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":203.75,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 500 MG TABLET [18919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-925-50","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":195.75,"discounted_cash":164.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":293.75,"discounted_cash":246.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0409-0528-15","type":"NDC"}],"standard_charges":[{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0409-0528-13","type":"NDC"}],"standard_charges":[{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000-046-24","type":"NDC"}],"standard_charges":[{"gross_charge":86.75,"discounted_cash":72.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0143-9722-24","type":"NDC"}],"standard_charges":[{"gross_charge":102.75,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"0143-9722-01","type":"NDC"}],"standard_charges":[{"gross_charge":102.75,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021-132-81","type":"NDC"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"LEVOFLOXACIN 250 MG TABLET [18918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-721-50","type":"NDC"}],"standard_charges":[{"gross_charge":113.75,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":227.25,"discounted_cash":190.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":340.75,"discounted_cash":286.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 250 MG TABLET [18918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6351-61","type":"NDC"}],"standard_charges":[{"gross_charge":99.5,"discounted_cash":83.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":199.0,"discounted_cash":167.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":298.5,"discounted_cash":250.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 250 MG TABLET [18918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-536-50","type":"NDC"}],"standard_charges":[{"gross_charge":113.75,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":227.25,"discounted_cash":190.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":340.75,"discounted_cash":286.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 25 MG/ML INTRAVENOUS SOLUTION [18925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"55150-157-30","type":"NDC"}],"standard_charges":[{"gross_charge":242.75,"discounted_cash":203.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LEVOFLOXACIN 25 MG/ML INTRAVENOUS SOLUTION [18925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"55150-156-20","type":"NDC"}],"standard_charges":[{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LEVOFLOXACIN 25 MG/ML INTRAVENOUS SOLUTION [18925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"23155-201-32","type":"NDC"}],"standard_charges":[{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LEVOCARNITINE 330 MG TABLET [20952]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-172-90","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 330 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 660 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 990 MG"}]},{"description":"LEVOBUNOLOL 0.5 % EYE DROPS [10394]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-060-05","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1886-05","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"0409-1886-05","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-249-77","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-249-67","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-249-46","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-249-40","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4799-40","type":"NDC"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-241-06","type":"NDC"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-241-05","type":"NDC"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5293-05","type":"NDC"}],"standard_charges":[{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4799-05","type":"NDC"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-028-50","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-028-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK [113475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789-110-08","type":"NDC"}],"standard_charges":[{"gross_charge":167.75,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK [113475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789-110-05","type":"NDC"}],"standard_charges":[{"gross_charge":167.75,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK [113475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"70860-602-41","type":"NDC"}],"standard_charges":[{"gross_charge":276.25,"discounted_cash":232.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK [113475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"70860-602-82","type":"NDC"}],"standard_charges":[{"gross_charge":276.25,"discounted_cash":232.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK [113475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598-635-52","type":"NDC"}],"standard_charges":[{"gross_charge":204.25,"discounted_cash":171.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK [113475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598-635-10","type":"NDC"}],"standard_charges":[{"gross_charge":204.25,"discounted_cash":171.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK [113475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150-246-47","type":"NDC"}],"standard_charges":[{"gross_charge":235.25,"discounted_cash":197.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-470-11","type":"NDC"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-470-13","type":"NDC"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-790-05","type":"NDC"}],"standard_charges":[{"gross_charge":170.25,"discounted_cash":143.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457-790-05","type":"NDC"}],"standard_charges":[{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":127.75,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-790-00","type":"NDC"}],"standard_charges":[{"gross_charge":170.25,"discounted_cash":143.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457-790-00","type":"NDC"}],"standard_charges":[{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":127.75,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1886-22","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"0409-1886-22","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-177-05","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK [113475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457-255-00","type":"NDC"}],"standard_charges":[{"gross_charge":167.75,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150-177-05","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9673-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"0143-9673-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-400-05","type":"NDC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323-400-05","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-780-05","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"25021-780-05","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1886-02","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"0409-1886-02","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION [131713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4799-50","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4276-16","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-485-26","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-485-27","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4276-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-201-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-201-02","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL (PF) 100 MG/10 ML (1 %) IN 0.9 % SODIUM CHLORIDE SYRINGE [131906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71019-167-11","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (BULK) 100 % POWDER [4456]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49452-4050-2","type":"NDC"}],"standard_charges":[{"gross_charge":3607.25,"discounted_cash":3030.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82347-0505-4","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-477-30","type":"NDC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":181.75,"discounted_cash":152.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":272.75,"discounted_cash":229.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-477-11","type":"NDC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":181.75,"discounted_cash":152.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":272.75,"discounted_cash":229.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82347-0505-5","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61959-001-30","type":"NDC"}],"standard_charges":[{"gross_charge":181.25,"discounted_cash":152.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":362.5,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":543.75,"discounted_cash":456.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61959-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":181.25,"discounted_cash":152.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":362.5,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":543.75,"discounted_cash":456.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-495-11","type":"NDC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":181.75,"discounted_cash":152.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":272.75,"discounted_cash":229.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-252-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.43 ML"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.85 ML"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.71 ML"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-485-41","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-486-27","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-486-17","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4277-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-202-02","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL SOLUTION [127488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4950-40","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL SOLUTION [127488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4950-15","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL SOLUTION [127488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888-125-26","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL SOLUTION [127488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0903-40","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL SOLUTION [127488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0903-15","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL SOLUTION [127488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1244-15","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL SOLUTION [127488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-775-17","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL SOLUTION [127488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-775-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL SOLUTION [127488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-775-04","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL SOLUTION [127488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3500-49","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL JELLY [4448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-711-31","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL JELLY [4448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-711-30","type":"NDC"}],"standard_charges":[{"gross_charge":527.5,"discounted_cash":443.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE HCL 2 % MUCOSAL JELLY [4448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-711-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70756-645-86","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-485-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-791-08","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":208.25,"discounted_cash":174.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL OINTMENT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-878-01","type":"NDC"}],"standard_charges":[{"gross_charge":973.75,"discounted_cash":817.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 G"}]},{"description":"LIDOCAINE 5 % TOPICAL OINTMENT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-473-80","type":"NDC"}],"standard_charges":[{"gross_charge":1362.25,"discounted_cash":1144.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"LIDOCAINE 5 % TOPICAL OINTMENT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-418-20","type":"NDC"}],"standard_charges":[{"gross_charge":1133.75,"discounted_cash":952.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 G"}]},{"description":"LIDOCAINE 5 % TOPICAL OINTMENT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52565-008-14","type":"NDC"}],"standard_charges":[{"gross_charge":1133.75,"discounted_cash":952.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 G"}]},{"description":"LIDOCAINE 5 % TOPICAL OINTMENT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-3020-9","type":"NDC"}],"standard_charges":[{"gross_charge":1133.75,"discounted_cash":952.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 G"}]},{"description":"LIDOCAINE 5 % TOPICAL OINTMENT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-3020-2","type":"NDC"}],"standard_charges":[{"gross_charge":818.5,"discounted_cash":687.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE 5 % TOPICAL OINTMENT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0204-37","type":"NDC"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":902.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 G"}]},{"description":"LIDOCAINE 4 % TOPICAL CREAM [23461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-399-30","type":"NDC"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":153.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE 4 % TOPICAL CREAM [23461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0496-0882-06","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE 4 % TOPICAL CREAM [23461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24357-701-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"LIDOCAINE 4 % TOPICAL CREAM [23461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0496-0882-30","type":"NDC"}],"standard_charges":[{"gross_charge":222.25,"discounted_cash":186.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE 4 % (40 MG/ML) MUCOSAL SOLUTION - WOUND CARE [181294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-518-10","type":"NDC"}],"standard_charges":[{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":106.5,"discounted_cash":89.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":159.5,"discounted_cash":133.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"},{"gross_charge":265.75,"discounted_cash":223.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE 4 % (40 MG/ML) MUCOSAL SOLUTION - WOUND CARE [181294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52565-009-50","type":"NDC"}],"standard_charges":[{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":106.5,"discounted_cash":89.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":159.5,"discounted_cash":133.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"},{"gross_charge":265.75,"discounted_cash":223.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE 4 % (40 MG/ML) MUCOSAL SOLUTION - WOUND CARE [181294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3505-47","type":"NDC"}],"standard_charges":[{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":156.75,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"},{"gross_charge":261.25,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-483-01","type":"NDC"}],"standard_charges":[{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3182-21","type":"NDC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3182-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-483-03","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-483-27","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-483-57","type":"NDC"}],"standard_charges":[{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE 5 % TOPICAL OINTMENT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-878-02","type":"NDC"}],"standard_charges":[{"gross_charge":1363.25,"discounted_cash":1145.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"LIDOCAINE 5 % TOPICAL OINTMENT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70752-113-03","type":"NDC"}],"standard_charges":[{"gross_charge":1134.0,"discounted_cash":952.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 G"}]},{"description":"LIDOCAINE 5 % TOPICAL OINTMENT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70752-113-04","type":"NDC"}],"standard_charges":[{"gross_charge":1364.0,"discounted_cash":1145.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63481-687-06","type":"NDC"}],"standard_charges":[{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":286.25,"discounted_cash":240.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":429.25,"discounted_cash":360.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-791-04","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":208.25,"discounted_cash":174.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-118-30","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9055-16","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":208.25,"discounted_cash":174.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9055-93","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":208.25,"discounted_cash":174.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-1880-16","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":208.25,"discounted_cash":174.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-486-26","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-1880-10","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":208.25,"discounted_cash":174.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63481-687-01","type":"NDC"}],"standard_charges":[{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":286.25,"discounted_cash":240.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":429.25,"discounted_cash":360.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3525-30","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":126.5,"discounted_cash":106.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":189.75,"discounted_cash":159.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % TOPICAL PATCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3525-11","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":126.5,"discounted_cash":106.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":189.75,"discounted_cash":159.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3182-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4277-16","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9575-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIOTHYRONINE 25 MCG TABLET [4504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794-019-12","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIOTHYRONINE 25 MCG TABLET [4504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-321-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIOTHYRONINE 25 MCG TABLET [4504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794-019-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIOTHYRONINE 25 MCG TABLET [4504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60793-116-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LINEZOLID IV SYRINGE 2 MG/ML FROM PREMIX (NEO/PED) [195390]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"67457-843-30","type":"NDC"}],"standard_charges":[{"gross_charge":409.25,"discounted_cash":343.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"},{"gross_charge":409.25,"discounted_cash":343.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IV SYRINGE 2 MG/ML FROM PREMIX (NEO/PED) [195390]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"67457-843-00","type":"NDC"}],"standard_charges":[{"gross_charge":409.25,"discounted_cash":343.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"},{"gross_charge":409.25,"discounted_cash":343.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"63323-713-03","type":"NDC"}],"standard_charges":[{"gross_charge":278.5,"discounted_cash":233.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"66794-219-63","type":"NDC"}],"standard_charges":[{"gross_charge":208.25,"discounted_cash":174.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"66794-219-43","type":"NDC"}],"standard_charges":[{"gross_charge":208.25,"discounted_cash":174.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"57664-683-57","type":"NDC"}],"standard_charges":[{"gross_charge":374.75,"discounted_cash":314.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"57664-683-31","type":"NDC"}],"standard_charges":[{"gross_charge":374.75,"discounted_cash":314.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"55150-242-51","type":"NDC"}],"standard_charges":[{"gross_charge":506.75,"discounted_cash":425.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"63323-713-13","type":"NDC"}],"standard_charges":[{"gross_charge":278.5,"discounted_cash":233.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"0009-7807-02","type":"NDC"}],"standard_charges":[{"gross_charge":269.75,"discounted_cash":226.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"0009-7807-01","type":"NDC"}],"standard_charges":[{"gross_charge":269.75,"discounted_cash":226.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"0009-5140-04","type":"NDC"}],"standard_charges":[{"gross_charge":269.75,"discounted_cash":226.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [128318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"0009-5140-01","type":"NDC"}],"standard_charges":[{"gross_charge":269.75,"discounted_cash":226.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID 600 MG TABLET [28224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-309-21","type":"NDC"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":435.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID 600 MG TABLET [28224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-309-11","type":"NDC"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":435.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LIOTHYRONINE 25 MCG TABLET [4504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-1207-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [111147]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0032-1203-70","type":"NDC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS OF LIPASE"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS OF LIPASE"},{"gross_charge":183.0,"discounted_cash":153.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS/KG OF LIPASE"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS OF LIPASE"}]},{"description":"LIPASE-PROTEASE-AMYLASE 10,440-39,150-39,150 UNIT TABLET [116035]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"73562-104-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10440 UNITS OF LIPASE"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20880 UNITS OF LIPASE"},{"gross_charge":126.5,"discounted_cash":106.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS/KG OF LIPASE"}]},{"description":"LIOTHYRONINE 5 MCG TABLET [10443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-589-88","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIOTHYRONINE 5 MCG TABLET [10443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794-018-12","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":86.25,"discounted_cash":72.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIOTHYRONINE 5 MCG TABLET [10443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-320-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":127.75,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":191.5,"discounted_cash":160.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIOTHYRONINE 5 MCG TABLET [10443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-0320-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":127.75,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":191.5,"discounted_cash":160.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIOTHYRONINE 5 MCG TABLET [10443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60793-115-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LINEZOLID 600 MG TABLET [28224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-419-33","type":"NDC"}],"standard_charges":[{"gross_charge":753.25,"discounted_cash":632.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID 600 MG TABLET [28224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6553-04","type":"NDC"}],"standard_charges":[{"gross_charge":750.5,"discounted_cash":630.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID 600 MG TABLET [28224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-419-84","type":"NDC"}],"standard_charges":[{"gross_charge":753.25,"discounted_cash":632.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION WRAPPER [179987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-488-07","type":"NDC"}],"standard_charges":[{"gross_charge":144.5,"discounted_cash":121.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION WRAPPER [179987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-488-01","type":"NDC"}],"standard_charges":[{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION WRAPPER [179987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1209-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION WRAPPER [179987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-488-17","type":"NDC"}],"standard_charges":[{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION WRAPPER [179987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-488-37","type":"NDC"}],"standard_charges":[{"gross_charge":144.5,"discounted_cash":121.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION WRAPPER [179987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1209-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION [10428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-487-07","type":"NDC"}],"standard_charges":[{"gross_charge":124.75,"discounted_cash":104.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION [10428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-487-17","type":"NDC"}],"standard_charges":[{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION [10428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-487-37","type":"NDC"}],"standard_charges":[{"gross_charge":124.75,"discounted_cash":104.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE HCL 4 %-BENZALKONIUM 0.13 % TOPICAL GEL [190558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68229-406-02","type":"NDC"}],"standard_charges":[{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"LIDOCAINE HCL 4 %-BENZALKONIUM 0.13 % TOPICAL GEL [190558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68229-300-03","type":"NDC"}],"standard_charges":[{"gross_charge":110.5,"discounted_cash":92.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 ML"}]},{"description":"LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION [43717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-6300-5","type":"NDC"}],"standard_charges":[{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":148.0,"discounted_cash":124.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":197.25,"discounted_cash":165.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION [43717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4698-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION [4450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-6004-80","type":"NDC"}],"standard_charges":[{"gross_charge":265.75,"discounted_cash":223.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-202-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-486-41","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-486-02","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-486-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-255-20","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-254-10","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION [10431]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3183-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION [10431]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-489-21","type":"NDC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION [10431]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-489-17","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION [10431]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-489-27","type":"NDC"}],"standard_charges":[{"gross_charge":153.5,"discounted_cash":128.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LINEZOLID 600 MG TABLET [28224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-419-20","type":"NDC"}],"standard_charges":[{"gross_charge":753.25,"discounted_cash":632.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID 600 MG TABLET [28224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-749-20","type":"NDC"}],"standard_charges":[{"gross_charge":753.25,"discounted_cash":632.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-5136-04","type":"NDC"}],"standard_charges":[{"gross_charge":1054.75,"discounted_cash":885.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-865-25","type":"NDC"}],"standard_charges":[{"gross_charge":2238.75,"discounted_cash":1880.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0319-50","type":"NDC"}],"standard_charges":[{"gross_charge":2908.5,"discounted_cash":2443.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-5136-01","type":"NDC"}],"standard_charges":[{"gross_charge":2487.5,"discounted_cash":2089.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"LINDANE 1 % SHAMPOO [4498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-834-60","type":"NDC"}],"standard_charges":[{"gross_charge":562.5,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"LINAGLIPTIN 5 MG TABLET [109773]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0140-61","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LINAGLIPTIN 5 MG TABLET [109773]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0140-90","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LINACLOTIDE 72 MCG CAPSULE [408710]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1203-30","type":"NDC"}],"standard_charges":[{"gross_charge":153.5,"discounted_cash":128.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 72 MCG"}]},{"description":"LINACLOTIDE 290 MCG CAPSULE [117353]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1202-30","type":"NDC"}],"standard_charges":[{"gross_charge":158.5,"discounted_cash":133.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 290 MCG"}]},{"description":"LINACLOTIDE 145 MCG CAPSULE [117352]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1201-30","type":"NDC"}],"standard_charges":[{"gross_charge":153.5,"discounted_cash":128.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MCG"}]},{"description":"LIFITEGRAST 5 % EYE DROPS IN A DROPPERETTE [172891]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0911-12","type":"NDC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LIFITEGRAST 5 % EYE DROPS IN A DROPPERETTE [172891]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0911-05","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9575-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT [30183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0496-0882-07","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-582-31","type":"NDC"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":124.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2070-72","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2070-26","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0357-05","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1468-53","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1468-60","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1468-45","type":"NDC"}],"standard_charges":[{"gross_charge":250.75,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0357-55","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-667-30","type":"NDC"}],"standard_charges":[{"gross_charge":218.5,"discounted_cash":183.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE (LET) TOPICAL SOLUTION WRAPPER [134360]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70092-1135-44","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION [10431]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-489-03","type":"NDC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION [10431]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-489-01","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION [10431]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3183-11","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION [10431]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-489-02","type":"NDC"}],"standard_charges":[{"gross_charge":153.5,"discounted_cash":128.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL KIT [11934]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69176-140-00","type":"NDC"}],"standard_charges":[{"gross_charge":5730.5,"discounted_cash":4813.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3182-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 2 %-EPINEPHRINE BITARTRATE 1:100,000 INJECTION CARTRIDGE [131387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0362-0898-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.7 ML"}]},{"description":"LIDOCAINE 2 %-EPINEPHRINE BITARTRATE 1:100,000 INJECTION CARTRIDGE [131387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50227-1030-5","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.7 ML"}]},{"description":"LEVOTHYROXINE 50 MCG TABLET [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-464-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 50 MCG TABLET [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1803-77","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 50 MCG TABLET [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5181-92","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 50 MCG TABLET [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67544-884-60","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 50 MCG TABLET [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-464-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 88 MCG TABLET [10403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-6594-90","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 88 MCG TABLET [10403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1344-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 500 MCG INTRAVENOUS POWDER FOR SOLUTION [113058]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-648-10","type":"NDC"}],"standard_charges":[{"gross_charge":770.5,"discounted_cash":647.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":1155.5,"discounted_cash":970.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":1540.75,"discounted_cash":1294.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":1926.0,"discounted_cash":1617.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"LEVOTHYROXINE 50 MCG TABLET [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6950-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 25 MCG TABLET [4420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-453-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 25 MCG TABLET [4420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-453-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 25 MCG TABLET [4420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1800-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 25 MCG TABLET [4420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5180-92","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 50 MCG TABLET [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-440-20","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 50 MCG TABLET [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-4552-19","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 50 MCG TABLET [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-4552-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9594-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4282-12","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2066-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-495-26","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-165-05","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-164-02","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-495-07","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-495-27","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-496-97","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4282-02","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2066-05","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE WRAPPER [104459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73177-120-02","type":"NDC"}],"standard_charges":[{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE WRAPPER [104459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3390-1","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"},{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE WRAPPER [104459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1323-05","type":"NDC"}],"standard_charges":[{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE WRAPPER [104459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-208-05","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4713-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-04","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-41","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-43","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-09","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-45","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.43 ML"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.85 ML"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.71 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9594-25","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-495-04","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-495-41","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-496-03","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE 2 %-EPINEPHRINE 0.1 % TOPICAL GEL [408086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5548-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"LIDOCAINE 2 %-EPINEPHRINE 0.1 % TOPICAL GEL [408086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"00000-0002-16","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR [131523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25021-673-76","type":"NDC"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR [131523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76329-3013-5","type":"NDC"}],"standard_charges":[{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-482-41","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3178-17","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3178-16","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-482-03","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-482-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-482-26","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-482-27","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-482-17","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3178-02","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3178-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-07","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE 0.9 % BUFFERED WITH 8.4 % SODIUM BICARB (5 ML) INJ SYRINGE [132875]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-947-50","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE [4457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9137-11","type":"NDC"}],"standard_charges":[{"gross_charge":110.5,"discounted_cash":92.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE [4457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4904-11","type":"NDC"}],"standard_charges":[{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE [4457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9137-05","type":"NDC"}],"standard_charges":[{"gross_charge":110.5,"discounted_cash":92.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE [4457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4904-34","type":"NDC"}],"standard_charges":[{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [106363]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-491-57","type":"NDC"}],"standard_charges":[{"gross_charge":117.5,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION [4455]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"83090-007-10","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION [4455]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"83090-007-01","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION [4455]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4283-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14868]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0409-03","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14868]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-9594-10","type":"NDC"}],"standard_charges":[{"gross_charge":125.25,"discounted_cash":105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-495-09","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION [23617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288-164-50","type":"NDC"}],"standard_charges":[{"gross_charge":424.25,"discounted_cash":356.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65282-1605-1","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9595-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVOTHYROXINE 88 MCG TABLET [10403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292-038-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 88 MCG TABLET [10403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292-038-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 88 MCG TABLET [10403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1807-77","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE 88 MCG TABLET [10403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5183-92","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4713-75","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4713-42","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4713-12","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4279-16","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-26","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-36","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-16","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4713-65","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4713-62","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-163-30","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-162-05","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-161-02","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-159-74","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-27","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9595-25","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-57","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4713-02","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4713-32","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4279-02","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LEVOTHYROXINE 88 MCG TABLET [10403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1833-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-492-37","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION [23617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021-828-50","type":"NDC"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":363.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 50 MG SOLUTION FOR INJECTION [4394]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"0143-9555-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":90.75,"discounted_cash":76.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-128-41","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-128-37","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE DINITRATE 5 MG TABLET [4068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-020-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 5 MG TABLET [4068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1769-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG TABLET [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6620-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG TABLET [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-083-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG TABLET [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-083-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG TABLET [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1695-13","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG TABLET [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1695-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG TABLET [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1772-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-104-10","type":"NDC"}],"standard_charges":[{"gross_charge":81.75,"discounted_cash":68.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-592-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-452-15","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-178-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-105-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-119-41","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-119-37","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-519-01","type":"NDC"}],"standard_charges":[{"gross_charge":90.75,"discounted_cash":76.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6449-61","type":"NDC"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-591-11","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-591-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE DINITRATE 10 MG TABLET [4064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6619-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69918-731-01","type":"NDC"}],"standard_charges":[{"gross_charge":837.75,"discounted_cash":703.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"14789-015-07","type":"NDC"}],"standard_charges":[{"gross_charge":2189.0,"discounted_cash":1838.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0548-9502-00","type":"NDC"}],"standard_charges":[{"gross_charge":859.25,"discounted_cash":721.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69097-521-31","type":"NDC"}],"standard_charges":[{"gross_charge":3338.0,"discounted_cash":2803.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":16689.75,"discounted_cash":14019.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69097-522-35","type":"NDC"}],"standard_charges":[{"gross_charge":1787.75,"discounted_cash":1501.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"14789-015-05","type":"NDC"}],"standard_charges":[{"gross_charge":2189.0,"discounted_cash":1838.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0187-4330-05","type":"NDC"}],"standard_charges":[{"gross_charge":5306.0,"discounted_cash":4457.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0187-4330-01","type":"NDC"}],"standard_charges":[{"gross_charge":5371.75,"discounted_cash":4512.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1410-01","type":"NDC"}],"standard_charges":[{"gross_charge":262.25,"discounted_cash":220.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ISONIAZID 300 MG TABLET [4027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-083-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ISONIAZID 300 MG TABLET [4027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0071-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ISONIAZID 300 MG TABLET [4027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0071-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ISONIAZID 100 MG TABLET [4026]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0066-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [184787]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"0024-0656-01","type":"NDC"}],"standard_charges":[{"gross_charge":8648.75,"discounted_cash":7264.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [184787]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"0024-0654-01","type":"NDC"}],"standard_charges":[{"gross_charge":23708.75,"discounted_cash":19915.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":3075.25,"discounted_cash":2583.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IRON SUCROSE IV PUSH [171576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-2310-05","type":"NDC"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":261.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":622.0,"discounted_cash":522.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"IRON SUCROSE IV PUSH [171576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-2340-25","type":"NDC"}],"standard_charges":[{"gross_charge":311.25,"discounted_cash":261.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":622.25,"discounted_cash":522.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69918-731-10","type":"NDC"}],"standard_charges":[{"gross_charge":837.75,"discounted_cash":703.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-661-31","type":"NDC"}],"standard_charges":[{"gross_charge":690.5,"discounted_cash":580.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [127039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-661-42","type":"NDC"}],"standard_charges":[{"gross_charge":690.5,"discounted_cash":580.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ISOSORBIDE DINITRATE 10 MG TABLET [4064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-082-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSORBIDE DINITRATE 10 MG TABLET [4064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-021-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSORBIDE DINITRATE 10 MG TABLET [4064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1556-13","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSORBIDE DINITRATE 10 MG TABLET [4064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1556-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSORBIDE DINITRATE 10 MG TABLET [4064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1771-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"IRON SUCROSE IV PUSH [171576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-2340-10","type":"NDC"}],"standard_charges":[{"gross_charge":311.25,"discounted_cash":261.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":622.25,"discounted_cash":522.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-452-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETAMINE 50 MG/ML IN STERILE WATER INJECTION SYRINGE [182106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-511-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":93.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLORIDE IV SYRINGE WRAPPER [131689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73177-156-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLORIDE IV SYRINGE WRAPPER [131689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-982-55","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLORIDE IV SYRINGE WRAPPER [131689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-9119-44","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLORIDE IV SYRINGE WRAPPER [131689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42852-301-07","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLORIDE IV SYRINGE WRAPPER [131689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-5597-05","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLORIDE IV SYRINGE WRAPPER [131689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1119-44","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLORIDE IV SYRINGE WRAPPER [131689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61553-320-33","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"KETAMINE 30 MG/3 ML (10 MG/ML) IN SODIUM CHLOR,ISO-OSMOTIC INJ SYRINGE [180094]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73177-156-35","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"KETAMINE 100 MG/ML INJECTION SOLUTION [4237]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2051-15","type":"NDC"}],"standard_charges":[{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETAMINE 100 MG/ML INJECTION SOLUTION [4237]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9509-10","type":"NDC"}],"standard_charges":[{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETAMINE 100 MG/ML INJECTION SOLUTION [4237]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9509-01","type":"NDC"}],"standard_charges":[{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETAMINE 100 MG/ML INJECTION SOLUTION [4237]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-115-10","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETAMINE 100 MG/ML INJECTION SOLUTION [4237]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2051-05","type":"NDC"}],"standard_charges":[{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETAMINE 10 MG/ML INJECTION SOLUTION [4236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-184-20","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KETAMINE 10 MG/ML INJECTION SOLUTION [4236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-184-01","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KETAMINE 10 MG/ML INJECTION SOLUTION [4236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-438-10","type":"NDC"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":136.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-001-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7118-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":0.5,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9508-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9508-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-001-00","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-114-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2053-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":0.5,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 10 MG/ML INJECTION SOLUTION [4236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-438-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":136.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KETAMINE 10 MG/ML INJECTION SOLUTION [4236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-181-00","type":"NDC"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":136.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KETAMINE 10 MG/ML INJECTION SOLUTION [4236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-181-20","type":"NDC"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":136.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ITRACONAZOLE 100 MG CAPSULE [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10147-1700-3","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":125.5,"discounted_cash":105.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":188.0,"discounted_cash":157.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ITRACONAZOLE 100 MG CAPSULE [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0550-83","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":188.75,"discounted_cash":158.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ITRACONAZOLE 100 MG CAPSULE [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0550-30","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":125.5,"discounted_cash":105.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":188.25,"discounted_cash":158.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ITRACONAZOLE 100 MG CAPSULE [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-290-04","type":"NDC"}],"standard_charges":[{"gross_charge":183.5,"discounted_cash":154.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":367.0,"discounted_cash":308.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":550.25,"discounted_cash":462.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ISRADIPINE 2.5 MG CAPSULE [10362]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16252-539-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION [10358]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-220-00","type":"NDC"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":372.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":886.0,"discounted_cash":744.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION [10358]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-586-05","type":"NDC"}],"standard_charges":[{"gross_charge":272.75,"discounted_cash":229.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":545.25,"discounted_cash":458.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION [10358]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-586-00","type":"NDC"}],"standard_charges":[{"gross_charge":338.75,"discounted_cash":284.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":677.5,"discounted_cash":569.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION [10358]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-220-05","type":"NDC"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":372.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":886.0,"discounted_cash":744.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-540-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6450-61","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ITRACONAZOLE 100 MG CAPSULE [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10147-1700-7","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":188.75,"discounted_cash":158.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ITRACONAZOLE 100 MG CAPSULE [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-5100-93","type":"NDC"}],"standard_charges":[{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":212.5,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":318.75,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"KETAMINE 10 MG/ML INJECTION SOLUTION [4236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-113-10","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0409-6653-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MEQ/100 ML"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"IXABEPILONE 45 MG INTRAVENOUS SOLUTION [88653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9207","type":"HCPCS"},{"code":"70020-1911-2","type":"NDC"}],"standard_charges":[{"gross_charge":558073.75,"discounted_cash":468781.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"IXABEPILONE 45 MG INTRAVENOUS SOLUTION [88653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9207","type":"HCPCS"},{"code":"70020-1911-1","type":"NDC"}],"standard_charges":[{"gross_charge":558073.75,"discounted_cash":468781.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"IXABEPILONE 15 MG INTRAVENOUS SOLUTION [88652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9207","type":"HCPCS"},{"code":"70020-1910-1","type":"NDC"}],"standard_charges":[{"gross_charge":62008.25,"discounted_cash":52086.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-360-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":187.75,"discounted_cash":157.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG/KG"}]},{"description":"IVERMECTIN 3 MG TABLET [25820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-806-01","type":"NDC"}],"standard_charges":[{"gross_charge":134.5,"discounted_cash":112.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG/KG"},{"gross_charge":177.5,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG/KG"}]},{"description":"IVERMECTIN 0.5 % LOTION [116027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4230-8","type":"NDC"}],"standard_charges":[{"gross_charge":807.5,"discounted_cash":678.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"IVABRADINE 5 MG TABLET [165129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55513-800-60","type":"NDC"}],"standard_charges":[{"gross_charge":42.5,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":84.75,"discounted_cash":71.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":127.0,"discounted_cash":106.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION [2357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7520-10","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ITRACONAZOLE 100 MG CAPSULE [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-450-12","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":114.75,"discounted_cash":96.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ITRACONAZOLE 100 MG CAPSULE [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-450-11","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":114.75,"discounted_cash":96.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ITRACONAZOLE 100 MG CAPSULE [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-743-02","type":"NDC"}],"standard_charges":[{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":251.5,"discounted_cash":211.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":377.25,"discounted_cash":316.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION [133523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-5649-1","type":"NDC"}],"standard_charges":[{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IODIXANOL 270 MG IODINE/ML INTRAVENOUS SOLUTION [17594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"65219-381-05","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 270 MG IODINE/ML INTRAVENOUS SOLUTION [17594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-381-03","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 270 MG IODINE/ML INTRAVENOUS SOLUTION [17594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"65219-381-03","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 270 MG IODINE/ML INTRAVENOUS SOLUTION [17594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-381-50","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 270 MG IODINE/ML INTRAVENOUS SOLUTION [17594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"65219-381-50","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 270 MG IODINE/ML INTRAVENOUS SOLUTION [17594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-381-10","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 270 MG IODINE/ML INTRAVENOUS SOLUTION [17594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"65219-381-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION [127060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433-230-15","type":"NDC"}],"standard_charges":[{"gross_charge":210.75,"discounted_cash":177.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 ML"}]},{"description":"IOBENGUANE SULFATE I-123 10 MCI/5 ML (370 MBQ/5 ML) INTRAVENOUS SOLN [98451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9582","type":"HCPCS"},{"code":"17156-235-01","type":"NDC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MILLICURIE"},{"gross_charge":3480.0,"discounted_cash":2923.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK [129938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0553-11","type":"NDC"}],"standard_charges":[{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":324.5,"discounted_cash":272.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"},{"gross_charge":151.5,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 ML"}]},{"description":"INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION [10289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8215-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS/ML"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 UNITS"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION [10289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-8215-17","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 UNITS"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"INSULIN REGULAR HUMAN U-500(CONCENTRATE) 500 UNIT/ML SUBCUTANEOUS SOLN [19180]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8501-01","type":"NDC"}],"standard_charges":[{"gross_charge":7316.25,"discounted_cash":6145.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN [169185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8824-27","type":"NDC"}],"standard_charges":[{"gross_charge":1233.5,"discounted_cash":1036.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IODIXANOL 270 MG IODINE/ML INTRAVENOUS SOLUTION [17594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-381-05","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN [169185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8824-01","type":"NDC"}],"standard_charges":[{"gross_charge":1233.5,"discounted_cash":1036.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-2223-17","type":"NDC"}],"standard_charges":[{"gross_charge":127.25,"discounted_cash":106.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":190.75,"discounted_cash":160.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 180 MG IODINE/ML INTRATHECAL SOLUTION [10319]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9965","type":"HCPCS"},{"code":"0407-1411-10","type":"NDC"}],"standard_charges":[{"gross_charge":523.0,"discounted_cash":439.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":1307.0,"discounted_cash":1097.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-08","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219-383-08","type":"NDC"}],"standard_charges":[{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-06","type":"NDC"}],"standard_charges":[{"gross_charge":100.5,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":150.5,"discounted_cash":126.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219-383-06","type":"NDC"}],"standard_charges":[{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-04","type":"NDC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219-383-04","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-02","type":"NDC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219-383-02","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-70","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219-383-70","type":"NDC"}],"standard_charges":[{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-50","type":"NDC"}],"standard_charges":[{"gross_charge":100.5,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":150.5,"discounted_cash":126.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219-383-50","type":"NDC"}],"standard_charges":[{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-10","type":"NDC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219-383-10","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-05","type":"NDC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219-383-05","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-2223-19","type":"NDC"}],"standard_charges":[{"gross_charge":126.75,"discounted_cash":106.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":190.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0407-2223-19","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0407-2223-17","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9% SODIUM CHLORIDE (PREMIX) [180672]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0126-12","type":"NDC"}],"standard_charges":[{"gross_charge":282.75,"discounted_cash":237.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":228.5,"discounted_cash":191.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"INSULIN PUMP REFILL WITH REGULAR (HUMULIN R) 100 UNIT/ML INJECTION [172719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8215-17","type":"NDC"}],"standard_charges":[{"gross_charge":108.5,"discounted_cash":91.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [17405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7510-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN [124845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8222-59","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN [124845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8222-01","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN [124845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8799-01","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN [124845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8799-59","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS CARTRIDGE [124846]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7516-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS"}]},{"description":"INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS CARTRIDGE [124846]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7516-59","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS"}]},{"description":"INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP [10286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8715-17","type":"NDC"}],"standard_charges":[{"gross_charge":220.25,"discounted_cash":185.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP [10286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8715-01","type":"NDC"}],"standard_charges":[{"gross_charge":220.25,"discounted_cash":185.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN GLULISINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [87889]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0088-2500-33","type":"NDC"}],"standard_charges":[{"gross_charge":420.25,"discounted_cash":353.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN GLULISINE (U-100) 100 UNIT/ML SUBCUTANEOUS PEN [124843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0088-2502-00","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN GLULISINE (U-100) 100 UNIT/ML SUBCUTANEOUS PEN [124843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0088-2502-05","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN GLARGINE 100 UNIT-LIXISENATIDE 33 MCG/ML SUBCUTANEOUS PEN [408696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0024-5761-05","type":"NDC"}],"standard_charges":[{"gross_charge":765.5,"discounted_cash":643.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN GLARGINE (U-300) CONC. 300 UNIT/ML (3 ML) SUBCUTANEOUS PEN [178704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-5871-02","type":"NDC"}],"standard_charges":[{"gross_charge":1227.5,"discounted_cash":1031.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN GLARGINE (U-300) CONC. 300 UNIT/ML (3 ML) SUBCUTANEOUS PEN [178704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-5871-00","type":"NDC"}],"standard_charges":[{"gross_charge":1227.5,"discounted_cash":1031.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN GLARGINE (U-300) CONC. 300 UNIT/ML (1.5 ML) SUBCUTANEOUS PEN [165890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0024-5869-01","type":"NDC"}],"standard_charges":[{"gross_charge":704.75,"discounted_cash":591.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"INSULIN GLARGINE (U-300) CONC. 300 UNIT/ML (1.5 ML) SUBCUTANEOUS PEN [165890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0024-5869-03","type":"NDC"}],"standard_charges":[{"gross_charge":704.75,"discounted_cash":591.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [28282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0088-2220-33","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 UNITS"}]},{"description":"INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124840]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0955-1728-05","type":"NDC"}],"standard_charges":[{"gross_charge":222.25,"discounted_cash":186.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124840]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0955-1728-01","type":"NDC"}],"standard_charges":[{"gross_charge":222.25,"discounted_cash":186.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124840]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0088-2219-01","type":"NDC"}],"standard_charges":[{"gross_charge":156.25,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [17405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7510-17","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 UNITS"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"INSULIN NPH-REGULAR 70-30 U-100 INSULIN 100 UNIT/ML SUBCUTANEOUS PEN [124859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8803-59","type":"NDC"}],"standard_charges":[{"gross_charge":184.75,"discounted_cash":155.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN NPH-REGULAR 70-30 U-100 INSULIN 100 UNIT/ML SUBCUTANEOUS PEN [124859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8803-01","type":"NDC"}],"standard_charges":[{"gross_charge":184.75,"discounted_cash":155.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION [10284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8315-17","type":"NDC"}],"standard_charges":[{"gross_charge":361.75,"discounted_cash":303.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8805-59","type":"NDC"}],"standard_charges":[{"gross_charge":184.75,"discounted_cash":155.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8805-01","type":"NDC"}],"standard_charges":[{"gross_charge":184.75,"discounted_cash":155.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO PROTAMINE-LISPRO 100 UNIT/ML (75-25) SUBCUTANEOUS PEN [124857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8233-05","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO PROTAMINE-LISPRO 100 UNIT/ML (75-25) SUBCUTANEOUS PEN [124857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8233-01","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO PROTAMINE-LISPRO 100 UNIT/ML (75-25) SUBCUTANEOUS PEN [124857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8797-01","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO PROTAMINE-LISPRO 100 UNIT/ML (75-25) SUBCUTANEOUS PEN [124857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8797-59","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO PROTAMINE-LISPRO 100 UNIT/ML (50-50) SUBCUTANEOUS SUSP [70694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7512-01","type":"NDC"}],"standard_charges":[{"gross_charge":1855.25,"discounted_cash":1558.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN LISPRO PROTAMINE-LISPRO 100 UNIT/ML (50-50) SUBCUTANEOUS PEN [124858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8798-01","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO PROTAMINE-LISPRO 100 UNIT/ML (50-50) SUBCUTANEOUS PEN [124858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8798-59","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO (U-200) 200 UNIT/ML (3 ML) SUBCUTANEOUS PEN [166416]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0002-7712-27","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 UNITS"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"INSULIN LISPRO (U-200) 200 UNIT/ML (3 ML) SUBCUTANEOUS PEN [166416]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7712-01","type":"NDC"}],"standard_charges":[{"gross_charge":911.5,"discounted_cash":765.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [17405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7533-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [17405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7737-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-2340-99","type":"NDC"}],"standard_charges":[{"gross_charge":240.25,"discounted_cash":201.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":480.5,"discounted_cash":403.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":720.75,"discounted_cash":605.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"IOHEXOL 180 MG IODINE/ML INTRATHECAL SOLUTION [10319]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1411-10","type":"NDC"}],"standard_charges":[{"gross_charge":2614.0,"discounted_cash":2195.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":3921.0,"discounted_cash":3293.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 180 MG IODINE/ML INTRATHECAL SOLUTION [10319]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9965","type":"HCPCS"},{"code":"0407-1411-20","type":"NDC"}],"standard_charges":[{"gross_charge":257.25,"discounted_cash":216.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":643.25,"discounted_cash":540.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"0487-0201-00","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"47335-756-49","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"47335-756-48","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"69097-840-53","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"69097-840-34","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"60687-405-83","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"60687-405-79","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204-600-60","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204-600-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204-600-12","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204-600-05","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204-600-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"0487-0201-03","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"0487-0201-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0054-0045-44","type":"NDC"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":385.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0597-0087-17","type":"NDC"}],"standard_charges":[{"gross_charge":1318.25,"discounted_cash":1107.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.9 G"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"60687-394-83","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"60687-394-79","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"0378-7970-64","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"0378-7970-31","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"0378-7970-55","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"76204-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"0378-7970-91","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"76204-100-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"0487-9801-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION [165098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0024-02","type":"NDC"}],"standard_charges":[{"gross_charge":1838.75,"discounted_cash":1544.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION [108956]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0003-2328-22","type":"NDC"}],"standard_charges":[{"gross_charge":84267.25,"discounted_cash":70784.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":72864.0,"discounted_cash":61205.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [108955]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"0003-2327-11","type":"NDC"}],"standard_charges":[{"gross_charge":18216.25,"discounted_cash":15301.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [168723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9205","type":"HCPCS"},{"code":"15054-0043-1","type":"NDC"}],"standard_charges":[{"gross_charge":8898.5,"discounted_cash":7474.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [178617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"0023-6082-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG/KG"},{"gross_charge":187.75,"discounted_cash":157.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":243.5,"discounted_cash":204.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":61.0,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IRON SUCROSE 50 MG IRON/2.5 ML INTRAVENOUS SOLUTION [132844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0517-2325-01","type":"NDC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"IRON SUCROSE 50 MG IRON/2.5 ML INTRAVENOUS SOLUTION [132844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0517-2325-10","type":"NDC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION [132871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-2310-01","type":"NDC"}],"standard_charges":[{"gross_charge":622.0,"discounted_cash":522.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-2340-01","type":"NDC"}],"standard_charges":[{"gross_charge":311.25,"discounted_cash":261.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":622.25,"discounted_cash":522.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE [28034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6025818601","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [178617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"0023-6082-10","type":"NDC"}],"standard_charges":[{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG/KG"},{"gross_charge":187.75,"discounted_cash":157.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":243.5,"discounted_cash":204.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":61.0,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION [119842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1413-63","type":"NDC"}],"standard_charges":[{"gross_charge":447.75,"discounted_cash":376.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":671.5,"discounted_cash":564.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION [119842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0407-1413-63","type":"NDC"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":224.0,"discounted_cash":188.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION [119842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1413-61","type":"NDC"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":383.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":683.75,"discounted_cash":574.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION [119842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0407-1413-61","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":228.0,"discounted_cash":191.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION [119842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1413-10","type":"NDC"}],"standard_charges":[{"gross_charge":2624.5,"discounted_cash":2204.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":3936.5,"discounted_cash":3306.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION [119842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0407-1413-10","type":"NDC"}],"standard_charges":[{"gross_charge":262.5,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1312.25,"discounted_cash":1102.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION [119843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1412-33","type":"NDC"}],"standard_charges":[{"gross_charge":373.25,"discounted_cash":313.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":560.0,"discounted_cash":470.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":746.5,"discounted_cash":627.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION [119843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"0407-1412-33","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":186.75,"discounted_cash":156.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION [119843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1412-30","type":"NDC"}],"standard_charges":[{"gross_charge":511.5,"discounted_cash":429.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":767.25,"discounted_cash":644.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":1022.75,"discounted_cash":859.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION [119843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"0407-1412-30","type":"NDC"}],"standard_charges":[{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":255.75,"discounted_cash":214.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION [119843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1412-20","type":"NDC"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":953.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":1702.25,"discounted_cash":1429.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":2269.75,"discounted_cash":1906.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION [119843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"0407-1412-20","type":"NDC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":190.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":567.5,"discounted_cash":476.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 180 MG IODINE/ML INTRATHECAL SOLUTION [10319]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1411-20","type":"NDC"}],"standard_charges":[{"gross_charge":1286.25,"discounted_cash":1080.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":1929.25,"discounted_cash":1620.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION [119842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0407-1413-65","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":217.75,"discounted_cash":182.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION [119842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1413-65","type":"NDC"}],"standard_charges":[{"gross_charge":435.25,"discounted_cash":365.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":653.0,"discounted_cash":548.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOVERSOL 320 MG IODINE/ML INTRAVENOUS SYRINGE [39700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0019-1323-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOVERSOL 320 MG IODINE/ML INTRAVENOUS SYRINGE [39700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0019-1323-52","type":"NDC"}],"standard_charges":[{"gross_charge":165.5,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOVERSOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [127083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0019-1323-11","type":"NDC"}],"standard_charges":[{"gross_charge":113.75,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOVERSOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [127083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0019-1323-06","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":119.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOVERSOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [127083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0019-1323-02","type":"NDC"}],"standard_charges":[{"gross_charge":212.75,"discounted_cash":178.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOVERSOL 300 MG IODINE/ML INTRAVENOUS SYRINGE [127530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0019-1332-75","type":"NDC"}],"standard_charges":[{"gross_charge":235.5,"discounted_cash":197.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION [10333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Q9961","type":"HCPCS"},{"code":"0019-0953-13","type":"NDC"}],"standard_charges":[{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 43 % INTRAVENOUS SOLUTION [10332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0019-3183-09","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 17.2 % URETHRAL SOLUTION [10330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0019-0862-07","type":"NDC"}],"standard_charges":[{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"},{"gross_charge":149.75,"discounted_cash":125.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":179.75,"discounted_cash":150.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"},{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 ML"}]},{"description":"IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION [10328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0270-1316-45","type":"NDC"}],"standard_charges":[{"gross_charge":249.5,"discounted_cash":209.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":374.25,"discounted_cash":314.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION [27737]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0270-1315-25","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":82.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":144.0,"discounted_cash":120.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION [27737]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0270-1315-25","type":"NDC"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION [10323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1414-91","type":"NDC"}],"standard_charges":[{"gross_charge":497.75,"discounted_cash":418.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":746.75,"discounted_cash":627.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION [10323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0407-1414-91","type":"NDC"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":209.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION [10323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1414-90","type":"NDC"}],"standard_charges":[{"gross_charge":496.5,"discounted_cash":417.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":744.75,"discounted_cash":625.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION [10323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0407-1414-90","type":"NDC"}],"standard_charges":[{"gross_charge":248.25,"discounted_cash":208.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION [10323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1414-89","type":"NDC"}],"standard_charges":[{"gross_charge":497.75,"discounted_cash":418.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":746.75,"discounted_cash":627.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION [10323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0407-1414-89","type":"NDC"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":209.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION-CATH LAB ONLY 50 ML [408680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0407-1413-08","type":"NDC"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":191.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION [10328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"0270-1316-45","type":"NDC"}],"standard_charges":[{"gross_charge":124.75,"discounted_cash":104.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LAMOTRIGINE 100 MG TABLET [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-499-20","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 100 MG TABLET [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-008-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 100 MG TABLET [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-246-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 100 MG TABLET [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4131-1","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 100 MG TABLET [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0642-55","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":185.25,"discounted_cash":155.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET [21810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-506-60","type":"NDC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET [21810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-597-60","type":"NDC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET [21810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-202-18","type":"NDC"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LAMIVUDINE 150 MG TABLET [15880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-710-03","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LAMIVUDINE 150 MG TABLET [15880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-3251-6","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LAMIVUDINE 150 MG TABLET [15880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-203-18","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LAMIVUDINE 100 MG TABLET [24419]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-3250-6","type":"NDC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":326.5,"discounted_cash":274.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LAMOTRIGINE 100 MG TABLET [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-228-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 25 MG TABLET [13981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-318-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 25 MG TABLET [13981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-245-01","type":"NDC"}],"standard_charges":[{"gross_charge":112.25,"discounted_cash":94.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":168.25,"discounted_cash":141.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":224.25,"discounted_cash":188.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 25 MG TABLET [13981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4130-1","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":243.5,"discounted_cash":204.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 25 MG TABLET [13981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0633-02","type":"NDC"}],"standard_charges":[{"gross_charge":348.25,"discounted_cash":292.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":522.5,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":696.5,"discounted_cash":585.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":87.25,"discounted_cash":73.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 100 MG TABLET [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-701-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 100 MG TABLET [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-319-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 100 MG TABLET [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-319-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMIVUDINE 10 MG/ML ORAL SOLUTION [15881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-274-24","type":"NDC"}],"standard_charges":[{"gross_charge":492.25,"discounted_cash":413.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"LACTATED RINGERS IV BOLUS [400296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-164-76","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IV BOLUS [400296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"7700-1082-05","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IV BOLUS [400296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7953-09","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IV BOLUS [400296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0117-03","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IV BOLUS [400296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0117-02","type":"NDC"}],"standard_charges":[{"gross_charge":202.75,"discounted_cash":170.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IRRIGATION SOLUTION [4319]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0137-27","type":"NDC"}],"standard_charges":[{"gross_charge":175.75,"discounted_cash":147.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 ML"}]},{"description":"LACTATED RINGERS INTRAVENOUS SOLUTION [4318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7953-03","type":"NDC"}],"standard_charges":[{"gross_charge":148.75,"discounted_cash":124.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS INTRAVENOUS SOLUTION [4318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7953-09","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS INTRAVENOUS SOLUTION [4318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0117-04","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"31722-203-31","type":"NDC"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":81.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 50 MG TABLET [96968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-676-57","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 50 MG TABLET [96968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-348-06","type":"NDC"}],"standard_charges":[{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":233.0,"discounted_cash":195.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":310.5,"discounted_cash":260.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LAMIVUDINE 10 MG/ML ORAL SOLUTION [15881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1973-05","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LAMIVUDINE 10 MG/ML ORAL SOLUTION [15881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-566-70","type":"NDC"}],"standard_charges":[{"gross_charge":492.25,"discounted_cash":413.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"LAMIVUDINE 10 MG/ML ORAL SOLUTION [15881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-205-48","type":"NDC"}],"standard_charges":[{"gross_charge":546.5,"discounted_cash":459.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"LACTULOSE ENEMA [171533]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0000-0000-14","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACTULOSE ENEMA [171533]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0000-0000-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0116-4005-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0116-4005-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-5125-70","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1825-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-779-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0577-32","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0577-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-795-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LACTOBACILLUS RHAMNOSUS GG 5 BILLION CELL ORAL POWDER PACKET [116448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4910040008","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"LACTOBACILLUS RHAMNOSUS GG 15 BILLION CELL SPRINKLE CAPSULE [134615]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4910036374","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE [27974]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4910040007","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"LAMOTRIGINE 25 MG TABLET [13981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-318-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LEUCOVORIN CALCIUM 25 MG TABLET [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-227-94","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 25 MG TABLET [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-227-11","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 25 MG TABLET [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4499-11","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":100.25,"discounted_cash":84.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":133.75,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":167.25,"discounted_cash":140.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION [15426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"70436-118-80","type":"NDC"}],"standard_charges":[{"gross_charge":156.5,"discounted_cash":131.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION [15426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457-529-20","type":"NDC"}],"standard_charges":[{"gross_charge":260.75,"discounted_cash":219.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION [15426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"0143-9553-01","type":"NDC"}],"standard_charges":[{"gross_charge":156.5,"discounted_cash":131.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION [15426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021-815-67","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION [15426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021-815-30","type":"NDC"}],"standard_charges":[{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION [15426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"63323-710-50","type":"NDC"}],"standard_charges":[{"gross_charge":150.25,"discounted_cash":126.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION [4392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"0143-9554-01","type":"NDC"}],"standard_charges":[{"gross_charge":129.75,"discounted_cash":108.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION [4392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021-814-67","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION [4392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021-814-30","type":"NDC"}],"standard_charges":[{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION [4392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"0703-5140-01","type":"NDC"}],"standard_charges":[{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 10 MG/ML INJECTION SOLUTION [15370]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"63323-631-50","type":"NDC"}],"standard_charges":[{"gross_charge":583.25,"discounted_cash":489.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LEUCOVORIN CALCIUM 10 MG/ML INJECTION SOLUTION [15370]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"63323-631-10","type":"NDC"}],"standard_charges":[{"gross_charge":157.5,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LETROZOLE 2.5 MG TABLET [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-3255-3","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LETROZOLE 2.5 MG TABLET [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63323-772-30","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LETROZOLE 2.5 MG TABLET [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-511-83","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LETROZOLE 2.5 MG TABLET [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-759-33","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LETROZOLE 2.5 MG TABLET [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-034-10","type":"NDC"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":106.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LEUCOVORIN CALCIUM 25 MG TABLET [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6703-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 50 MG SOLUTION FOR INJECTION [4394]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021-813-66","type":"NDC"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 50 MG SOLUTION FOR INJECTION [4394]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021-813-10","type":"NDC"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":363.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 5 MG TABLET [4398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71205-908-60","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 5 MG TABLET [4398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-358-30","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 5 MG TABLET [4398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0484-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION [4393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021-816-67","type":"NDC"}],"standard_charges":[{"gross_charge":142.75,"discounted_cash":119.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION [4393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021-816-30","type":"NDC"}],"standard_charges":[{"gross_charge":344.5,"discounted_cash":289.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION [4393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"0703-5145-01","type":"NDC"}],"standard_charges":[{"gross_charge":153.75,"discounted_cash":129.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEUCOVORIN CALCIUM 25 MG TABLET [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-359-25","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LETROZOLE 2.5 MG TABLET [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7620-56","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LETROZOLE 2.5 MG TABLET [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0249-15","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LENVATINIB 4 MG CAPSULE [179377]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62856-704-30","type":"NDC"}],"standard_charges":[{"gross_charge":3038.0,"discounted_cash":2551.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":6076.0,"discounted_cash":5103.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"LATANOPROST 0.005 % EYE DROPS [18621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-463-25","type":"NDC"}],"standard_charges":[{"gross_charge":164.75,"discounted_cash":138.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET [39975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092-252-90","type":"NDC"}],"standard_charges":[{"gross_charge":194.75,"discounted_cash":163.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET [39975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092-252-45","type":"NDC"}],"standard_charges":[{"gross_charge":194.75,"discounted_cash":163.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [34595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-544-11","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":112.25,"discounted_cash":94.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET [34594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6981-88","type":"NDC"}],"standard_charges":[{"gross_charge":106.75,"discounted_cash":89.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET [34594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6981-32","type":"NDC"}],"standard_charges":[{"gross_charge":106.75,"discounted_cash":89.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET [34594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-771-77","type":"NDC"}],"standard_charges":[{"gross_charge":106.75,"discounted_cash":89.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET [34594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-771-30","type":"NDC"}],"standard_charges":[{"gross_charge":106.75,"discounted_cash":89.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET [34594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-543-11","type":"NDC"}],"standard_charges":[{"gross_charge":112.25,"discounted_cash":94.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE [87861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69097-870-67","type":"NDC"}],"standard_charges":[{"gross_charge":18247.75,"discounted_cash":15328.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE [87861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"15054-1120-4","type":"NDC"}],"standard_charges":[{"gross_charge":19621.25,"discounted_cash":16481.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"LAMOTRIGINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [97967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-564-11","type":"NDC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"LAMOTRIGINE 25 MG TABLET [13981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-037-31","type":"NDC"}],"standard_charges":[{"gross_charge":112.25,"discounted_cash":94.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":168.25,"discounted_cash":141.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":224.25,"discounted_cash":188.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LAMOTRIGINE 25 MG TABLET [13981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-700-01","type":"NDC"}],"standard_charges":[{"gross_charge":116.5,"discounted_cash":97.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":174.75,"discounted_cash":146.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":233.0,"discounted_cash":195.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"LATANOPROST 0.005 % EYE DROPS [18621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0333-2","type":"NDC"}],"standard_charges":[{"gross_charge":391.75,"discounted_cash":329.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LATANOPROST 0.005 % EYE DROPS [18621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-547-01","type":"NDC"}],"standard_charges":[{"gross_charge":390.5,"discounted_cash":328.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LATANOPROST 0.005 % EYE DROPS [18621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-625-12","type":"NDC"}],"standard_charges":[{"gross_charge":131.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LATANOPROST 0.005 % EYE DROPS [18621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-421-01","type":"NDC"}],"standard_charges":[{"gross_charge":390.5,"discounted_cash":328.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LENVATINIB 4 MG CAPSULE [179377]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62856-704-05","type":"NDC"}],"standard_charges":[{"gross_charge":3038.0,"discounted_cash":2551.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":6076.0,"discounted_cash":5103.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"LENVATINIB 10 MG/DAY (10 MG X 1) CAPSULE [165820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62856-710-30","type":"NDC"}],"standard_charges":[{"gross_charge":3038.0,"discounted_cash":2551.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"LENVATINIB 10 MG/DAY (10 MG X 1) CAPSULE [165820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62856-710-05","type":"NDC"}],"standard_charges":[{"gross_charge":3038.0,"discounted_cash":2551.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"LENALIDOMIDE 25 MG CAPSULE [76784]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59572-425-21","type":"NDC"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":1097.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1956.5,"discounted_cash":1643.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":330.25,"discounted_cash":277.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2607.0,"discounted_cash":2189.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3257.5,"discounted_cash":2736.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":655.5,"discounted_cash":550.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LENALIDOMIDE 25 MG CAPSULE [76784]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59572-425-00","type":"NDC"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":1097.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1956.5,"discounted_cash":1643.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":330.25,"discounted_cash":277.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2607.0,"discounted_cash":2189.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3257.5,"discounted_cash":2736.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":655.5,"discounted_cash":550.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEFLUNOMIDE 20 MG TABLET [23873]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-062-30","type":"NDC"}],"standard_charges":[{"gross_charge":55.5,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"LEFLUNOMIDE 10 MG TABLET [23872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-277-03","type":"NDC"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":226.5,"discounted_cash":190.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"LEFLUNOMIDE 10 MG TABLET [23872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-061-30","type":"NDC"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":226.5,"discounted_cash":190.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"LEFLUNOMIDE 10 MG TABLET [23872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-043-03","type":"NDC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":226.75,"discounted_cash":190.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"LEFLUNOMIDE 10 MG TABLET [23872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2502-1","type":"NDC"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":226.5,"discounted_cash":190.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"LEFLUNOMIDE 10 MG TABLET [23872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0088-2160-30","type":"NDC"}],"standard_charges":[{"gross_charge":250.25,"discounted_cash":210.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":495.25,"discounted_cash":416.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"LATANOPROST 0.005 % EYE DROPS [18621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-421-03","type":"NDC"}],"standard_charges":[{"gross_charge":61.5,"discounted_cash":51.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LACOSAMIDE 50 MG TABLET [96968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0131-2477-60","type":"NDC"}],"standard_charges":[{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":323.0,"discounted_cash":271.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":430.75,"discounted_cash":361.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72611-722-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72611-722-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860-701-41","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266-118-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"0338-0072-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"47781-584-93","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"47781-584-68","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860-701-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323-162-16","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"0409-3795-19","type":"NDC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"0409-3795-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":92.5,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70512-842-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70512-842-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323-162-00","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":92.5,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323-162-43","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KIT PREPARATION OF TC-99M-SODIUM PYROPHOSPHATE 11.9 MG IV SOLUTION [197929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69945-094-20","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLICURIE"}]},{"description":"KIT FOR THE PREPARATION OF TC-99M-TETROFOSMIN 1.38 MG IV SOLUTION [166071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9502","type":"HCPCS"},{"code":"17156-026-30","type":"NDC"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"KIT FOR THE PREPARATION OF TC-99M-MEBROFENIN 45 MG IV SOLUTION [132345]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9537","type":"HCPCS"},{"code":"0270-0083-20","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLICURIE"}]},{"description":"KIT FOR THE PREPARATION OF TC-99M-MEBROFENIN 45 MG IV SOLUTION [132345]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9537","type":"HCPCS"},{"code":"45567-0455-2","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLICURIE"}]},{"description":"KIT FOR THE PREPARATION OF TC-99M-MEBROFENIN 45 MG IV SOLUTION [132345]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9537","type":"HCPCS"},{"code":"45567-0455-1","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLICURIE"}]},{"description":"KIT FOR THE PREPARATION OF GA-68-DOTATATE 40 MCG INTRAVENOUS SOLN [173505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9587","type":"HCPCS"},{"code":"69488-001-40","type":"NDC"}],"standard_charges":[{"gross_charge":3182.0,"discounted_cash":2672.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.4 MILLICURIE"}]},{"description":"KIT FOR THE PREP OF TC-99M-TILMANOCEPT 250 MCG SOLUTION FOR INJECTION [180297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9520","type":"HCPCS"},{"code":"65857-425-05","type":"NDC"}],"standard_charges":[{"gross_charge":628.5,"discounted_cash":527.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"KIT FOR THE PREP OF TC-99M-TILMANOCEPT 250 MCG SOLUTION FOR INJECTION [180297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9520","type":"HCPCS"},{"code":"65857-450-05","type":"NDC"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":2639.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 EACH"}]},{"description":"KIT FOR THE PREP OF TC-99M-TILMANOCEPT 250 MCG SOLUTION FOR INJECTION [180297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9520","type":"HCPCS"},{"code":"65857-400-01","type":"NDC"}],"standard_charges":[{"gross_charge":628.5,"discounted_cash":527.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"KIT FOR PREPARATION TC-99M-SUCCIMER INTRAVENOUS SOLUTION [98464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9551","type":"HCPCS"},{"code":"17156-525-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MILLICURIE"},{"gross_charge":120.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":599.5,"discounted_cash":503.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLICURIE"}]},{"description":"KIT FOR PREPARATION OF TC-99M-SODIUM OXIDRONATE 3.15 MG IV SOLUTION [183211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9561","type":"HCPCS"},{"code":"0019-9091-40","type":"NDC"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MILLICURIE"}]},{"description":"KIT FOR PREPARATION OF TC-99M-SODIUM OXIDRONATE 3.15 MG IV SOLUTION [183211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9561","type":"HCPCS"},{"code":"69945-091-20","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MILLICURIE"}]},{"description":"KIT FOR PREPARATION OF TC-99M-MEDRONATE SODIUM 20 MG IV SOLUTION [132339]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9503","type":"HCPCS"},{"code":"45567-0040-1","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"KIT FOR PREPARATION OF TC-99M-EXAMETAZIME 0.5 MG SOLUTION WRAPPER [182873]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9569","type":"HCPCS"},{"code":"17156-025-05","type":"NDC"}],"standard_charges":[{"gross_charge":1080.0,"discounted_cash":907.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MILLICURIE"},{"gross_charge":1439.75,"discounted_cash":1209.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLICURIE"},{"gross_charge":1799.75,"discounted_cash":1511.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MILLICURIE"}]},{"description":"KIT FOR PREPARATION OF TC-99M-EXAMETAZIME 0.5 MG SOLUTION WRAPPER [182873]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9521","type":"HCPCS"},{"code":"17156-022-05","type":"NDC"}],"standard_charges":[{"gross_charge":1028.5,"discounted_cash":863.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MILLICURIE"},{"gross_charge":1371.25,"discounted_cash":1151.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLICURIE"},{"gross_charge":1714.0,"discounted_cash":1439.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MILLICURIE"}]},{"description":"KIT FOR PREPARATION OF TC-99M-BICISATE 0.9 MG INTRAVENOUS SOLUTION [180002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9557","type":"HCPCS"},{"code":"11994-006-02","type":"NDC"}],"standard_charges":[{"gross_charge":2444.25,"discounted_cash":2053.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLICURIE"}]},{"description":"KIT FOR PREPARATION OF TC 99M-SODIUM THIOSULFATE 2 MG SOLUTION [132669]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9541","type":"HCPCS"},{"code":"45567-0030-1","type":"NDC"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"KIT FOR PREPARATION OF TC 99M-ALBUMIN 2.5 MG INTRAVENOUS SOLUTION [133165]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9540","type":"HCPCS"},{"code":"65174-270-30","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLICURIE"}]},{"description":"KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266-119-25","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323-162-26","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"0409-3796-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323-162-02","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266-234-25","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266-234-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 0.5 % EYE DROPS [19733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-209-10","type":"NDC"}],"standard_charges":[{"gross_charge":439.25,"discounted_cash":368.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC 0.5 % EYE DROPS [19733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-2181-05","type":"NDC"}],"standard_charges":[{"gross_charge":1183.5,"discounted_cash":994.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOCONAZOLE 200 MG TABLET [10369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4026-6","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"KETOCONAZOLE 200 MG TABLET [10369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4026-1","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"KETOCONAZOLE 2 % TOPICAL CREAM [10368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-955-01","type":"NDC"}],"standard_charges":[{"gross_charge":258.5,"discounted_cash":217.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"KETOCONAZOLE 2 % TOPICAL CREAM [10368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0099-15","type":"NDC"}],"standard_charges":[{"gross_charge":168.25,"discounted_cash":141.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"KETOCONAZOLE 2 % TOPICAL CREAM [10368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1298-1","type":"NDC"}],"standard_charges":[{"gross_charge":539.75,"discounted_cash":453.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"KETOCONAZOLE 2 % SHAMPOO [14132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63646-010-04","type":"NDC"}],"standard_charges":[{"gross_charge":159.75,"discounted_cash":134.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"KETOCONAZOLE 2 % SHAMPOO [14132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-465-64","type":"NDC"}],"standard_charges":[{"gross_charge":164.75,"discounted_cash":138.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-188-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-188-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-439-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETAMINE 50 MG/ML INJECTION SOLUTION [4238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-439-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"KETOROLAC 0.5 % EYE DROPS [19733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-209-19","type":"NDC"}],"standard_charges":[{"gross_charge":265.25,"discounted_cash":222.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"KETOROLAC 0.5 % EYE DROPS [19733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-1003-1","type":"NDC"}],"standard_charges":[{"gross_charge":439.25,"discounted_cash":368.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC 0.5 % EYE DROPS [19733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-126-05","type":"NDC"}],"standard_charges":[{"gross_charge":433.75,"discounted_cash":364.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323-161-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":61.0,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"62332-599-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"62332-599-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323-161-00","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":61.0,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72611-719-25","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72611-719-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860-700-41","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"0338-0069-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KIT PREPARATION OF TC-99M-SODIUM PYROPHOSPHATE 12 MG IV SOLUTION [132351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9538","type":"HCPCS"},{"code":"45567-0060-1","type":"NDC"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MILLICURIE"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860-700-02","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"47781-583-93","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"47781-583-68","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323-161-16","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"0409-3793-19","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"25021-700-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"0409-3793-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LABETALOL 100 MG TABLET [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0010-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION [105482]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1012-95","type":"NDC"}],"standard_charges":[{"gross_charge":366.5,"discounted_cash":307.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":549.75,"discounted_cash":461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":733.0,"discounted_cash":615.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":183.25,"discounted_cash":153.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION [105482]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1012-05","type":"NDC"}],"standard_charges":[{"gross_charge":366.5,"discounted_cash":307.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":549.75,"discounted_cash":461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":733.0,"discounted_cash":615.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":183.25,"discounted_cash":153.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION [105482]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0131-5410-72","type":"NDC"}],"standard_charges":[{"gross_charge":85.5,"discounted_cash":71.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION [105482]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-6090-05","type":"NDC"}],"standard_charges":[{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":226.0,"discounted_cash":189.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":301.25,"discounted_cash":253.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION [105482]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0131-5410-71","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":66.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":118.75,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION [105482]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0131-5410-70","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":86.75,"discounted_cash":72.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"31722-203-31","type":"NDC"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":387.75,"discounted_cash":325.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"25021-317-40","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"36000-324-02","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"36000-320-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"36000-320-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"69374-946-34","type":"NDC"}],"standard_charges":[{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"0409-2339-24","type":"NDC"}],"standard_charges":[{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LACOSAMIDE 100 MG TABLET [96969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0131-2478-35","type":"NDC"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":128.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":229.5,"discounted_cash":192.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 50 MG TABLET [96968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0131-2477-35","type":"NDC"}],"standard_charges":[{"gross_charge":195.75,"discounted_cash":164.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":293.75,"discounted_cash":246.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":391.5,"discounted_cash":328.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"83090-012-10","type":"NDC"}],"standard_charges":[{"gross_charge":130.75,"discounted_cash":109.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"83090-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":130.75,"discounted_cash":109.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"31722-203-20","type":"NDC"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0131-1810-67","type":"NDC"}],"standard_charges":[{"gross_charge":244.5,"discounted_cash":205.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"LACOSAMIDE 100 MG TABLET [96969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-549-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":182.25,"discounted_cash":153.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":242.75,"discounted_cash":203.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"72266-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LACOSAMIDE 100 MG TABLET [96969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-734-60","type":"NDC"}],"standard_charges":[{"gross_charge":120.25,"discounted_cash":101.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":180.25,"discounted_cash":151.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":240.25,"discounted_cash":201.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 100 MG TABLET [96969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-349-06","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":182.0,"discounted_cash":152.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":242.75,"discounted_cash":203.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 100 MG TABLET [96969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0131-2478-60","type":"NDC"}],"standard_charges":[{"gross_charge":168.5,"discounted_cash":141.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":336.75,"discounted_cash":282.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":84.25,"discounted_cash":70.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION [23617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"63323-711-00","type":"NDC"}],"standard_charges":[{"gross_charge":424.25,"discounted_cash":356.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"0143-9320-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"47781-586-56","type":"NDC"}],"standard_charges":[{"gross_charge":149.75,"discounted_cash":125.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL 200 MG TABLET [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-929-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 200 MG TABLET [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0117-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 100 MG TABLET [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7109-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 100 MG TABLET [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-723-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 100 MG TABLET [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-439-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 100 MG TABLET [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-439-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 100 MG TABLET [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-122-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 100 MG TABLET [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-928-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 100 MG TABLET [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-928-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 100 MG TABLET [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0605-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 200 MG TABLET [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-366-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"47781-586-29","type":"NDC"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"0143-9622-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"51991-935-98","type":"NDC"}],"standard_charges":[{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"51991-934-98","type":"NDC"}],"standard_charges":[{"gross_charge":101.25,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"0409-2267-20","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"0409-2339-34","type":"NDC"}],"standard_charges":[{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"0409-2267-54","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"17478-420-40","type":"NDC"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"17478-420-20","type":"NDC"}],"standard_charges":[{"gross_charge":170.25,"discounted_cash":143.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL 200 MG TABLET [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7110-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 200 MG TABLET [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63629-1163-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION WRAPPER [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"0143-9623-01","type":"NDC"}],"standard_charges":[{"gross_charge":113.5,"discounted_cash":95.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"LABETALOL 200 MG TABLET [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-724-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 200 MG TABLET [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-450-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 200 MG TABLET [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-450-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 200 MG TABLET [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5929-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL 200 MG TABLET [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-929-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124840]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7715-59","type":"NDC"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":270.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LIPASE-PROTEASE-AMYLASE 3,000-9,500-15,000 UNIT CAPSULE, DELAYED REL [111147]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0032-0045-70","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS OF LIPASE"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS OF LIPASE"},{"gross_charge":189.0,"discounted_cash":158.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS/KG OF LIPASE"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS OF LIPASE"}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET [4993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"42806-400-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET [4993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"68382-916-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET [4993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"59746-001-06","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET [4993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"0781-5022-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":77.25,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET [4993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"0603-4593-21","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":77.25,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION [10579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0850-01","type":"NDC"}],"standard_charges":[{"gross_charge":535.75,"discounted_cash":450.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":2564.5,"discounted_cash":2154.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 124.2 MG/KG"},{"gross_charge":535.75,"discounted_cash":450.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 MG"},{"gross_charge":619.5,"discounted_cash":520.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG/KG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [10577]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-265-30","type":"NDC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":187.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET [4993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"0904-6914-61","type":"NDC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":90.25,"discounted_cash":75.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":120.5,"discounted_cash":101.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121-1573-5","type":"NDC"}],"standard_charges":[{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":78.25,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121-1573-1","type":"NDC"}],"standard_charges":[{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":78.25,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"0009-3073-03","type":"NDC"}],"standard_charges":[{"gross_charge":177.75,"discounted_cash":149.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":92.25,"discounted_cash":77.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"0009-3073-01","type":"NDC"}],"standard_charges":[{"gross_charge":177.5,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":92.25,"discounted_cash":77.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE 4 MG TABLETS IN A DOSE PACK [4991]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"0591-0790-21","type":"NDC"}],"standard_charges":[{"gross_charge":202.75,"discounted_cash":170.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 EACH"}]},{"description":"METHYLPREDNISOLONE 4 MG TABLETS IN A DOSE PACK [4991]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"59746-001-03","type":"NDC"}],"standard_charges":[{"gross_charge":234.25,"discounted_cash":196.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 EACH"}]},{"description":"METHYLPREDNISOLONE 4 MG TABLETS IN A DOSE PACK [4991]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"0781-5022-07","type":"NDC"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":170.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 EACH"}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET [4993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"72647-331-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLPHENIDATE ER 54 MG TABLET,EXTENDED RELEASE 24 HR [29388]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0154-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36 MG"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"METHYLPHENIDATE CD 20 MG BIPHASIC 30-70 CAPSULE,EXTENDED RELEASE [30076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5296-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":61.75,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPHENIDATE 5 MG TABLET [4988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-616-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHYLPHENIDATE 5 MG TABLET [4988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1800-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHYLPHENIDATE 5 MG TABLET [4988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-821-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHYLPHENIDATE 5 MG TABLET [4988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHYLPHENIDATE 5 MG TABLET [4988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-1142-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHYLPHENIDATE 5 MG TABLET [4988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0439-05","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHYLPHENIDATE 20 MG/9 HR DAILY TRANSDERMAL PATCH [76395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68968-5554-3","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAPPER [408748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65649-551-03","type":"NDC"}],"standard_charges":[{"gross_charge":703.75,"discounted_cash":591.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":730.25,"discounted_cash":613.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAPPER [408748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649-551-03","type":"NDC"}],"standard_charges":[{"gross_charge":486.75,"discounted_cash":408.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAPPER [408748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65649-551-02","type":"NDC"}],"standard_charges":[{"gross_charge":703.75,"discounted_cash":591.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":730.25,"discounted_cash":613.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS WRAPPER [408748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649-551-02","type":"NDC"}],"standard_charges":[{"gross_charge":486.75,"discounted_cash":408.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"51991-144-99","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"51991-144-17","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"0517-0740-01","type":"NDC"}],"standard_charges":[{"gross_charge":204.25,"discounted_cash":171.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHYLPHENIDATE CD 30 MG BIPHASIC 30-70 CAPSULE,EXTENDED RELEASE [36349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5297-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":55.5,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-586-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 MG"},{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36 MG"},{"gross_charge":170.75,"discounted_cash":143.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0127-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 MG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"METHYLPHENIDATE ER 10 MG TABLET,EXTENDED RELEASE [26855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-1445-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":207.5,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPHENIDATE CD 60 MG BIPHASIC 30-70 CAPSULE,EXTENDED RELEASE [70648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5293-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":68.75,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"METHYLPHENIDATE CD 50 MG BIPHASIC 30-70 CAPSULE,EXTENDED RELEASE [70647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5292-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":68.75,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METHYLPHENIDATE CD 40 MG BIPHASIC 30-70 CAPSULE,EXTENDED RELEASE [70646]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5298-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"0517-0740-20","type":"NDC"}],"standard_charges":[{"gross_charge":204.25,"discounted_cash":171.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"16714-088-01","type":"NDC"}],"standard_charges":[{"gross_charge":136.25,"discounted_cash":114.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION [77725]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0576-16","type":"NDC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":162.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"METOCLOPRAMIDE 5 MG TABLET [5006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-620-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG TABLET [5006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-620-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG TABLET [5006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG TABLET [5006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-886-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG TABLET [5006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-886-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG TABLET [5006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2204-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 10 MG TABLET [5005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-293-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 10 MG TABLET [5005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-888-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 10 MG TABLET [5005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-888-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 10 MG TABLET [5005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2203-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION [77725]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1576-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION [77725]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-031-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION [77725]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-837-42","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METOLAZONE 2.5 MG TABLET [10587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-023-20","type":"NDC"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOLAZONE 2.5 MG TABLET [10587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6172-01","type":"NDC"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOLAZONE 2.5 MG TABLET [10587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-5050-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOLAZONE 2.5 MG TABLET [10587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65580-643-71","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"0409-3414-21","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"83634-779-41","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"83634-779-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"0409-3414-18","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"23155-240-41","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"23155-240-31","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"0703-4502-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"0409-3414-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"0703-4502-04","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION [77725]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-837-56","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION [77725]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-0187-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-128-11","type":"NDC"}],"standard_charges":[{"gross_charge":143.5,"discounted_cash":120.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [132210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0009-0047-03","type":"NDC"}],"standard_charges":[{"gross_charge":88.25,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.5 MG"}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [132210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0009-0047-25","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.5 MG"}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [132210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0009-0047-22","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.5 MG"}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [132212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0018-20","type":"NDC"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7990-09","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0758-01","type":"NDC"}],"standard_charges":[{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70121-1574-5","type":"NDC"}],"standard_charges":[{"gross_charge":198.5,"discounted_cash":166.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121-1574-5","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70121-1574-1","type":"NDC"}],"standard_charges":[{"gross_charge":198.5,"discounted_cash":166.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121-1574-1","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-0051-01","type":"NDC"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":146.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"0703-0051-01","type":"NDC"}],"standard_charges":[{"gross_charge":111.75,"discounted_cash":93.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-3475-01","type":"NDC"}],"standard_charges":[{"gross_charge":239.75,"discounted_cash":201.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"0009-3475-01","type":"NDC"}],"standard_charges":[{"gross_charge":154.25,"discounted_cash":129.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"16714-088-25","type":"NDC"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [132209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0009-0039-28","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":78.75,"discounted_cash":66.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [132209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0009-0039-30","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":78.75,"discounted_cash":66.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"63323-255-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0143-9753-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"43598-127-45","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"63323-255-03","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION [10579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0796-01","type":"NDC"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":343.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0143-9754-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"43598-129-25","type":"NDC"}],"standard_charges":[{"gross_charge":61.75,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"43598-129-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.75,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"25021-808-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [10577]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9851-01","type":"NDC"}],"standard_charges":[{"gross_charge":206.25,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [10577]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0698-02","type":"NDC"}],"standard_charges":[{"gross_charge":216.5,"discounted_cash":181.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [10577]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0698-01","type":"NDC"}],"standard_charges":[{"gross_charge":216.5,"discounted_cash":181.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC RIVA 40 MG/4 ML [408039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"00000-0004-00","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 500 MG/4 ML INTRAVENOUS SOLUTION [132211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0003-02","type":"NDC"}],"standard_charges":[{"gross_charge":1078.5,"discounted_cash":905.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG/KG"}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [132209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0009-0039-06","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [132209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0009-0039-05","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"63323-258-03","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLERGONOVINE 0.2 MG TABLET [10572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010-786-28","type":"NDC"}],"standard_charges":[{"gross_charge":275.5,"discounted_cash":231.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHYLERGONOVINE 0.2 MG TABLET [10572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1605-8","type":"NDC"}],"standard_charges":[{"gross_charge":275.5,"discounted_cash":231.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHAZOLAMIDE 50 MG TABLET [4962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0791-01","type":"NDC"}],"standard_charges":[{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":42.5,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METHAZOLAMIDE 50 MG TABLET [4962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-241-01","type":"NDC"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METHAZOLAMIDE 25 MG TABLET [4961]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0790-01","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METHAMPHETAMINE 5 MG TABLET [4959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0389-25","type":"NDC"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":95.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE 5 MG TABLET [4954]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-5755-23","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE 5 MG TABLET [4954]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-5755-62","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE 5 MG TABLET [4954]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-5755-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE 5 MG TABLET [4954]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8553-24","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE 10 MG/ML ORAL CONCENTRATE [15996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7110-05","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METHADONE 10 MG/ML ORAL CONCENTRATE [15996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0391-68","type":"NDC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":362.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"METHADONE 10 MG/ML ORAL CONCENTRATE [15996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3553-44","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"METHADONE 10 MG/ML INJECTION SOLUTION [10546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1230","type":"HCPCS"},{"code":"7700-1097-01","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"METHADONE 10 MG/ML INJECTION SOLUTION [10546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1230","type":"HCPCS"},{"code":"17478-380-20","type":"NDC"}],"standard_charges":[{"gross_charge":2837.75,"discounted_cash":2383.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"METHADONE 10 MG/ML INJECTION SOLUTION [10546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1230","type":"HCPCS"},{"code":"67457-217-20","type":"NDC"}],"standard_charges":[{"gross_charge":3061.5,"discounted_cash":2571.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"METHADONE 10 MG/5 ML ORAL SOLUTION [4951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7313-20","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"METHADONE 10 MG/5 ML ORAL SOLUTION [4951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-6221-05","type":"NDC"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"METHENAMINE HIPPURATE 1 GRAM TABLET [10549]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-332-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"METHENAMINE MANDELATE 0.5 GRAM TABLET [4965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-105-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"70069-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":139.5,"discounted_cash":117.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"55150-223-10","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"0641-6103-25","type":"NDC"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":153.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":91.5,"discounted_cash":76.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"0641-6103-01","type":"NDC"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":153.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":91.5,"discounted_cash":76.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHIMAZOLE 5 MG TABLET [10553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHIMAZOLE 10 MG TABLET [10552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-071-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHIMAZOLE 10 MG TABLET [10552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-641-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHIMAZOLE 10 MG TABLET [10552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0210-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHENAMINE MANDELATE 1 GRAM TABLET [4966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-106-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHENAMINE MANDELATE 1 GRAM TABLET [4966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13925-107-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHADONE 10 MG/5 ML ORAL SOLUTION [4951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7112-15","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"METHADONE 10 MG/5 ML ORAL SOLUTION [4951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3556-63","type":"NDC"}],"standard_charges":[{"gross_charge":283.75,"discounted_cash":238.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"METHADONE 10 MG TABLET [4953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6530-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-142-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METFORMIN 850 MG TABLET [14719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-562-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN 850 MG TABLET [14719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-143-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN 850 MG TABLET [14719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN 850 MG TABLET [14719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-435-51","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN 850 MG TABLET [14719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-009-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN 500 MG TABLET [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7162-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN 500 MG TABLET [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6689-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN 500 MG TABLET [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-561-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN 500 MG TABLET [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-155-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN 500 MG TABLET [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-155-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-178-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-531-15","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHADONE 10 MG TABLET [4953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-5771-23","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE 10 MG TABLET [4953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-116-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE 10 MG TABLET [4953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-5771-62","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE 10 MG TABLET [4953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-5771-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"70069-101-25","type":"NDC"}],"standard_charges":[{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHADONE 10 MG TABLET [4953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8554-24","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE 10 MG TABLET [4953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4571-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION [27032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64281-100-06","type":"NDC"}],"standard_charges":[{"gross_charge":447.75,"discounted_cash":376.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-904-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010-491-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-531-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [28995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-178-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHYLERGONOVINE 0.2 MG TABLET [10572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3655-28","type":"NDC"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":244.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"0517-1825-01","type":"NDC"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":140.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":125.25,"discounted_cash":105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET [4973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"0555-0572-02","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET [4973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"0378-0014-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":126.5,"discounted_cash":106.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET [4973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"0054-8550-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET [4973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"0054-4550-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET [4973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"0054-4550-15","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [117032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"0143-9519-10","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [117032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"0143-9519-01","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [117032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"16729-277-30","type":"NDC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [117032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"0703-3671-01","type":"NDC"}],"standard_charges":[{"gross_charge":152.75,"discounted_cash":128.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"METHOHEXITAL 500 MG SOLUTION FOR INJECTION [70545]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-105-01","type":"NDC"}],"standard_charges":[{"gross_charge":553.75,"discounted_cash":465.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHOCARBAMOL 750 MG TABLET [4972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7058-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 750 MG TABLET [4972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010-770-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 750 MG TABLET [4972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-534-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 500 MG TABLET [4971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-520-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET [4973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"0555-0572-35","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHYLERGONOVINE 0.2 MG TABLET [10572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1605-2","type":"NDC"}],"standard_charges":[{"gross_charge":275.75,"discounted_cash":231.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHYLERGONOVINE 0.2 MG TABLET [10572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0639-05","type":"NDC"}],"standard_charges":[{"gross_charge":275.75,"discounted_cash":231.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHYLERGONOVINE 0.2 MG TABLET [10572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27437-050-56","type":"NDC"}],"standard_charges":[{"gross_charge":306.25,"discounted_cash":257.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHYLERGONOVINE 0.2 MG TABLET [10572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-140-28","type":"NDC"}],"standard_charges":[{"gross_charge":275.5,"discounted_cash":231.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [173499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0374-01","type":"NDC"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":845.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [173499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0374-05","type":"NDC"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":845.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [4985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-504-10","type":"NDC"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":605.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLDOPA 250 MG TABLET [4982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-200-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHYLDOPA 250 MG TABLET [4982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-200-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [76971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1349-57","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [76971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-116-03","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [76971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167-0600-3","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM [76971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-174-53","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION [4974]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"61703-350-37","type":"NDC"}],"standard_charges":[{"gross_charge":127.25,"discounted_cash":106.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION [4974]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"61703-350-38","type":"NDC"}],"standard_charges":[{"gross_charge":127.25,"discounted_cash":106.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET [4973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"16729-486-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":81.5,"discounted_cash":68.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET [4973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"47335-235-96","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET [4973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"42291-594-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET [4973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"51079-670-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":126.5,"discounted_cash":106.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOCARBAMOL 500 MG TABLET [4971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-520-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"43598-839-36","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"43598-839-11","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"70860-653-41","type":"NDC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"70860-653-10","type":"NDC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"63323-778-21","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"63323-778-10","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"71288-716-10","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"25021-675-10","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"0517-1825-10","type":"NDC"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":140.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":125.25,"discounted_cash":105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [4970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"71288-716-11","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 500 MG TABLET [4971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-533-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 500 MG TABLET [4971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7057-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 500 MG TABLET [4971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-559-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 500 MG TABLET [4971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-559-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 500 MG TABLET [4971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010-754-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 500 MG TABLET [4971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-123-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 500 MG TABLET [4971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-405-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METOLAZONE 2.5 MG TABLET [10587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-023-01","type":"NDC"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6210-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6209-25","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6209-01","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"47781-588-68","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70860-600-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155-600-41","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155-600-31","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6057-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6059-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6059-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6057-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6056-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6056-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323-411-25","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323-411-12","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9380-10","type":"NDC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9380-01","type":"NDC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-2131-4","type":"NDC"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-2131-1","type":"NDC"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-611-10","type":"NDC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-611-01","type":"NDC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-314-10","type":"NDC"}],"standard_charges":[{"gross_charge":202.75,"discounted_cash":170.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70324-102-02","type":"NDC"}],"standard_charges":[{"gross_charge":202.75,"discounted_cash":170.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1418-36","type":"NDC"}],"standard_charges":[{"gross_charge":204.75,"discounted_cash":171.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7012-10","type":"NDC"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1030-36","type":"NDC"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS WRAPPER [40834270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61553-196-48","type":"NDC"}],"standard_charges":[{"gross_charge":191.25,"discounted_cash":160.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6210-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323-411-18","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70860-600-41","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"72611-749-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70860-601-42","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6211-10","type":"NDC"}],"standard_charges":[{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70860-601-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155-601-42","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155-601-32","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0409-2596-03","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323-412-25","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MIDAZOLAM 2 MG/ML ORAL SYRUP [24176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-3235-02","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"MIDAZOLAM 2 MG/ML ORAL SYRUP [24176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-762-62","type":"NDC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"MIDAZOLAM 2 MG/ML ORAL SYRUP [24176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-762-59","type":"NDC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"MIDAZOLAM 2 MG/ML ORAL SYRUP [24176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3566-99","type":"NDC"}],"standard_charges":[{"gross_charge":910.5,"discounted_cash":764.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION WRAPPER [183607]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323-411-15","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION WRAPPER [183607]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"47781-588-46","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION WRAPPER [183607]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6057-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION WRAPPER [183607]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0409-2305-17","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION WRAPPER [183607]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0409-2305-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION [134187]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"55390-138-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDAZOLAM (PF) 2 MG/2 ML (1 MG/ML) INJECTION SYRINGE [130970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"76045-001-20","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093957433","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-689-72","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION [77685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-230-01","type":"NDC"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":619.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":738.0,"discounted_cash":619.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION [77685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-230-10","type":"NDC"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":619.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION [77685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0469-3211-10","type":"NDC"}],"standard_charges":[{"gross_charge":803.5,"discounted_cash":674.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MEXILETINE 250 MG CAPSULE [10597]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8741-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"MEXILETINE 200 MG CAPSULE [10596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-240-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"MEXILETINE 200 MG CAPSULE [10596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8740-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"MEXILETINE 150 MG CAPSULE [10595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8739-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"METRONIDAZOLE IV SYRINGE 5 MG/ML FROM PREMIX (NEO/PED) [184632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0338-9541-24","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE IV SYRINGE 5 MG/ML FROM PREMIX (NEO/PED) [184632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0409-7811-24","type":"NDC"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE IV SYRINGE 5 MG/ML FROM PREMIX (NEO/PED) [184632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0338-1055-48","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE IV SYRINGE 5 MG/ML FROM PREMIX (NEO/PED) [184632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0264-5535-32","type":"NDC"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE IV SYRINGE 5 MG/ML FROM PREMIX (NEO/PED) [184632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"0338-9541-24","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK [5018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"0409-0152-24","type":"NDC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK [5018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"0409-0152-01","type":"NDC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK [5018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"47335-993-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK [5018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"0409-7811-37","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1134-28","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61269-735-56","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-481-45","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1375-75","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"MIDAZOLAM (PF) 2 MG/2 ML (1 MG/ML) INJECTION SYRINGE [130970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0409-2306-12","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION [134188]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70069-817-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION [134188]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70069-817-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION [134188]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0409-2305-04","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER [10606]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"53276-1010-02","type":"NDC"}],"standard_charges":[{"gross_charge":1038.25,"discounted_cash":872.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"72611-749-10","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MICROFIBRILLAR COLLAGEN HEMOSTAT 8 CM X 6.25 CM X 1 CM SPONGE [33186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0174-1010-53","type":"NDC"}],"standard_charges":[{"gross_charge":231.25,"discounted_cash":194.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":462.5,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"MICONAZOLE NITRATE 4 % (200 MG)-2 % (9 GRAM)VAGINAL,PREFILL APPL,CREAM [94365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-1223-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 G"}]},{"description":"MICONAZOLE NITRATE 4 % (200 MG)-2 % (9 GRAM)VAGINAL,PREFILL APPL,CREAM [94365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-645-73","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 G"}]},{"description":"MICONAZOLE NITRATE 200 MG-2 % (9 GRAM) VAGINAL KIT [104246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093938333","type":"NDC"}],"standard_charges":[{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY [127518]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-1738-03","type":"NDC"}],"standard_charges":[{"gross_charge":235.75,"discounted_cash":198.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 EACH"}]},{"description":"MICONAZOLE NITRATE 2 % VAGINAL CREAM [5040]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61269-730-63","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"MICONAZOLE NITRATE 2 % VAGINAL CREAM [5040]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61269-730-41","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"MICONAZOLE NITRATE 2 % VAGINAL CREAM [5040]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093937933","type":"NDC"}],"standard_charges":[{"gross_charge":74.25,"discounted_cash":62.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"MICONAZOLE NITRATE 2 % VAGINAL CREAM [5040]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2035-6","type":"NDC"}],"standard_charges":[{"gross_charge":77.25,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL POWDER - WOUND CARE [181295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"11701-038-16","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL POWDER - WOUND CARE [181295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11701-038-16","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL OINTMENT [13651]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43553-0003-2","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 G"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL OINTMENT [13651]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43553-0003-5","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 141 G"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL OINTMENT [13651]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11701-067-23","type":"NDC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 G"}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL OINTMENT [13651]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11701-067-14","type":"NDC"}],"standard_charges":[{"gross_charge":102.75,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 142 G"}]},{"description":"METRONIDAZOLE IV SYRINGE 5 MG/ML FROM PREMIX (NEO/PED) [184632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"0409-7811-24","type":"NDC"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323-412-10","type":"NDC"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":189.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0409-2308-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MINERAL OIL ENEMA [5087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0132-0301-40","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ENEMA"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ENEMA"}]},{"description":"MILRINONE 40 MG/200 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [122187]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0338-6011-37","type":"NDC"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":329.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [122186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0409-2045-10","type":"NDC"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":154.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [122186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0409-2045-01","type":"NDC"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":154.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [122186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"25021-313-82","type":"NDC"}],"standard_charges":[{"gross_charge":131.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [122186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"55150-287-10","type":"NDC"}],"standard_charges":[{"gross_charge":177.25,"discounted_cash":148.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [122186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"55150-287-01","type":"NDC"}],"standard_charges":[{"gross_charge":177.25,"discounted_cash":148.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [122186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0143-9719-10","type":"NDC"}],"standard_charges":[{"gross_charge":177.25,"discounted_cash":148.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [122186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0409-2776-23","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK [122186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0338-6010-48","type":"NDC"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":230.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"63323-617-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"70069-807-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"70069-807-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0143-9710-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0409-0212-11","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0409-0212-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0409-0212-02","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0409-0212-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"0143-9710-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"63323-617-10","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILRINONE 1 MG/ML INTRAVENOUS SOLUTION [122190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"55390-019-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG/KG"}]},{"description":"MILNACIPRAN 50 MG TABLET [97089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1550-60","type":"NDC"}],"standard_charges":[{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":74.25,"discounted_cash":62.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MIFEPRISTONE 200 MG TABLET [28975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"S0190","type":"HCPCS"},{"code":"43393-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":633.5,"discounted_cash":532.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MIFEPRISTONE 200 MG TABLET [28975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"S0190","type":"HCPCS"},{"code":"64875-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":632.5,"discounted_cash":531.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MIDOSTAURIN 25 MG CAPSULE [174445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0698-02","type":"NDC"}],"standard_charges":[{"gross_charge":3734.25,"discounted_cash":3136.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":933.75,"discounted_cash":784.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1867.25,"discounted_cash":1568.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MINERAL OIL ENEMA [5087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-185-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ENEMA"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ENEMA"}]},{"description":"MINERAL OIL ENEMA [5087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"132030140","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ENEMA"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ENEMA"}]},{"description":"MINOCYCLINE 100 MG TABLET [5112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-487-50","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MINOCYCLINE 100 MG INTRAVENOUS SOLUTION [10612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70842-160-10","type":"NDC"}],"standard_charges":[{"gross_charge":1107.5,"discounted_cash":930.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2215.0,"discounted_cash":1860.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MINOCYCLINE 100 MG INTRAVENOUS SOLUTION [10612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70842-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":1107.5,"discounted_cash":930.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2215.0,"discounted_cash":1860.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MINOCYCLINE 100 MG INTRAVENOUS SOLUTION [10612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"14290-545-92","type":"NDC"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":245.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":583.75,"discounted_cash":490.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MINERAL OIL WRAPPER [184630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6332325410","type":"NDC"}],"standard_charges":[{"gross_charge":148.75,"discounted_cash":124.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MINERAL OIL ORAL [5086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0869-4206-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"MINERAL OIL ORAL [5086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1315-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"MINERAL OIL ORAL [5086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433-202-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"MINERAL OIL ORAL [5086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0869-0831-43","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"MINERAL OIL ORAL [5086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0363-0831-43","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"MINERAL OIL ORAL [5086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-110-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-562-15","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 2.5 MG TABLET [10609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-387-11","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 2.5 MG TABLET [10609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-387-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 2.5 MG TABLET [10609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-560-90","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 2.5 MG TABLET [10609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-1320-1","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 2.5 MG TABLET [10609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0211-11","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-601-42","type":"NDC"}],"standard_charges":[{"gross_charge":149.25,"discounted_cash":125.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0409-2308-21","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0409-2308-22","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323-412-18","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323-412-13","type":"NDC"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":189.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"47781-589-91","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"47781-589-22","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155-601-31","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6063-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0641-6063-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION WRAPPER [40810608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"0409-2308-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDODRINE 2.5 MG TABLET [10609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6817-06","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-562-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6818-61","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-398-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-398-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-1321-1","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-453-20","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-453-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0212-11","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0212-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE 5 MG TABLET [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1902-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METRONIDAZOLE IV SYRINGE 5 MG/ML FROM PREMIX (NEO/PED) [184632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"0338-1055-48","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE IV SYRINGE 5 MG/ML FROM PREMIX (NEO/PED) [184632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"0264-5535-32","type":"NDC"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG TABLET [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-550-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4596-77","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62037-831-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72603-142-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-390-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-390-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-540-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-852-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-615-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-170-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-402-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-541-15","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-541-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-853-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-616-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6323-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-467-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-170-20","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-659-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [30071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-617-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [30071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6324-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [30071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-468-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [30071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-171-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [30071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-171-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [30071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-454-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [30071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62037-832-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOLAZONE 2.5 MG TABLET [10587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-2215-37","type":"NDC"}],"standard_charges":[{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [30071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-413-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6322-61","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-466-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-169-20","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-169-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62037-830-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [30071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-413-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-402-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 50 MG TABLET [5009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 50 MG TABLET [5009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-477-52","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 50 MG TABLET [5009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-166-52","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 50 MG TABLET [5009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-063-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 50 MG TABLET [5009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-266-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 50 MG TABLET [5009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-266-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 50 MG TABLET [5009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-801-20","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 50 MG TABLET [5009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-801-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL [10592]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7077-87","type":"NDC"}],"standard_charges":[{"gross_charge":628.25,"discounted_cash":527.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 G"}]},{"description":"METRONIDAZOLE 500 MG TABLET [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-550-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 500 MG TABLET [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-535-15","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 500 MG TABLET [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-535-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 500 MG TABLET [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-227-46","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 500 MG TABLET [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-227-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 500 MG TABLET [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-334-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 500 MG TABLET [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-1821-50","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"72611-740-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METRONIDAZOLE 250 MG TABLET [5015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7156-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 250 MG TABLET [5015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-665-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 250 MG TABLET [5015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-333-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 250 MG TABLET [5015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-1453-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 250 MG TABLET [5015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-1831-50","type":"NDC"}],"standard_charges":[{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 1 % TOPICAL GEL [41899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4164-3","type":"NDC"}],"standard_charges":[{"gross_charge":992.75,"discounted_cash":833.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"METRONIDAZOLE 0.75 % TOPICAL GEL [19741]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-962-45","type":"NDC"}],"standard_charges":[{"gross_charge":1144.25,"discounted_cash":961.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"METRONIDAZOLE 0.75 % TOPICAL GEL [19741]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1474-46","type":"NDC"}],"standard_charges":[{"gross_charge":702.5,"discounted_cash":590.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL [10592]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-557-01","type":"NDC"}],"standard_charges":[{"gross_charge":638.25,"discounted_cash":536.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 G"}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL [10592]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-455-70","type":"NDC"}],"standard_charges":[{"gross_charge":657.25,"discounted_cash":552.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 G"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"72611-740-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0143-9873-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-062-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-265-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-265-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-255-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-255-20","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0018-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 12.5 MG PO SPLIT TABLET [400503]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7029-05","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-506-52","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0409-1778-15","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"70860-300-05","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0143-9873-25","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0143-9660-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"36000-033-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0143-9660-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323-660-05","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0409-1778-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-112-31","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [5007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"70860-300-41","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6340-61","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-579-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG TABLET [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-506-58","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METFORMIN 500 MG TABLET [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-397-53","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6207-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":524.75,"discounted_cash":440.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":314.75,"discounted_cash":264.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"LORAZEPAM 4 MG/ML INJECTION SOLUTION [10468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6047-10","type":"NDC"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LORAZEPAM 2 MG/ML ORAL CONCENTRATE [4571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5969-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LORAZEPAM 2 MG/ML ORAL CONCENTRATE [4571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3532-44","type":"NDC"}],"standard_charges":[{"gross_charge":324.5,"discounted_cash":272.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION WRAPPER [171586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0409-1985-03","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION WRAPPER [171586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6046-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION WRAPPER [171586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6046-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION WRAPPER [171586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6044-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION WRAPPER [171586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6044-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION WRAPPER [171586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6001-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION WRAPPER [171586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0409-6778-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION WRAPPER [171586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0409-6780-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LOSARTAN 100 MG TABLET [22588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-378-09","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0952-54","type":"NDC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0952-31","type":"NDC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 25 MG TABLET [14823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-376-09","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 25 MG TABLET [14823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-673-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 25 MG TABLET [14823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-700-90","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 25 MG TABLET [14823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-346-11","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 25 MG TABLET [14823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-346-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 25 MG TABLET [14823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-201-90","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 25 MG TABLET [14823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-113-90","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 25 MG TABLET [14823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0951-54","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION WRAPPER [171586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0409-1985-30","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG TABLET [4574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0187-0065-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":81.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":193.75,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":387.5,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG TABLET [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3426-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG TABLET [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3426-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG TABLET [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6008-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG TABLET [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-905-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG TABLET [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-905-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SYRINGE [128369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0409-1985-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0409-6778-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0409-6780-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6207-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"76329-8261-0","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"76329-8261-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-202-90","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LUSPATERCEPT-AAMT SUBCUTANEOUS SOLUTION DOSES GREATER THAN 60 MG [185816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59572-775-01","type":"NDC"}],"standard_charges":[{"gross_charge":25587.75,"discounted_cash":21493.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":34009.0,"discounted_cash":28567.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.33 MG/KG"},{"gross_charge":44727.0,"discounted_cash":37570.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.75 MG/KG"}]},{"description":"LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION [183758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59572-711-01","type":"NDC"}],"standard_charges":[{"gross_charge":36929.75,"discounted_cash":31020.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":49094.0,"discounted_cash":41238.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.33 MG/KG"},{"gross_charge":64575.5,"discounted_cash":54243.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.75 MG/KG"}]},{"description":"LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION [185613]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9223","type":"HCPCS"},{"code":"68727-712-01","type":"NDC"}],"standard_charges":[{"gross_charge":66635.75,"discounted_cash":55974.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LURASIDONE 40 MG TABLET [107668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-304-30","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":237.75,"discounted_cash":199.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":354.25,"discounted_cash":297.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":470.5,"discounted_cash":395.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE 40 MG TABLET [107668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-304-10","type":"NDC"}],"standard_charges":[{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":226.0,"discounted_cash":189.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":336.25,"discounted_cash":282.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":446.75,"discounted_cash":375.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE 40 MG TABLET [107668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-304-01","type":"NDC"}],"standard_charges":[{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":226.0,"discounted_cash":189.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":336.25,"discounted_cash":282.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":446.75,"discounted_cash":375.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE 20 MG TABLET [113587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-638-30","type":"NDC"}],"standard_charges":[{"gross_charge":214.25,"discounted_cash":179.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":423.5,"discounted_cash":355.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":632.75,"discounted_cash":531.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":842.0,"discounted_cash":707.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE 20 MG TABLET [113587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-879-03","type":"NDC"}],"standard_charges":[{"gross_charge":226.25,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":447.25,"discounted_cash":375.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":668.25,"discounted_cash":561.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":889.25,"discounted_cash":746.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN [191276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"69488-010-61","type":"NDC"}],"standard_charges":[{"gross_charge":33336.25,"discounted_cash":28002.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MILLICURIE"}]},{"description":"MAFENIDE 85 MG/G TOPICAL CREAM [10478]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-623-81","type":"NDC"}],"standard_charges":[{"gross_charge":490.75,"discounted_cash":412.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56.7 G"}]},{"description":"MAGNESIUM 200 MG TABLET [4703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"1184509611","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MAGNESIUM IV SYRINGE 40 MG/ML FROM PREMIX (NEO/PED) [183963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567-420-24","type":"NDC"}],"standard_charges":[{"gross_charge":109.25,"discounted_cash":91.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG/KG"},{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"}]},{"description":"MAGNESIUM IV SYRINGE 40 MG/ML FROM PREMIX (NEO/PED) [183963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567-420-00","type":"NDC"}],"standard_charges":[{"gross_charge":109.25,"discounted_cash":91.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG/KG"},{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"}]},{"description":"MAGNESIUM IV SYRINGE 40 MG/ML FROM PREMIX (NEO/PED) [183963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-106-26","type":"NDC"}],"standard_charges":[{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG/KG"},{"gross_charge":110.75,"discounted_cash":93.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"}]},{"description":"MAGNESIUM IV SYRINGE 40 MG/ML FROM PREMIX (NEO/PED) [183963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-106-05","type":"NDC"}],"standard_charges":[{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":154.5,"discounted_cash":129.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG/KG"},{"gross_charge":254.75,"discounted_cash":213.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"}]},{"description":"MAGNESIUM IV SYRINGE 40 MG/ML FROM PREMIX (NEO/PED) [183963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-6729-24","type":"NDC"}],"standard_charges":[{"gross_charge":185.5,"discounted_cash":155.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":180.75,"discounted_cash":151.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG/KG"},{"gross_charge":307.5,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION [127330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-153-17","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION [127330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-153-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION [127330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1205-30","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION [127330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-053-99","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION [127330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-053-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION [127330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0431-30","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MAGNESIUM GLUCONATE 27 MG MAGNESIUM (500 MG) TABLET [130235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6025817201","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION [4712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-1111-1","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION [4712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-389-98","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION [4712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0869-0166-38","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION [4712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6787-44","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION [4712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093990844","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION [4712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-0051-1","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION [4712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0869-0686-38","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM 70 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE [173942]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5789663506","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"}]},{"description":"MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE [114555]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6858500575","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 128 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"MAGIC MOUTHWASH WITH NYSTATIN ORAL SUSPENSION MIXTURE (COMPOUNDED BY PHARMACY) [172666]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0000-0003-56","type":"NDC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":144.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"LURASIDONE 20 MG TABLET [113587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-494-30","type":"NDC"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":416.75,"discounted_cash":350.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":622.5,"discounted_cash":522.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":828.25,"discounted_cash":695.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LOVASTATIN 40 MG TABLET [10471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-469-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7048-61","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-505-15","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-505-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-686-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-701-90","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-701-30","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-701-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-361-09","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN 50 MG TABLET [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-347-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOXAPINE SUCCINATE 25 MG CAPSULE [4600]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0371-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LURASIDONE 20 MG TABLET [113587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-302-30","type":"NDC"}],"standard_charges":[{"gross_charge":237.75,"discounted_cash":199.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":470.5,"discounted_cash":395.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":703.25,"discounted_cash":590.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":935.75,"discounted_cash":786.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LUBIPROSTONE 8 MCG CAPSULE [91534]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-841-06","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LUBIPROSTONE 8 MCG CAPSULE [91534]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-163-60","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LUBIPROSTONE 8 MCG CAPSULE [91534]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0254-3028-02","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LUBIPROSTONE 8 MCG CAPSULE [91534]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-080-60","type":"NDC"}],"standard_charges":[{"gross_charge":155.5,"discounted_cash":130.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LUBIPROSTONE 24 MCG CAPSULE [70472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-240-40","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LUBIPROSTONE 24 MCG CAPSULE [70472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-240-60","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LOXAPINE SUCCINATE 5 MG CAPSULE [4601]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0369-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOXAPINE SUCCINATE 25 MG CAPSULE [4600]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-902-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOXAPINE SUCCINATE 25 MG CAPSULE [4600]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-902-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LORAZEPAM 1 MG TABLET [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0187-0064-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":243.25,"discounted_cash":204.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":486.5,"discounted_cash":408.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LISINOPRIL 20 MG TABLET [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-350-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 20 MG TABLET [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0408-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 2.5 MG TABLET [13089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-656-21","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 2.5 MG TABLET [13089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-656-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 2.5 MG TABLET [13089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-414-50","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 2.5 MG TABLET [13089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-414-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 20 MG TABLET [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-354-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 5 MG TABLET [10451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-196-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 5 MG TABLET [10451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-513-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 20 MG TABLET [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6799-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 20 MG TABLET [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-333-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 20 MG TABLET [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-981-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 20 MG TABLET [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-354-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 2.5 MG TABLET [13089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-351-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISDEXAMFETAMINE 70 MG CAPSULE [81476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59417-107-10","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":80.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"LISDEXAMFETAMINE 60 MG CAPSULE [89785]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59417-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"LISDEXAMFETAMINE 50 MG CAPSULE [81475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59417-105-10","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":151.75,"discounted_cash":127.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"LISDEXAMFETAMINE 40 MG CAPSULE [89784]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59417-104-10","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"LISDEXAMFETAMINE 30 MG CAPSULE [81474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59417-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":179.5,"discounted_cash":150.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":249.5,"discounted_cash":209.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"LISDEXAMFETAMINE 20 MG CAPSULE [89783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59417-102-10","type":"NDC"}],"standard_charges":[{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":214.5,"discounted_cash":180.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":319.25,"discounted_cash":268.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"LISDEXAMFETAMINE 10 MG CAPSULE [165602]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59417-101-10","type":"NDC"}],"standard_charges":[{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"LIRAGLUTIDE 0.6 MG/0.1 ML (18 MG/3 ML) SUBCUTANEOUS PEN INJECTOR [124865]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-4060-12","type":"NDC"}],"standard_charges":[{"gross_charge":1167.5,"discounted_cash":980.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL [98034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0032-0046-70","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS OF LIPASE"},{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS/KG OF LIPASE"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS OF LIPASE"}]},{"description":"LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL [98034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0032-1206-07","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS OF LIPASE"},{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS/KG OF LIPASE"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS OF LIPASE"}]},{"description":"LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL [98034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0032-1206-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS OF LIPASE"},{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS/KG OF LIPASE"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS OF LIPASE"}]},{"description":"LIPASE-PROTEASE-AMYLASE 36,000-114,000-180,000 UNIT CAPSULE,DELAY REL [121529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0032-3016-13","type":"NDC"}],"standard_charges":[{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LISINOPRIL 10 MG TABLET [10449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0407-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 2.5 MG TABLET [13089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0405-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 10 MG TABLET [10449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6798-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 10 MG TABLET [10449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-416-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 10 MG TABLET [10449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-980-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 10 MG TABLET [10449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-349-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 5 MG TABLET [10451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-352-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 5 MG/5 ML ORAL SOLUTION [76472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-558-40","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 5 MG/5 ML ORAL SOLUTION [76472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11523-7197-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 5 MG/5 ML ORAL SOLUTION [76472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2073-8","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69848-019-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-898-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6852-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-112-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-482-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-246-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-246-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-650-78","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-248-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-650-87","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-650-65","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0147-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 5 MG/5 ML ORAL SOLUTION [76472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-3596-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LORATADINE-PSEUDOEPHEDRINE ER 10 MG-240 MG TABLET,EXTENDED RELEASE24HR [27521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51660-724-15","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LORAZEPAM 1 MG TABLET [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6008-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG TABLET [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0241-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG TABLET [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0241-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 0.5 MG TABLET [4572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3425-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 0.5 MG TABLET [4572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6007-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 0.5 MG TABLET [4572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-904-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 0.5 MG TABLET [4572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-904-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 0.5 MG TABLET [4572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6007-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 0.5 MG TABLET [4572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0240-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORATADINE-PSEUDOEPHEDRINE ER 10 MG-240 MG TABLET,EXTENDED RELEASE24HR [27521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5833-15","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LORATADINE-PSEUDOEPHEDRINE ER 10 MG-240 MG TABLET,EXTENDED RELEASE24HR [27521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-543-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5728-89","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LITHIUM CARBONATE 300 MG CAPSULE [4529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-806-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LITHIUM CARBONATE 300 MG CAPSULE [4529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8527-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LITHIUM CARBONATE 300 MG CAPSULE [4529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-2527-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LITHIUM CARBONATE 150 MG CAPSULE [4528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-2526-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LISINOPRIL 5 MG TABLET [10451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6797-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 5 MG TABLET [10451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-415-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LITHIUM CARBONATE 300 MG CAPSULE [4529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-806-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LORATADINE 10 MG TABLET [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5077-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LOPINAVIR-RITONAVIR 400 MG-100 MG/5 ML ORAL SOLUTION [28929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1947-48","type":"NDC"}],"standard_charges":[{"gross_charge":1587.75,"discounted_cash":1333.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 ML"}]},{"description":"LOPINAVIR-RITONAVIR 400 MG-100 MG/5 ML ORAL SOLUTION [28929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-3956-46","type":"NDC"}],"standard_charges":[{"gross_charge":1868.5,"discounted_cash":1569.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 ML"}]},{"description":"LOPINAVIR-RITONAVIR 200 MG-50 MG TABLET [43391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-6799-22","type":"NDC"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"LOPERAMIDE 2 MG CAPSULE [4560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-229-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LOPERAMIDE 2 MG CAPSULE [4560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-229-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LOPERAMIDE 2 MG CAPSULE [4560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-690-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LOPERAMIDE 2 MG CAPSULE [4560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-690-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LOPERAMIDE 2 MG CAPSULE [4560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-2100-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LOPERAMIDE 2 MG CAPSULE [4560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0311-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LOPERAMIDE 2 MG CAPSULE [4560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0311-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID [42219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7125-07","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID [42219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-029-62","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID [42219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-029-59","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE [10455]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-224-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE [10455]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0020-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE [10454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-223-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE [10454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0021-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-0209-22","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-354-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE [129928]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"0409-1176-03","type":"NDC"}],"standard_charges":[{"gross_charge":195.75,"discounted_cash":164.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE [129928]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"0409-1176-30","type":"NDC"}],"standard_charges":[{"gross_charge":195.75,"discounted_cash":164.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION [4903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"0641-6052-25","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION [4903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"0641-6052-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MEPERIDINE (PF) 100 MG/ML INJECTION SYRINGE [129932]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"0409-1180-59","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MEPERIDINE (PF) 100 MG/ML INJECTION SYRINGE [129932]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"0409-1180-69","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MEPERIDINE (PF) 100 MG/ML INJECTION SOLUTION WRAPPER [202993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"0641-6054-25","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MEPERIDINE (PF) 100 MG/ML INJECTION SOLUTION WRAPPER [202993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"0641-6054-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT - WOUND CARE [181290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-701-04","type":"NDC"}],"standard_charges":[{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT - WOUND CARE [181290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4687600040","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT - WOUND CARE [181290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-322-12","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE [129928]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"0409-1362-01","type":"NDC"}],"standard_charges":[{"gross_charge":315.5,"discounted_cash":265.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":157.75,"discounted_cash":132.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":236.75,"discounted_cash":198.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323-508-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0409-3506-01","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":190.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323-508-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MERCAPTOPURINE 50 MG TABLET [10531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3547-52","type":"NDC"}],"standard_charges":[{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MERCAPTOPURINE 50 MG TABLET [10531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4581-11","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":123.75,"discounted_cash":103.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEPROBAMATE 400 MG TABLET [4917]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-641-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"MEPROBAMATE 200 MG TABLET [4916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-640-01","type":"NDC"}],"standard_charges":[{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [168809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0173-0881-01","type":"NDC"}],"standard_charges":[{"gross_charge":10469.5,"discounted_cash":8794.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [105638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"63323-294-27","type":"NDC"}],"standard_charges":[{"gross_charge":100.25,"discounted_cash":84.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [105638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"0409-1067-20","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [105637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"0409-1036-30","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MEPERIDINE 50 MG TABLET [4908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-050-30","type":"NDC"}],"standard_charges":[{"gross_charge":514.75,"discounted_cash":432.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":257.5,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE [129928]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"0409-1362-11","type":"NDC"}],"standard_charges":[{"gross_charge":315.5,"discounted_cash":265.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":157.75,"discounted_cash":132.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":236.75,"discounted_cash":198.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MENTHOL 0.44 %-ZINC OXIDE 20.6 % TOPICAL OINTMENT - WOUND CARE [181290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0799-0001-04","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"MEMANTINE 28 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR [121476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-3428-90","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":94.25,"discounted_cash":79.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MEMANTINE 28 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR [121476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-3428-33","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":94.25,"discounted_cash":79.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MEMANTINE 21 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR [121475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-3421-33","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":167.5,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MEMANTINE 14 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR [121474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-3414-90","type":"NDC"}],"standard_charges":[{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":188.5,"discounted_cash":158.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":251.25,"discounted_cash":211.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MEMANTINE 14 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR [121474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-3414-33","type":"NDC"}],"standard_charges":[{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":188.5,"discounted_cash":158.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":251.25,"discounted_cash":211.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MELPHALAN FLUFENAMIDE 20 MG INTRAVENOUS SOLUTION [187925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9247","type":"HCPCS"},{"code":"73657-020-01","type":"NDC"}],"standard_charges":[{"gross_charge":19494.0,"discounted_cash":16374.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":38988.0,"discounted_cash":32749.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MELOXICAM 7.5 MG TABLET [20566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-525-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MELOXICAM 7.5 MG TABLET [20566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-525-15","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MELOXICAM 7.5 MG TABLET [20566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61442-126-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MELOXICAM 7.5 MG TABLET [20566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-097-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MELOXICAM 7.5 MG TABLET [20566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MELOXICAM 7.5 MG TABLET [20566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0029-01","type":"NDC"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10939-8954-04","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MEMANTINE 28 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR [121476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-249-06","type":"NDC"}],"standard_charges":[{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":77.5,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION [186397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90619","type":"HCPCS"},{"code":"49281-590-58","type":"NDC"}],"standard_charges":[{"gross_charge":738.5,"discounted_cash":620.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MCG"}]},{"description":"MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION [186397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90619","type":"HCPCS"},{"code":"49281-590-05","type":"NDC"}],"standard_charges":[{"gross_charge":717.0,"discounted_cash":602.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MCG"}]},{"description":"MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE [165212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90620","type":"HCPCS"},{"code":"58160-976-20","type":"NDC"}],"standard_charges":[{"gross_charge":1018.25,"discounted_cash":855.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE [165212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90620","type":"HCPCS"},{"code":"58160-976-02","type":"NDC"}],"standard_charges":[{"gross_charge":1018.25,"discounted_cash":855.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MENINGOCOCCAL A CONJ VACC 2 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION [165943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-958-01","type":"NDC"}],"standard_charges":[{"gross_charge":775.5,"discounted_cash":651.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MENINGOC VAC A,C,Y,W-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS) [101034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90734","type":"HCPCS"},{"code":"58160-955-09","type":"NDC"}],"standard_charges":[{"gross_charge":773.75,"discounted_cash":649.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MENINGOC VAC A,C,Y,W-135 DIP (PF) 4 MCG/0.5 ML INTRAMUSCULAR SOLUTION [40540]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90734","type":"HCPCS"},{"code":"49281-589-05","type":"NDC"}],"standard_charges":[{"gross_charge":698.25,"discounted_cash":586.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MEMANTINE 7 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR [121473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-3407-33","type":"NDC"}],"standard_charges":[{"gross_charge":251.25,"discounted_cash":211.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":376.75,"discounted_cash":316.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":502.5,"discounted_cash":422.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MEMANTINE 5 MG TABLET [37170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6505-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323-508-31","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEMANTINE 5 MG TABLET [37170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6505-61","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEMANTINE 5 MG TABLET [37170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1112-60","type":"NDC"}],"standard_charges":[{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEMANTINE 5 MG TABLET [37170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-173-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEMANTINE 5 MG TABLET [37170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-321-86","type":"NDC"}],"standard_charges":[{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEMANTINE 5 MG TABLET [37170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-3205-11","type":"NDC"}],"standard_charges":[{"gross_charge":120.25,"discounted_cash":101.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEMANTINE 5 MG TABLET [37170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-3205-63","type":"NDC"}],"standard_charges":[{"gross_charge":120.25,"discounted_cash":101.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEMANTINE 5 MG TABLET [37170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-3205-60","type":"NDC"}],"standard_charges":[{"gross_charge":120.25,"discounted_cash":101.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323-508-25","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":178.5,"discounted_cash":149.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-397-25","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 G"},{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"},{"gross_charge":337.25,"discounted_cash":283.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.8 G"}]},{"description":"MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-830-01","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 G"},{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"},{"gross_charge":274.0,"discounted_cash":230.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.8 G"}]},{"description":"MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 G"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"},{"gross_charge":273.25,"discounted_cash":229.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.8 G"}]},{"description":"MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-711-19","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 G"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"},{"gross_charge":273.25,"discounted_cash":229.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.8 G"}]},{"description":"MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092-476-12","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 G"},{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"},{"gross_charge":303.75,"discounted_cash":255.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.8 G"}]},{"description":"MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69918-560-30","type":"NDC"}],"standard_charges":[{"gross_charge":227.25,"discounted_cash":190.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":113.75,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0118-3","type":"NDC"}],"standard_charges":[{"gross_charge":207.5,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":103.75,"discounted_cash":87.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58914-501-01","type":"NDC"}],"standard_charges":[{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58914-501-42","type":"NDC"}],"standard_charges":[{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58914-501-56","type":"NDC"}],"standard_charges":[{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323-507-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-397-95","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 G"},{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"},{"gross_charge":337.25,"discounted_cash":283.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.8 G"}]},{"description":"MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-175-13","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 G"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"},{"gross_charge":273.25,"discounted_cash":229.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.8 G"}]},{"description":"METFORMIN 500 MG TABLET [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-397-51","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN 500 MG TABLET [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-008-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METAXALONE 800 MG TABLET [33963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-650-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"METAXALONE 800 MG TABLET [33963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1435-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"METAXALONE 800 MG TABLET [33963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0448-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"METAXALONE 800 MG TABLET [33963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-530-15","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"METAXALONE 800 MG TABLET [33963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-530-11","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"METAXALONE 800 MG TABLET [33963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60793-136-01","type":"NDC"}],"standard_charges":[{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MESNA 100 MG/ML INTRAVENOUS SOLUTION [10537]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"0703-4805-01","type":"NDC"}],"standard_charges":[{"gross_charge":243.25,"discounted_cash":204.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MESNA 100 MG/ML INTRAVENOUS SOLUTION [10537]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"25021-201-10","type":"NDC"}],"standard_charges":[{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MESNA 100 MG/ML INTRAVENOUS SOLUTION [10537]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"0338-1305-01","type":"NDC"}],"standard_charges":[{"gross_charge":202.75,"discounted_cash":170.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MESNA 100 MG/ML INTRAVENOUS SOLUTION [10537]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"10019-953-01","type":"NDC"}],"standard_charges":[{"gross_charge":202.75,"discounted_cash":170.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MESALAMINE ER 250 MG CAPSULE,EXTENDED RELEASE [10533]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092-189-81","type":"NDC"}],"standard_charges":[{"gross_charge":98.5,"discounted_cash":82.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":49.25,"discounted_cash":41.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MESALAMINE 800 MG TABLET,DELAYED RELEASE [96949]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-435-28","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MESALAMINE 4 GRAM/60 ML ENEMA [10535]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-098-51","type":"NDC"}],"standard_charges":[{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"70121-1454-7","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":194.75,"discounted_cash":163.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0409-1391-21","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":335.75,"discounted_cash":282.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0069-0314-10","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":190.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0069-0314-01","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":190.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"68001-324-58","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":190.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"68001-324-57","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":190.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0781-3098-96","type":"NDC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":395.75,"discounted_cash":332.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0781-3098-95","type":"NDC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":395.75,"discounted_cash":332.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0781-3098-94","type":"NDC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":395.75,"discounted_cash":332.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"55150-208-30","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":178.5,"discounted_cash":149.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0409-1391-22","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":335.75,"discounted_cash":282.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567-401-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":82.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":195.5,"discounted_cash":164.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":391.0,"discounted_cash":328.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"70121-1454-1","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":194.75,"discounted_cash":163.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"55150-207-20","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":194.75,"discounted_cash":163.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323-507-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323-507-20","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0409-3412-10","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":335.75,"discounted_cash":282.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0409-3412-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":335.75,"discounted_cash":282.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567-401-10","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":82.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":195.5,"discounted_cash":164.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":391.0,"discounted_cash":328.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"2055503601","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MANNITOL 25 % INTRAVENOUS SOLUTION [4750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2150","type":"HCPCS"},{"code":"0409-4031-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"MANNITOL 25 % INTRAVENOUS SOLUTION [4750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2150","type":"HCPCS"},{"code":"63323-024-25","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":195.75,"discounted_cash":164.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"MANNITOL 20 % INTRAVENOUS SOLUTION [4749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7715-12","type":"NDC"}],"standard_charges":[{"gross_charge":342.5,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"MANNITOL 20 % INTRAVENOUS SOLUTION [4749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7715-02","type":"NDC"}],"standard_charges":[{"gross_charge":342.5,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"MANNITOL 20 % INTRAVENOUS SOLUTION [4749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7715-13","type":"NDC"}],"standard_charges":[{"gross_charge":209.5,"discounted_cash":175.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"MANNITOL 20 % INTRAVENOUS SOLUTION [4749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7715-03","type":"NDC"}],"standard_charges":[{"gross_charge":209.5,"discounted_cash":175.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"MANNITOL 20 % INTRAVENOUS SOLUTION [4749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0357-03","type":"NDC"}],"standard_charges":[{"gross_charge":364.5,"discounted_cash":306.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"MAINTENANCE 4:1 LOW K (12 MEQ) IN RINGER'S 504.8ML BAG [172736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"71285-0205-1","type":"NDC"}],"standard_charges":[{"gross_charge":249.25,"discounted_cash":209.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 504.8 ML"}]},{"description":"MAINTENANCE 4:1 LOW K (12 MEQ) IN RINGER'S 504.8ML BAG [172736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"66647-0120-05","type":"NDC"}],"standard_charges":[{"gross_charge":308.25,"discounted_cash":258.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 504.8 ML"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-064-43","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG/KG"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SYRINGE [128358]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-1754-10","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-064-23","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-064-21","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-064-41","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"51754-1000-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"51754-1000-4","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-064-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MANNITOL 25 % INTRAVENOUS SOLUTION [4750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2150","type":"HCPCS"},{"code":"0409-4031-16","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"MECLIZINE 25 MG CHEWABLE TABLET [26024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-028-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MECLIZINE 12.5 MG TABLET [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-775-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MECLIZINE 12.5 MG TABLET [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-775-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MECLIZINE 12.5 MG TABLET [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6516-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MECLIZINE 12.5 MG TABLET [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-027-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MECLIZINE 12.5 MG TABLET [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-423-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MECLIZINE 12.5 MG TABLET [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-522-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MECLIZINE 12.5 MG TABLET [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-522-15","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MECLIZINE 12.5 MG TABLET [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-490-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [10512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-4681-01","type":"NDC"}],"standard_charges":[{"gross_charge":466.75,"discounted_cash":392.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [10512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-4681-00","type":"NDC"}],"standard_charges":[{"gross_charge":466.75,"discounted_cash":392.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MEASLES,MUMPS,RUBEL,VARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT [42622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-4171-01","type":"NDC"}],"standard_charges":[{"gross_charge":1189.75,"discounted_cash":999.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MEASLES,MUMPS,RUBEL,VARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT [42622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-4171-00","type":"NDC"}],"standard_charges":[{"gross_charge":1189.75,"discounted_cash":999.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MARGETUXIMAB-CMKB 25 MG/ML INTRAVENOUS SOLUTION [187803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"74527-022-03","type":"NDC"}],"standard_charges":[{"gross_charge":51443.25,"discounted_cash":43212.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"}]},{"description":"MARGETUXIMAB-CMKB 25 MG/ML INTRAVENOUS SOLUTION [187803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"74527-022-01","type":"NDC"}],"standard_charges":[{"gross_charge":51443.25,"discounted_cash":43212.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"}]},{"description":"MARGETUXIMAB-CMKB 25 MG/ML INTRAVENOUS SOLUTION [187803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"74527-022-02","type":"NDC"}],"standard_charges":[{"gross_charge":51443.25,"discounted_cash":43212.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"}]},{"description":"MANNITOL 25 % INTRAVENOUS SOLUTION [4750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2150","type":"HCPCS"},{"code":"63323-024-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":195.75,"discounted_cash":164.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-064-04","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-064-03","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [16162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-108-02","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [16162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457-567-00","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [16162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-6727-11","type":"NDC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [16162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-108-00","type":"NDC"}],"standard_charges":[{"gross_charge":129.25,"discounted_cash":108.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [16162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-108-26","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [16162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567-410-24","type":"NDC"}],"standard_charges":[{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [16162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-108-01","type":"NDC"}],"standard_charges":[{"gross_charge":129.25,"discounted_cash":108.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [16162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-6727-23","type":"NDC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6498033990","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6498033901","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1000673038","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1000670028","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54738-973-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5789663412","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-354-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5164578508","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5199108136","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [16162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0338-1709-40","type":"NDC"}],"standard_charges":[{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-064-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-064-02","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 40 GRAM/1,000 ML (4 %) IN WATER INTRAVENOUS SOLUTION [131208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-3164-12","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE 40 GRAM/1,000 ML (4 %) IN WATER INTRAVENOUS SOLUTION [131208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-3164-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE 40 GRAM/1,000 ML (4 %) IN WATER INTRAVENOUS SOLUTION [131208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-6729-09","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [4719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121-1720-1","type":"NDC"}],"standard_charges":[{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [4719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457-554-00","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [4719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-106-00","type":"NDC"}],"standard_charges":[{"gross_charge":127.75,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [4719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-106-01","type":"NDC"}],"standard_charges":[{"gross_charge":127.75,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"MECLIZINE 25 MG TABLET [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-442-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [4719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-6729-23","type":"NDC"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION [131207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-2050-01","type":"NDC"}],"standard_charges":[{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION [131207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-106-15","type":"NDC"}],"standard_charges":[{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION [131207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-6729-03","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [131156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121-1719-2","type":"NDC"}],"standard_charges":[{"gross_charge":155.5,"discounted_cash":130.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [131156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121-1719-1","type":"NDC"}],"standard_charges":[{"gross_charge":155.5,"discounted_cash":130.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [131156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0264-4204-52","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [131156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-106-03","type":"NDC"}],"standard_charges":[{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [131156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457-553-00","type":"NDC"}],"standard_charges":[{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [131156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-106-02","type":"NDC"}],"standard_charges":[{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK [131156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-6729-11","type":"NDC"}],"standard_charges":[{"gross_charge":185.5,"discounted_cash":155.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION [131207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-2050-20","type":"NDC"}],"standard_charges":[{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"MECLIZINE 25 MG TABLET [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-491-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8770140813","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4098521240","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4934889810","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1191707508","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54629-0609-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1184511285","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 2.5 MG/10 ML ORAL LIQUID [134668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47469-07405","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-160-16","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-063-61","type":"NDC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-063-59","type":"NDC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4776-00","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3160402741","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026852415","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068108600","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1000670031","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5789686406","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6809411059","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6809411061","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-250-62","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733351625","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733351610","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026852411","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MELATONIN 3 MG TABLET [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093931444","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-250-59","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEDROXYPROGESTERONE 2.5 MG TABLET [4855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0872-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE [128373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59762-4538-2","type":"NDC"}],"standard_charges":[{"gross_charge":472.5,"discounted_cash":396.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0548-5400-00","type":"NDC"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":136.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59762-4537-1","type":"NDC"}],"standard_charges":[{"gross_charge":401.25,"discounted_cash":337.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-6801-01","type":"NDC"}],"standard_charges":[{"gross_charge":401.25,"discounted_cash":337.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0746-30","type":"NDC"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":217.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR INJECTION WRAPPER [178024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-329-25","type":"NDC"}],"standard_charges":[{"gross_charge":238.75,"discounted_cash":200.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR INJECTION WRAPPER [178024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-329-01","type":"NDC"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":200.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR INJECTION WRAPPER [178024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0548-5400-25","type":"NDC"}],"standard_charges":[{"gross_charge":221.5,"discounted_cash":186.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE 10 MG TABLET [4854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0056-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEDROXYPROGESTERONE 10 MG TABLET [4854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3742-2","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEDROXYPROGESTERONE 10 MG TABLET [4854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0779-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MECLIZINE 25 MG TABLET [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-511-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MECLIZINE 25 MG TABLET [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-511-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MECLIZINE 25 MG TABLET [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-491-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"MEDROXYPROGESTERONE 2.5 MG TABLET [4855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0872-04","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-020-50","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-020-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION [76824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4776-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEGESTROL 40 MG TABLET [4871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7236-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MEGESTROL 40 MG TABLET [4871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-165-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MEGESTROL 40 MG TABLET [4871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-290-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MEGESTROL 40 MG TABLET [4871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-3571-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MEGESTROL 20 MG TABLET [4870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-158-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"MEGESTROL 20 MG TABLET [4870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-434-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"MEGESTROL 20 MG TABLET [4870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-289-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"MINOCYCLINE 50 MG CAPSULE [5111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5694-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124840]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7715-01","type":"NDC"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":270.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124847]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-6438-10","type":"NDC"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":383.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"FLUCONAZOLE 100 MG TABLET [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6500-61","type":"NDC"}],"standard_charges":[{"gross_charge":65.75,"discounted_cash":55.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.5,"discounted_cash":82.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":131.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCONAZOLE 100 MG TABLET [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67405-602-03","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":118.5,"discounted_cash":99.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCONAZOLE 100 MG TABLET [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-691-02","type":"NDC"}],"standard_charges":[{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCONAZOLE 100 MG TABLET [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-691-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":89.0,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":118.5,"discounted_cash":99.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCONAZOLE 100 MG TABLET [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-102-30","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCONAZOLE 100 MG TABLET [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-5411-60","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCONAZOLE 100 MG TABLET [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-5411-46","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":118.5,"discounted_cash":99.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCONAZOLE 100 MG TABLET [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-3420-41","type":"NDC"}],"standard_charges":[{"gross_charge":167.5,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":251.0,"discounted_cash":210.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":334.75,"discounted_cash":281.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCONAZOLE 100 MG TABLET [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6500-06","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCYTOSINE 500 MG CAPSULE [10052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794-010-08","type":"NDC"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":488.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":290.5,"discounted_cash":244.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 500 MG CAPSULE [10052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-770-01","type":"NDC"}],"standard_charges":[{"gross_charge":1302.25,"discounted_cash":1093.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":651.25,"discounted_cash":547.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 250 MG CAPSULE [10051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42494-339-03","type":"NDC"}],"standard_charges":[{"gross_charge":1346.0,"discounted_cash":1130.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":673.0,"discounted_cash":565.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 250 MG CAPSULE [10051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794-009-08","type":"NDC"}],"standard_charges":[{"gross_charge":814.5,"discounted_cash":684.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":407.25,"discounted_cash":342.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 250 MG CAPSULE [10051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-771-01","type":"NDC"}],"standard_charges":[{"gross_charge":1346.0,"discounted_cash":1130.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":673.0,"discounted_cash":565.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 250 MG CAPSULE [10051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42494-339-01","type":"NDC"}],"standard_charges":[{"gross_charge":1346.0,"discounted_cash":1130.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":673.0,"discounted_cash":565.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 250 MG CAPSULE [10051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0187-3554-10","type":"NDC"}],"standard_charges":[{"gross_charge":1512.5,"discounted_cash":1270.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":756.25,"discounted_cash":635.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCONAZOLE CUSTOM DOSE IV [408655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021-113-87","type":"NDC"}],"standard_charges":[{"gross_charge":167.75,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"FLUCONAZOLE CUSTOM DOSE IV [408655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021-113-82","type":"NDC"}],"standard_charges":[{"gross_charge":127.25,"discounted_cash":106.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FLUCONAZOLE CUSTOM DOSE IV [408655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"0338-6045-37","type":"NDC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":187.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"},{"gross_charge":223.0,"discounted_cash":187.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"FLUCONAZOLE 50 MG TABLET [10046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-990-30","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUCONAZOLE 50 MG TABLET [10046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-003-30","type":"NDC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUCONAZOLE 50 MG TABLET [10046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-694-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUCONAZOLE 50 MG TABLET [10046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-101-30","type":"NDC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUCONAZOLE 50 MG TABLET [10046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-5410-46","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUCONAZOLE 50 MG TABLET [10046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-3410-30","type":"NDC"}],"standard_charges":[{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK [10050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021-184-87","type":"NDC"}],"standard_charges":[{"gross_charge":167.75,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [10049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021-184-82","type":"NDC"}],"standard_charges":[{"gross_charge":127.25,"discounted_cash":106.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [10049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"0409-4688-18","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [10049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"0338-6046-48","type":"NDC"}],"standard_charges":[{"gross_charge":205.5,"discounted_cash":172.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [14232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-695-01","type":"NDC"}],"standard_charges":[{"gross_charge":191.75,"discounted_cash":161.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 ML"}]},{"description":"FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [14232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5029-1","type":"NDC"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":157.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 ML"}]},{"description":"FLECAINIDE 50 MG TABLET [10043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-641-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 50 MG TABLET [10043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0010-25","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 50 MG TABLET [10043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0010-21","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 100 MG TABLET [10041]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0011-20","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 100 MG TABLET [10041]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-321-15","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 100 MG TABLET [10041]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-321-11","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 100 MG TABLET [10041]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-642-10","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 100 MG TABLET [10041]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0011-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 50 MG TABLET [10043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-320-11","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCICLOVINE F18 10 MCI (370 MBQ) INTRAVENOUS SOLUTION [176891]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9588","type":"HCPCS"},{"code":"69932-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":3955.25,"discounted_cash":3322.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MILLICURIE"}]},{"description":"FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE [199069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90662","type":"HCPCS"},{"code":"49281-124-88","type":"NDC"}],"standard_charges":[{"gross_charge":361.25,"discounted_cash":303.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE [199069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90662","type":"HCPCS"},{"code":"49281-124-65","type":"NDC"}],"standard_charges":[{"gross_charge":361.25,"discounted_cash":303.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE [199068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"58160-884-52","type":"NDC"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE [199068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"58160-884-41","type":"NDC"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE [199068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"49281-424-88","type":"NDC"}],"standard_charges":[{"gross_charge":166.5,"discounted_cash":139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE [199068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"49281-424-50","type":"NDC"}],"standard_charges":[{"gross_charge":166.5,"discounted_cash":139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLU VACC 2024-25(65YR UP)-MF59C(PF) 45 MCG(15 MCGX3)/0.5 ML IM SYRINGE [199064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90653","type":"HCPCS"},{"code":"70461-024-04","type":"NDC"}],"standard_charges":[{"gross_charge":361.25,"discounted_cash":303.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLU VACC 2024-25(65YR UP)-MF59C(PF) 45 MCG(15 MCGX3)/0.5 ML IM SYRINGE [199064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90653","type":"HCPCS"},{"code":"70461-024-03","type":"NDC"}],"standard_charges":[{"gross_charge":361.25,"discounted_cash":303.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLU VAC TS 2024(6 MOS UP)C.DER.(PF) 45 MCG(15 MCGX3)/0.5 ML IM SYRINGE [199062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90661","type":"HCPCS"},{"code":"70461-654-04","type":"NDC"}],"standard_charges":[{"gross_charge":211.25,"discounted_cash":177.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLU VAC TS 2024(6 MOS UP)C.DER.(PF) 45 MCG(15 MCGX3)/0.5 ML IM SYRINGE [199062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90661","type":"HCPCS"},{"code":"70461-654-03","type":"NDC"}],"standard_charges":[{"gross_charge":211.25,"discounted_cash":177.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLOTUFOLASTAT F 18 GALLIUM 296-5,846 MBQ/ML (8-158 MCI/ML) IV SOLUTION [195627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9608","type":"HCPCS"},{"code":"69932-002-50","type":"NDC"}],"standard_charges":[{"gross_charge":4503.0,"discounted_cash":3782.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MILLICURIE"}]},{"description":"FLOTUFOLASTAT F 18 GALLIUM 296-5,846 MBQ/ML (8-158 MCI/ML) IV SOLUTION [195627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9608","type":"HCPCS"},{"code":"69932-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":4503.0,"discounted_cash":3782.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MILLICURIE"}]},{"description":"FLECAINIDE SUSPENSION 20 MG/ML [400568]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0000-0001-20","type":"NDC"}],"standard_charges":[{"gross_charge":396.25,"discounted_cash":332.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"FLECAINIDE 50 MG TABLET [10043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-293-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.5,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":84.75,"discounted_cash":71.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 50 MG TABLET [10043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-621-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 50 MG TABLET [10043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-380-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLECAINIDE 50 MG TABLET [10043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-320-15","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUCYTOSINE 500 MG CAPSULE [10052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42494-340-03","type":"NDC"}],"standard_charges":[{"gross_charge":1302.25,"discounted_cash":1093.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":651.25,"discounted_cash":547.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUDARABINE 50 MG INTRAVENOUS SOLUTION [10053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9185","type":"HCPCS"},{"code":"61703-344-18","type":"NDC"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0721-04","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 20 MG CAPSULE [10070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7346-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 20 MG CAPSULE [10070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-721-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 20 MG CAPSULE [10070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-605-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 20 MG CAPSULE [10070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-193-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 20 MG CAPSULE [10070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5785-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 20 MG CAPSULE [10070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-648-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 10 MG TABLET [25087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":78.5,"discounted_cash":65.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":117.5,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FLUOXETINE 10 MG TABLET [25087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-150-30","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":77.5,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":116.25,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4721-05","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":92.5,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 10 MG CAPSULE [10069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7345-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-523-40","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUPHENAZINE 2.5 MG/5 ML ORAL ELIXIR [10072]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0654-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FLUPHENAZINE 2.5 MG/5 ML ORAL ELIXIR [10072]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0654-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FLUPHENAZINE 2.5 MG TABLET [3220]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-336-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":183.75,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FLUPHENAZINE 2.5 MG TABLET [3220]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1789-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":183.75,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FLUPHENAZINE 1 MG TABLET [3218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1788-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":296.75,"discounted_cash":249.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":148.5,"discounted_cash":124.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FLUPHENAZINE 1 MG TABLET [3218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-485-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-244-77","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-244-40","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2051-05","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 10 MG CAPSULE [10069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-192-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOCINONIDE 0.05 % TOPICAL CREAM WRAPPER [183098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0262-15","type":"NDC"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":208.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"FLUOCINOLONE 0.025 % TOPICAL CREAM [3184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0709-15","type":"NDC"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":204.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"FLUOCINOLONE 0.01 % TOPICAL SOLUTION [3186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52565-012-59","type":"NDC"}],"standard_charges":[{"gross_charge":770.75,"discounted_cash":647.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"FLUOCINOLONE 0.01 % TOPICAL SOLUTION [3186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0059-60","type":"NDC"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [39744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"36000-148-10","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [39744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"36000-148-01","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [39744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0143-9784-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [39744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0143-9784-10","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [39744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323-424-05","type":"NDC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUDROCORTISONE 0.1 MG TABLET [10054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-330-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FLUDROCORTISONE 0.1 MG TABLET [10054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-330-15","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FLUDROCORTISONE 0.1 MG TABLET [10054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-288-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FLUDROCORTISONE 0.1 MG TABLET [10054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-288-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FLUDROCORTISONE 0.1 MG TABLET [10054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0997-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FLUDROCORTISONE 0.1 MG TABLET [10054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-7033-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FLUDEOXYGLUCOSE F-18 20 MCI TO 300 MCI/ML INTRAVENOUS SOLUTION WRAPPER [186167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9552","type":"HCPCS"},{"code":"65857-100-30","type":"NDC"}],"standard_charges":[{"gross_charge":1787.0,"discounted_cash":1501.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLICURIE"}]},{"description":"FLUDEOXYGLUCOSE F-18 20 MCI TO 300 MCI/ML INTRAVENOUS SOLUTION WRAPPER [186167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9552","type":"HCPCS"},{"code":"65857-300-30","type":"NDC"}],"standard_charges":[{"gross_charge":1787.0,"discounted_cash":1501.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLICURIE"}]},{"description":"FLUOCINONIDE 0.05 % TOPICAL CREAM WRAPPER [183098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1386-1","type":"NDC"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":208.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"FLUOCINONIDE 0.05 % TOPICAL CREAM WRAPPER [183098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1386-2","type":"NDC"}],"standard_charges":[{"gross_charge":374.5,"discounted_cash":314.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"FLUOCINONIDE 0.05 % TOPICAL CREAM WRAPPER [183098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1386-3","type":"NDC"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":629.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"FLUOCINONIDE 0.05 % TOPICAL CREAM WRAPPER [183098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-494-30","type":"NDC"}],"standard_charges":[{"gross_charge":374.5,"discounted_cash":314.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"FLUOXETINE 10 MG CAPSULE [10069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5784-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 10 MG CAPSULE [10069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-647-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 10 MG CAPSULE [10069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2823-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE 10 MG CAPSULE [10069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0777-3104-02","type":"NDC"}],"standard_charges":[{"gross_charge":115.25,"discounted_cash":96.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":230.25,"discounted_cash":193.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":460.25,"discounted_cash":386.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOROURACIL 5 % TOPICAL CREAM [10065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-362-40","type":"NDC"}],"standard_charges":[{"gross_charge":921.5,"discounted_cash":774.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 G"}]},{"description":"FLUOROURACIL 5 % TOPICAL CREAM [10065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0187-3204-47","type":"NDC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 G"}]},{"description":"FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION [3208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-880-05","type":"NDC"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":320.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION [3208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11980-211-05","type":"NDC"}],"standard_charges":[{"gross_charge":723.75,"discounted_cash":607.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [10059]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0065-0092-65","type":"NDC"}],"standard_charges":[{"gross_charge":283.5,"discounted_cash":238.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [10059]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-253-10","type":"NDC"}],"standard_charges":[{"gross_charge":355.25,"discounted_cash":298.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUORESCEIN 1 MG EYE STRIPS [27663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17238-900-99","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FLUORESCEIN 1 MG EYE STRIPS [27663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17238-900-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FLUORESCEIN 1 MG EYE STRIPS [27663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-404-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FLUORESCEIN 0.6 MG EYE STRIPS [27662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-403-03","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 STRIP"}]},{"description":"FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1273-4","type":"NDC"}],"standard_charges":[{"gross_charge":476.5,"discounted_cash":400.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"FLUOCINONIDE 0.05 % TOPICAL SOLUTION [3190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0134-60","type":"NDC"}],"standard_charges":[{"gross_charge":399.5,"discounted_cash":335.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1264-1","type":"NDC"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":244.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"FLUOCINONIDE 0.05 % TOPICAL OINTMENT [3189]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0264-15","type":"NDC"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":244.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"FLUOCINONIDE 0.05 % TOPICAL CREAM WRAPPER [183098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0664-15","type":"NDC"}],"standard_charges":[{"gross_charge":262.25,"discounted_cash":220.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"FLUOROURACIL 5 % TOPICAL CREAM [10065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66530-249-40","type":"NDC"}],"standard_charges":[{"gross_charge":921.5,"discounted_cash":774.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 G"}]},{"description":"FLAVOXATE 100 MG TABLET [10039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24658-720-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9121-16","type":"NDC"}],"standard_charges":[{"gross_charge":389.75,"discounted_cash":327.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":195.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":292.25,"discounted_cash":245.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9121-98","type":"NDC"}],"standard_charges":[{"gross_charge":389.75,"discounted_cash":327.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":195.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":292.25,"discounted_cash":245.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 200 MCG LOZENGE ON A HANDLE [27913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9202-30","type":"NDC"}],"standard_charges":[{"gross_charge":762.25,"discounted_cash":640.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MCG"},{"gross_charge":1016.25,"discounted_cash":853.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MCG"},{"gross_charge":254.25,"discounted_cash":213.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":508.25,"discounted_cash":426.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MCG"}]},{"description":"FENTANYL 200 MCG LOZENGE ON A HANDLE [27913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-502-30","type":"NDC"}],"standard_charges":[{"gross_charge":2579.75,"discounted_cash":2166.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MCG"},{"gross_charge":3439.75,"discounted_cash":2889.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MCG"},{"gross_charge":860.0,"discounted_cash":722.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":1720.0,"discounted_cash":1444.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MCG"}]},{"description":"FENTANYL 200 MCG BUCCAL TABLET, EFFERVESCENT [77440]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-542-28","type":"NDC"}],"standard_charges":[{"gross_charge":199.75,"discounted_cash":167.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":394.5,"discounted_cash":331.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":589.25,"discounted_cash":494.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":784.0,"discounted_cash":658.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9112-76","type":"NDC"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":960.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MCG"},{"gross_charge":285.75,"discounted_cash":240.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":571.5,"discounted_cash":480.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":857.25,"discounted_cash":720.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-423-11","type":"NDC"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":960.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MCG"},{"gross_charge":285.75,"discounted_cash":240.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":571.5,"discounted_cash":480.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":857.25,"discounted_cash":720.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-423-47","type":"NDC"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":960.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MCG"},{"gross_charge":285.75,"discounted_cash":240.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":571.5,"discounted_cash":480.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":857.25,"discounted_cash":720.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9025-76","type":"NDC"}],"standard_charges":[{"gross_charge":389.75,"discounted_cash":327.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":195.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":292.25,"discounted_cash":245.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9125-76","type":"NDC"}],"standard_charges":[{"gross_charge":389.75,"discounted_cash":327.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":195.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":292.25,"discounted_cash":245.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7081-2","type":"NDC"}],"standard_charges":[{"gross_charge":574.75,"discounted_cash":482.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":287.5,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":431.0,"discounted_cash":362.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7081-0","type":"NDC"}],"standard_charges":[{"gross_charge":574.75,"discounted_cash":482.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":287.5,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":431.0,"discounted_cash":362.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-424-11","type":"NDC"}],"standard_charges":[{"gross_charge":574.75,"discounted_cash":482.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":287.5,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":431.0,"discounted_cash":362.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-424-47","type":"NDC"}],"standard_charges":[{"gross_charge":574.75,"discounted_cash":482.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":287.5,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":431.0,"discounted_cash":362.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7006-2","type":"NDC"}],"standard_charges":[{"gross_charge":574.75,"discounted_cash":482.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":287.5,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":431.0,"discounted_cash":362.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7006-0","type":"NDC"}],"standard_charges":[{"gross_charge":574.75,"discounted_cash":482.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":287.5,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":431.0,"discounted_cash":362.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323-806-14","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323-806-12","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323-806-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323-806-02","type":"NDC"}],"standard_charges":[{"gross_charge":185.5,"discounted_cash":155.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":463.75,"discounted_cash":389.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2500 MCG"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323-806-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9094-41","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9094-18","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9094-17","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9094-16","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9093-45","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9094-12","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"17478-030-25","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0641-6030-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0641-6029-25","type":"NDC"}],"standard_charges":[{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0641-6029-01","type":"NDC"}],"standard_charges":[{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0641-6028-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0641-6027-25","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0641-6027-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9094-28","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9094-61","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9094-25","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9094-22","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9093-35","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0409-9094-31","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [3037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323-806-50","type":"NDC"}],"standard_charges":[{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SYRINGE [187789]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323-808-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SYRINGE [187789]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323-808-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SYRINGE [187789]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0641-6248-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9012-76","type":"NDC"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":960.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MCG"},{"gross_charge":285.75,"discounted_cash":240.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":571.5,"discounted_cash":480.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":857.25,"discounted_cash":720.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9119-16","type":"NDC"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":960.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MCG"},{"gross_charge":285.75,"discounted_cash":240.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":571.5,"discounted_cash":480.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":857.25,"discounted_cash":720.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9119-98","type":"NDC"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":960.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MCG"},{"gross_charge":285.75,"discounted_cash":240.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":571.5,"discounted_cash":480.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":857.25,"discounted_cash":720.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH [27908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-428-11","type":"NDC"}],"standard_charges":[{"gross_charge":322.75,"discounted_cash":271.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH [27908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-428-47","type":"NDC"}],"standard_charges":[{"gross_charge":322.75,"discounted_cash":271.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH [27908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7009-2","type":"NDC"}],"standard_charges":[{"gross_charge":322.75,"discounted_cash":271.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH [27908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7009-0","type":"NDC"}],"standard_charges":[{"gross_charge":322.75,"discounted_cash":271.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH [27908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9000-76","type":"NDC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":183.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"FENTANYL 100 MCG BUCCAL TABLET, EFFERVESCENT [77439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-541-28","type":"NDC"}],"standard_charges":[{"gross_charge":313.25,"discounted_cash":263.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":621.5,"discounted_cash":522.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":929.75,"discounted_cash":780.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":1238.0,"discounted_cash":1039.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"}]},{"description":"FENTANYL 1,200 MCG LOZENGE ON A HANDLE [27917]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-512-30","type":"NDC"}],"standard_charges":[{"gross_charge":893.5,"discounted_cash":750.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MCG"},{"gross_charge":1191.25,"discounted_cash":1000.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MCG"},{"gross_charge":298.0,"discounted_cash":250.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":595.75,"discounted_cash":500.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MCG"}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SYRINGE [187789]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"0641-6248-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH [27908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9100-76","type":"NDC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":183.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"FENTANYL 400 MCG BUCCAL TABLET, EFFERVESCENT [77441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-544-28","type":"NDC"}],"standard_charges":[{"gross_charge":146.5,"discounted_cash":123.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":287.75,"discounted_cash":241.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":429.0,"discounted_cash":360.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":570.25,"discounted_cash":479.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"}]},{"description":"FILGRASTIM 480 MCG/0.8 ML INJECTION SYRINGE [108076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-209-10","type":"NDC"}],"standard_charges":[{"gross_charge":1557.0,"discounted_cash":1307.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FILGRASTIM 480 MCG/0.8 ML INJECTION SYRINGE [108076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-209-01","type":"NDC"}],"standard_charges":[{"gross_charge":1297.5,"discounted_cash":1089.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FILGRASTIM 300 MCG/ML INJECTION SOLUTION [10036]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-530-10","type":"NDC"}],"standard_charges":[{"gross_charge":1352.75,"discounted_cash":1136.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FILGRASTIM 300 MCG/ML INJECTION SOLUTION [10036]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-530-01","type":"NDC"}],"standard_charges":[{"gross_charge":1352.75,"discounted_cash":1136.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FILGRASTIM 300 MCG/0.5 ML INJECTION SYRINGE [108075]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-924-10","type":"NDC"}],"standard_charges":[{"gross_charge":1842.25,"discounted_cash":1547.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FILGRASTIM 300 MCG/0.5 ML INJECTION SYRINGE [108075]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-924-01","type":"NDC"}],"standard_charges":[{"gross_charge":1842.25,"discounted_cash":1547.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FIDAXOMICIN 200 MG TABLET [110360]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52015-080-01","type":"NDC"}],"standard_charges":[{"gross_charge":1115.0,"discounted_cash":936.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FESOTERODINE ER 4 MG TABLET,EXTENDED RELEASE 24 HR [96973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-0242-30","type":"NDC"}],"standard_charges":[{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE [3077]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"245010889","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"}]},{"description":"FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE [3077]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"245010801","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"}]},{"description":"FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536100901","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"}]},{"description":"FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904759160","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"}]},{"description":"FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904759080","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"}]},{"description":"FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904759060","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"}]},{"description":"FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904759161","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"}]},{"description":"FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904759082","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"}]},{"description":"FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID [3071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026833624","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID [3071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026833611","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID [3071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"121053005","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIXIR [172808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5489-07","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIXIR [172808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5038377816","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS [95693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7139974805","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS [95693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3932805750","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS [95693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5483801150","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS [95693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87074002","type":"NDC"}],"standard_charges":[{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FERROUS GLUCONATE 324 MG (37.5 MG OR 38 MG IRON) TABLET WRAPPER [408111196]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"2055501900","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 324 MG"}]},{"description":"FERROUS GLUCONATE 324 MG (37.5 MG OR 38 MG IRON) TABLET WRAPPER [408111196]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904213761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 324 MG"}]},{"description":"FERROUS GLUCONATE 324 MG (37.5 MG OR 38 MG IRON) TABLET WRAPPER [408111196]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574050811","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 324 MG"}]},{"description":"FILGRASTIM 480 MCG/1.6 ML INJECTION SOLUTION [108074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-546-01","type":"NDC"}],"standard_charges":[{"gross_charge":1469.0,"discounted_cash":1233.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FERRIC SULFATE 15.5% SOLUTION [408735]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7243-30","type":"NDC"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":149.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"FILGRASTIM 480 MCG/1.6 ML INJECTION SOLUTION [108074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-546-10","type":"NDC"}],"standard_charges":[{"gross_charge":1469.0,"discounted_cash":1233.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE [180032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-0291-01","type":"NDC"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":790.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":1209.0,"discounted_cash":1015.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FLAVOXATE 100 MG TABLET [10039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-324-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FLAVOXATE 100 MG TABLET [10039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0115-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FLASH GLUCOSE SCANNING READER [177264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5759980300","type":"NDC"}],"standard_charges":[{"gross_charge":344.5,"discounted_cash":289.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FLASH GLUCOSE SCANNING READER [177264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5759900200","type":"NDC"}],"standard_charges":[{"gross_charge":344.5,"discounted_cash":289.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-428-65","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-428-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-428-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-412-90","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-323-15","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-525-90","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-090-15","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-090-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-149-90","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-149-30","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7355-98","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG TABLET [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7355-56","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [167972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61314-326-10","type":"NDC"}],"standard_charges":[{"gross_charge":1286.25,"discounted_cash":1080.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [167972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61314-326-05","type":"NDC"}],"standard_charges":[{"gross_charge":1286.25,"discounted_cash":1080.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [167972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61314-326-01","type":"NDC"}],"standard_charges":[{"gross_charge":1286.25,"discounted_cash":1080.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [167973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61314-318-01","type":"NDC"}],"standard_charges":[{"gross_charge":1514.75,"discounted_cash":1272.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE [180033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-0292-10","type":"NDC"}],"standard_charges":[{"gross_charge":1505.5,"discounted_cash":1264.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MCG"},{"gross_charge":1209.0,"discounted_cash":1015.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE [180033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-0292-01","type":"NDC"}],"standard_charges":[{"gross_charge":1505.5,"discounted_cash":1264.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MCG"},{"gross_charge":1209.0,"discounted_cash":1015.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE [180032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-0291-10","type":"NDC"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":790.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":1209.0,"discounted_cash":1015.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION [28357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59365-6065-0","type":"NDC"}],"standard_charges":[{"gross_charge":368.75,"discounted_cash":309.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 G"}]},{"description":"FERRIC SUBSULFATE 0.2 GRAM TO 0.22 GRAM/ML TOPICAL SOLN AND APPLICATOR [119255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"48783-112-08","type":"NDC"}],"standard_charges":[{"gross_charge":98.5,"discounted_cash":82.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"FERRIC SUBSULFATE 0.2 GRAM TO 0.22 GRAM/ML TOPICAL SOLN AND APPLICATOR [119255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10481-0112-8","type":"NDC"}],"standard_charges":[{"gross_charge":98.5,"discounted_cash":82.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"FENTANYL 600 MCG BUCCAL TABLET, EFFERVESCENT [77442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-637-28","type":"NDC"}],"standard_charges":[{"gross_charge":99.5,"discounted_cash":83.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":288.5,"discounted_cash":242.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":382.75,"discounted_cash":321.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"}]},{"description":"FENTANYL 600 MCG BUCCAL TABLET, EFFERVESCENT [77442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-637-01","type":"NDC"}],"standard_charges":[{"gross_charge":99.5,"discounted_cash":83.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":288.5,"discounted_cash":242.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":382.75,"discounted_cash":321.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-426-11","type":"NDC"}],"standard_charges":[{"gross_charge":422.5,"discounted_cash":354.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":211.25,"discounted_cash":177.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-426-47","type":"NDC"}],"standard_charges":[{"gross_charge":422.5,"discounted_cash":354.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":211.25,"discounted_cash":177.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7007-2","type":"NDC"}],"standard_charges":[{"gross_charge":422.5,"discounted_cash":354.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":211.25,"discounted_cash":177.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7007-0","type":"NDC"}],"standard_charges":[{"gross_charge":422.5,"discounted_cash":354.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":211.25,"discounted_cash":177.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7242-55","type":"NDC"}],"standard_charges":[{"gross_charge":286.75,"discounted_cash":240.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":143.5,"discounted_cash":120.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9122-98","type":"NDC"}],"standard_charges":[{"gross_charge":286.5,"discounted_cash":240.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 400 MCG LOZENGE ON A HANDLE [27914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7866-65","type":"NDC"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":409.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MCG"},{"gross_charge":649.0,"discounted_cash":545.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MCG"},{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":327.0,"discounted_cash":274.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MCG"}]},{"description":"FENTANYL 400 MCG LOZENGE ON A HANDLE [27914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7866-19","type":"NDC"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":409.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MCG"},{"gross_charge":649.0,"discounted_cash":545.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MCG"},{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":327.0,"discounted_cash":274.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MCG"}]},{"description":"FENTANYL 600 MCG LOZENGE ON A HANDLE [27915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-506-01","type":"NDC"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":1124.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MCG"},{"gross_charge":1783.5,"discounted_cash":1498.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MCG"},{"gross_charge":449.75,"discounted_cash":377.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":894.25,"discounted_cash":751.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MCG"}]},{"description":"SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS [24932]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"0024-2792-10","type":"NDC"}],"standard_charges":[{"gross_charge":415.25,"discounted_cash":348.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.5 MG"}]},{"description":"FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION [186382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73594-9310-1","type":"NDC"}],"standard_charges":[{"gross_charge":10408.75,"discounted_cash":8743.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":10408.75,"discounted_cash":8743.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION [122648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0650-01","type":"NDC"}],"standard_charges":[{"gross_charge":5596.0,"discounted_cash":4700.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"FENTANYL-ROPIVACAINE-NACL (PF) 2 MCG/ML-0.2 % INJECTION SOLUTION [34272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-7108-36","type":"NDC"}],"standard_charges":[{"gross_charge":154.25,"discounted_cash":129.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL-ROPIVACAINE-NACL (PF) 2 MCG/ML-0.2 % INJECTION SOLUTION [34272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1504-36","type":"NDC"}],"standard_charges":[{"gross_charge":203.75,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL-ROPIVACAINE-NACL (PF) 2 MCG/ML-0.2 % INJECTION SOLUTION [34272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42852-215-10","type":"NDC"}],"standard_charges":[{"gross_charge":230.5,"discounted_cash":193.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL-ROPIVACAINE-NACL (PF) 2 MCG/ML-0.2 % INJECTION SOLUTION [34272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1108-36","type":"NDC"}],"standard_charges":[{"gross_charge":206.75,"discounted_cash":173.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL-ROPIVACAINE-NACL (PF) 2 MCG/ML-0.2 % INJECTION SOLUTION [34272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61553-148-48","type":"NDC"}],"standard_charges":[{"gross_charge":239.75,"discounted_cash":201.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL 800 MCG BUCCAL TABLET, EFFERVESCENT [77443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-548-04","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":201.75,"discounted_cash":169.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":300.25,"discounted_cash":252.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":398.5,"discounted_cash":334.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-427-11","type":"NDC"}],"standard_charges":[{"gross_charge":243.25,"discounted_cash":204.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-427-47","type":"NDC"}],"standard_charges":[{"gross_charge":243.25,"discounted_cash":204.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7008-2","type":"NDC"}],"standard_charges":[{"gross_charge":243.25,"discounted_cash":204.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7008-0","type":"NDC"}],"standard_charges":[{"gross_charge":243.25,"discounted_cash":204.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9075-76","type":"NDC"}],"standard_charges":[{"gross_charge":218.5,"discounted_cash":183.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9123-16","type":"NDC"}],"standard_charges":[{"gross_charge":218.5,"discounted_cash":183.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FLUPHENAZINE 2.5 MG/ML INJECTION SOLUTION [3216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-281-10","type":"NDC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":155.75,"discounted_cash":130.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SYRINGE [128084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"0409-1639-10","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9156-10","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"0143-9156-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9156-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"0143-9156-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72603-133-25","type":"NDC"}],"standard_charges":[{"gross_charge":110.75,"discounted_cash":93.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"72603-133-25","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72603-133-01","type":"NDC"}],"standard_charges":[{"gross_charge":110.75,"discounted_cash":93.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"72603-133-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-311-02","type":"NDC"}],"standard_charges":[{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"25021-311-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-324-25","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"55150-324-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML ORAL SOLUTION [3292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3294-50","type":"NDC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"FUROSEMIDE 40 MG TABLET [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4299-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 20 MG TABLET [3294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-401-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 20 MG TABLET [3294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-624-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 20 MG TABLET [3294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-624-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 20 MG TABLET [3294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-072-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 20 MG TABLET [3294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-072-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 20 MG TABLET [3294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8297-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML ORAL SOLUTION(NEO/PED) [171498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3294-46","type":"NDC"}],"standard_charges":[{"gross_charge":61.75,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"FUROSEMIDE 10 MG/ML ORAL SOLUTION [3292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-613-60","type":"NDC"}],"standard_charges":[{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-324-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"55150-324-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"0409-6102-18","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-280-36","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"63323-280-36","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-280-26","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"63323-280-26","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-280-16","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":182.25,"discounted_cash":153.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"63323-280-16","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-473-44","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"23155-473-44","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-473-42","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"23155-473-42","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6102-18","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"0409-6102-19","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":135.5,"discounted_cash":113.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-322-25","type":"NDC"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":89.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"55150-322-25","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-322-01","type":"NDC"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":89.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"55150-322-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6102-20","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"0409-6102-20","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-280-03","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"63323-280-03","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-280-01","type":"NDC"}],"standard_charges":[{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"63323-280-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":68.25,"discounted_cash":57.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6102-19","type":"NDC"}],"standard_charges":[{"gross_charge":169.5,"discounted_cash":142.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-473-41","type":"NDC"}],"standard_charges":[{"gross_charge":110.75,"discounted_cash":93.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 40 MG TABLET [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4299-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6665-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-591-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-783-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45963-555-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-222-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-198-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-661-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-661-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-580-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-662-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-662-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5027-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0805-40","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":42.5,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLUTION [29169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-2012-44","type":"NDC"}],"standard_charges":[{"gross_charge":1591.75,"discounted_cash":1337.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 470 ML"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLUTION [29169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5050-1","type":"NDC"}],"standard_charges":[{"gross_charge":612.5,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 470 ML"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLUTION [29169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4708-08","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLUTION [29169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42192-608-16","type":"NDC"}],"standard_charges":[{"gross_charge":1400.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 470 ML"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLUTION [29169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-698-90","type":"NDC"}],"standard_charges":[{"gross_charge":612.5,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLUTION [29169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5025-1","type":"NDC"}],"standard_charges":[{"gross_charge":612.5,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 470 ML"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLUTION [29169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-311-47","type":"NDC"}],"standard_charges":[{"gross_charge":612.5,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 470 ML"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLUTION [29169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-2012-23","type":"NDC"}],"standard_charges":[{"gross_charge":1787.0,"discounted_cash":1501.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 470 ML"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-902-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-580-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG CAPSULE [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5026-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"FUROSEMIDE 40 MG TABLET [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-625-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG TABLET [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-073-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG TABLET [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-073-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG TABLET [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1966-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG TABLET [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0216-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG TABLET [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0216-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG TABLET [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8299-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG TABLET [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-117-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG/5 ML (8 MG/ML) ORAL SOLUTION [3293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2052-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FUROSEMIDE 40 MG/5 ML (8 MG/ML) ORAL SOLUTION [3293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-867-62","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FUROSEMIDE 40 MG/5 ML (8 MG/ML) ORAL SOLUTION [3293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-867-59","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FUROSEMIDE 40 MG/5 ML (8 MG/ML) ORAL SOLUTION [3293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3298-63","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FUROSEMIDE 40 MG/4 ML ORAL SOLUTION [97803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"00000-0000-40","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG/4 ML ORAL SOLUTION [97803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-756-62","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG/4 ML ORAL SOLUTION [97803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-756-59","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"23155-473-41","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"49502-605-61","type":"NDC"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"0781-3465-94","type":"NDC"}],"standard_charges":[{"gross_charge":284.25,"discounted_cash":238.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"0781-3465-12","type":"NDC"}],"standard_charges":[{"gross_charge":488.5,"discounted_cash":410.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-232-10","type":"NDC"}],"standard_charges":[{"gross_charge":357.75,"discounted_cash":300.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-232-00","type":"NDC"}],"standard_charges":[{"gross_charge":357.75,"discounted_cash":300.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111-680-11","type":"NDC"}],"standard_charges":[{"gross_charge":558.25,"discounted_cash":468.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111-680-02","type":"NDC"}],"standard_charges":[{"gross_charge":558.25,"discounted_cash":468.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE [108027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"0781-3454-94","type":"NDC"}],"standard_charges":[{"gross_charge":284.25,"discounted_cash":238.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE [108027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"0781-3454-95","type":"NDC"}],"standard_charges":[{"gross_charge":284.25,"discounted_cash":238.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE [108027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-231-10","type":"NDC"}],"standard_charges":[{"gross_charge":358.25,"discounted_cash":300.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE [108027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-231-00","type":"NDC"}],"standard_charges":[{"gross_charge":358.25,"discounted_cash":300.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE [108027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457-583-04","type":"NDC"}],"standard_charges":[{"gross_charge":528.75,"discounted_cash":444.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE [108027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457-583-00","type":"NDC"}],"standard_charges":[{"gross_charge":528.75,"discounted_cash":444.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE [108027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111-679-11","type":"NDC"}],"standard_charges":[{"gross_charge":558.25,"discounted_cash":468.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"0781-3443-95","type":"NDC"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"0781-3443-94","type":"NDC"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-230-10","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-230-00","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457-592-10","type":"NDC"}],"standard_charges":[{"gross_charge":274.5,"discounted_cash":230.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457-592-00","type":"NDC"}],"standard_charges":[{"gross_charge":274.5,"discounted_cash":230.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457-582-10","type":"NDC"}],"standard_charges":[{"gross_charge":224.75,"discounted_cash":188.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457-582-00","type":"NDC"}],"standard_charges":[{"gross_charge":224.75,"discounted_cash":188.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1451","type":"HCPCS"},{"code":"70710-1478-1","type":"NDC"}],"standard_charges":[{"gross_charge":4219.0,"discounted_cash":3543.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0710-01","type":"NDC"}],"standard_charges":[{"gross_charge":5132.5,"discounted_cash":4311.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70710-1478-1","type":"NDC"}],"standard_charges":[{"gross_charge":5472.0,"discounted_cash":4596.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-211-02","type":"NDC"}],"standard_charges":[{"gross_charge":3746.0,"discounted_cash":3146.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"FOLIC ACID 5 MG/ML INJECTION SOLUTION [3232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1808","type":"HCPCS"},{"code":"39822-1100-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"49502-605-30","type":"NDC"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"49502-605-95","type":"NDC"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"62332-655-30","type":"NDC"}],"standard_charges":[{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"0641-6136-25","type":"NDC"}],"standard_charges":[{"gross_charge":924.5,"discounted_cash":776.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":1386.5,"discounted_cash":1164.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":1848.75,"discounted_cash":1552.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"0641-6136-01","type":"NDC"}],"standard_charges":[{"gross_charge":924.5,"discounted_cash":776.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":1386.5,"discounted_cash":1164.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":1848.75,"discounted_cash":1552.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70700-268-99","type":"NDC"}],"standard_charges":[{"gross_charge":411.75,"discounted_cash":345.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70700-268-94","type":"NDC"}],"standard_charges":[{"gross_charge":411.75,"discounted_cash":345.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-4300-01","type":"NDC"}],"standard_charges":[{"gross_charge":449.25,"discounted_cash":377.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-4300-08","type":"NDC"}],"standard_charges":[{"gross_charge":449.25,"discounted_cash":377.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9384-01","type":"NDC"}],"standard_charges":[{"gross_charge":320.75,"discounted_cash":269.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16714-248-01","type":"NDC"}],"standard_charges":[{"gross_charge":1212.75,"discounted_cash":1018.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-948-11","type":"NDC"}],"standard_charges":[{"gross_charge":405.5,"discounted_cash":340.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68180-690-01","type":"NDC"}],"standard_charges":[{"gross_charge":1292.5,"discounted_cash":1085.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72205-054-01","type":"NDC"}],"standard_charges":[{"gross_charge":1150.25,"discounted_cash":966.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-780-10","type":"NDC"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":633.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0591-4385-79","type":"NDC"}],"standard_charges":[{"gross_charge":1294.0,"discounted_cash":1086.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71839-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":1292.5,"discounted_cash":1085.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-889-10","type":"NDC"}],"standard_charges":[{"gross_charge":1292.5,"discounted_cash":1085.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72205-026-01","type":"NDC"}],"standard_charges":[{"gross_charge":1150.25,"discounted_cash":966.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-6105-1","type":"NDC"}],"standard_charges":[{"gross_charge":1294.0,"discounted_cash":1086.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-3061-03","type":"NDC"}],"standard_charges":[{"gross_charge":1437.75,"discounted_cash":1207.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-3061-02","type":"NDC"}],"standard_charges":[{"gross_charge":1437.75,"discounted_cash":1207.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-3061-01","type":"NDC"}],"standard_charges":[{"gross_charge":1437.75,"discounted_cash":1207.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-3061-00","type":"NDC"}],"standard_charges":[{"gross_charge":1437.75,"discounted_cash":1207.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"70748-261-60","type":"NDC"}],"standard_charges":[{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"70748-261-01","type":"NDC"}],"standard_charges":[{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"62332-655-60","type":"NDC"}],"standard_charges":[{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"62332-655-01","type":"NDC"}],"standard_charges":[{"gross_charge":143.25,"discounted_cash":120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"FOLIC ACID 5 MG/ML INJECTION SOLUTION [3232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1808","type":"HCPCS"},{"code":"7700-0615-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 5 MG/ML INJECTION SOLUTION [3232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1808","type":"HCPCS"},{"code":"99999-0007-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 5 MG/ML INJECTION SOLUTION [3232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1808","type":"HCPCS"},{"code":"63323-184-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104564]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0695-04","type":"NDC"}],"standard_charges":[{"gross_charge":224.5,"discounted_cash":188.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 EACH"}]},{"description":"FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104564]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0695-00","type":"NDC"}],"standard_charges":[{"gross_charge":769.5,"discounted_cash":646.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"FLUTAMIDE 125 MG CAPSULE [10081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-753-13","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"FLURAZEPAM 30 MG CAPSULE [3224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4430-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"FLURAZEPAM 15 MG CAPSULE [3223]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4415-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION [3215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"67457-359-59","type":"NDC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":202.0,"discounted_cash":169.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":404.0,"discounted_cash":339.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION [3215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"55150-267-05","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":82.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":195.5,"discounted_cash":164.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":391.0,"discounted_cash":328.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION [3215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"0143-9529-01","type":"NDC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":157.75,"discounted_cash":132.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":315.5,"discounted_cash":265.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION [3215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"42023-129-01","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":126.5,"discounted_cash":106.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":253.0,"discounted_cash":212.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION [3215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"63323-272-05","type":"NDC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":202.0,"discounted_cash":169.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":404.0,"discounted_cash":339.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUPHENAZINE 5 MG TABLET [3221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-487-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FLUPHENAZINE 5 MG TABLET [3221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-487-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0696-00","type":"NDC"}],"standard_charges":[{"gross_charge":841.25,"discounted_cash":706.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0696-04","type":"NDC"}],"standard_charges":[{"gross_charge":224.5,"discounted_cash":188.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 EACH"}]},{"description":"FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0697-00","type":"NDC"}],"standard_charges":[{"gross_charge":1139.75,"discounted_cash":957.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION [104566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0697-04","type":"NDC"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":307.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 EACH"}]},{"description":"FOLIC ACID 1 MG TABLET [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7224-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG TABLET [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-681-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG TABLET [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-681-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG TABLET [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-361-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG TABLET [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11534-165-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG TABLET [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-537-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG TABLET [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-897-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG TABLET [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-361-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG TABLET [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-897-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FLUVOXAMINE 25 MG TABLET [20634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-158-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUVOXAMINE 100 MG TABLET [10084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1672-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUVOXAMINE 100 MG TABLET [10084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION [70536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-264-15","type":"NDC"}],"standard_charges":[{"gross_charge":350.5,"discounted_cash":294.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 G"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION [70536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0829-1","type":"NDC"}],"standard_charges":[{"gross_charge":350.5,"discounted_cash":294.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 G"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION [70536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-700-16","type":"NDC"}],"standard_charges":[{"gross_charge":346.75,"discounted_cash":291.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 G"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION [70536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3270-99","type":"NDC"}],"standard_charges":[{"gross_charge":383.75,"discounted_cash":322.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 G"}]},{"description":"FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER [40697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-078-96","type":"NDC"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":701.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.6 G"}]},{"description":"FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER [40697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0718-20","type":"NDC"}],"standard_charges":[{"gross_charge":853.25,"discounted_cash":716.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.6 G"}]},{"description":"FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER [40699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0720-20","type":"NDC"}],"standard_charges":[{"gross_charge":1774.0,"discounted_cash":1490.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 G"}]},{"description":"FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER [40698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0719-20","type":"NDC"}],"standard_charges":[{"gross_charge":1142.25,"discounted_cash":959.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 G"}]},{"description":"FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER [165215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0882-14","type":"NDC"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":650.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 EACH"}]},{"description":"FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER [122009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0859-14","type":"NDC"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":650.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 EACH"}]},{"description":"FLUTICASONE FUR. 200 MCG-UMECLID 62.5 MCG-VILANT 25 MCG INHALAT.POWDER [186575]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0893-14","type":"NDC"}],"standard_charges":[{"gross_charge":1356.25,"discounted_cash":1139.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 EACH"}]},{"description":"FLUTICASONE FUR. 100 MCG-UMECLID 62.5 MCG-VILANT 25 MCG INHALAT.POWDER [177187]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0887-14","type":"NDC"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":1106.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 EACH"}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"0069-6001-02","type":"NDC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1709.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":3052.5,"discounted_cash":2564.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":4070.0,"discounted_cash":3418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"0409-6102-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6102-04","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"0409-6102-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6102-02","type":"NDC"}],"standard_charges":[{"gross_charge":169.5,"discounted_cash":142.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"0409-6102-02","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":135.5,"discounted_cash":113.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-280-10","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"63323-280-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-280-04","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"63323-280-04","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-280-02","type":"NDC"}],"standard_charges":[{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"63323-280-02","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":68.25,"discounted_cash":57.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"25021-471-74","type":"NDC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":362.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":863.25,"discounted_cash":725.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6102-10","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"36000-282-25","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-473-33","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"23155-473-33","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-473-32","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"23155-473-32","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-473-31","type":"NDC"}],"standard_charges":[{"gross_charge":110.75,"discounted_cash":93.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"23155-473-31","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"16714-070-02","type":"NDC"}],"standard_charges":[{"gross_charge":3033.75,"discounted_cash":2548.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6067.5,"discounted_cash":5096.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"36000-284-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"36000-284-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"36000-283-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"36000-283-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"36000-282-25","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"16714-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":3033.75,"discounted_cash":2548.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6067.5,"discounted_cash":5096.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"67457-517-10","type":"NDC"}],"standard_charges":[{"gross_charge":365.25,"discounted_cash":306.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":547.75,"discounted_cash":460.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":730.25,"discounted_cash":613.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"67457-517-01","type":"NDC"}],"standard_charges":[{"gross_charge":365.25,"discounted_cash":306.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":547.75,"discounted_cash":460.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":730.25,"discounted_cash":613.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"0069-6001-21","type":"NDC"}],"standard_charges":[{"gross_charge":922.5,"discounted_cash":774.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":1383.75,"discounted_cash":1162.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":1845.0,"discounted_cash":1549.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"0069-6001-10","type":"NDC"}],"standard_charges":[{"gross_charge":922.5,"discounted_cash":774.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":1383.75,"discounted_cash":1162.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":1845.0,"discounted_cash":1549.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"0641-6137-10","type":"NDC"}],"standard_charges":[{"gross_charge":361.25,"discounted_cash":303.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":542.0,"discounted_cash":455.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":722.5,"discounted_cash":606.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"0641-6137-01","type":"NDC"}],"standard_charges":[{"gross_charge":361.25,"discounted_cash":303.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":542.0,"discounted_cash":455.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":722.5,"discounted_cash":606.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"67457-516-00","type":"NDC"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":787.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":1405.25,"discounted_cash":1180.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":1873.75,"discounted_cash":1573.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"67457-516-25","type":"NDC"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":787.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":1405.25,"discounted_cash":1180.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":1873.75,"discounted_cash":1573.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"67457-516-22","type":"NDC"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":787.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":1405.25,"discounted_cash":1180.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":1873.75,"discounted_cash":1573.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"0069-6001-25","type":"NDC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1709.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":3052.5,"discounted_cash":2564.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":4070.0,"discounted_cash":3418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"},{"gross_charge":814.0,"discounted_cash":683.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG PE/KG"},{"gross_charge":1017.5,"discounted_cash":854.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG PE/KG"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"67457-517-00","type":"NDC"}],"standard_charges":[{"gross_charge":365.25,"discounted_cash":306.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":547.75,"discounted_cash":460.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":730.25,"discounted_cash":613.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"70860-211-74","type":"NDC"}],"standard_charges":[{"gross_charge":493.25,"discounted_cash":414.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":986.5,"discounted_cash":828.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"70860-211-41","type":"NDC"}],"standard_charges":[{"gross_charge":493.25,"discounted_cash":414.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":986.5,"discounted_cash":828.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"0310-7720-10","type":"NDC"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":631.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1503.75,"discounted_cash":1263.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"25021-462-74","type":"NDC"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1479.75,"discounted_cash":1242.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9394","type":"HCPCS"},{"code":"63323-715-05","type":"NDC"}],"standard_charges":[{"gross_charge":1824.0,"discounted_cash":1532.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3648.0,"discounted_cash":3064.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9394","type":"HCPCS"},{"code":"63323-715-01","type":"NDC"}],"standard_charges":[{"gross_charge":1824.0,"discounted_cash":1532.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3648.0,"discounted_cash":3064.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"0781-3079-12","type":"NDC"}],"standard_charges":[{"gross_charge":3316.0,"discounted_cash":2785.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6631.75,"discounted_cash":5570.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"0781-3079-01","type":"NDC"}],"standard_charges":[{"gross_charge":3316.0,"discounted_cash":2785.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6631.75,"discounted_cash":5570.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [108096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"0310-0720-10","type":"NDC"}],"standard_charges":[{"gross_charge":3537.0,"discounted_cash":2971.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":7073.75,"discounted_cash":5941.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FREMANEZUMAB-VFRM 225 MG/1.5 ML SUBCUTANEOUS SYRINGE [180159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51759-204-10","type":"NDC"}],"standard_charges":[{"gross_charge":2755.0,"discounted_cash":2314.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":8264.5,"discounted_cash":6942.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 675 MG"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"68462-622-64","type":"NDC"}],"standard_charges":[{"gross_charge":361.25,"discounted_cash":303.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":542.0,"discounted_cash":455.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":722.5,"discounted_cash":606.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"68462-622-10","type":"NDC"}],"standard_charges":[{"gross_charge":361.25,"discounted_cash":303.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG PE/KG"},{"gross_charge":542.0,"discounted_cash":455.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG PE/KG"},{"gross_charge":722.5,"discounted_cash":606.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG PE/KG"}]},{"description":"EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [191213]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-4250-1","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"EPHEDRINE (PF) 50 MG/5 ML (10 MG/ML) IN 0.9% SOD. CHLORIDE IV SYRINGE [131670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1477-44","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% NACL WRAPPER [408131687]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"14789-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% NACL WRAPPER [408131687]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"14789-251-09","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% NACL WRAPPER [408131687]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-4250-3","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% NACL WRAPPER [408131687]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1478-44","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":90.75,"discounted_cash":76.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENTACAPONE 200 MG TABLET [26547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-260-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ENTACAPONE 200 MG TABLET [26547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-049-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ENTACAPONE 200 MG TABLET [26547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-188-21","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ENTACAPONE 200 MG TABLET [26547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-188-11","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ENTACAPONE 200 MG TABLET [26547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-273-01","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [124987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"49502-500-01","type":"NDC"}],"standard_charges":[{"gross_charge":1303.75,"discounted_cash":1095.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [124987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"49502-102-02","type":"NDC"}],"standard_charges":[{"gross_charge":768.75,"discounted_cash":645.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [124987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"49502-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":768.75,"discounted_cash":645.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [124987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"49502-500-02","type":"NDC"}],"standard_charges":[{"gross_charge":1303.75,"discounted_cash":1095.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE WRAPPER [125001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"76329-3318-1","type":"NDC"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE WRAPPER [125001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"0409-4933-11","type":"NDC"}],"standard_charges":[{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE WRAPPER [125001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"0409-4933-01","type":"NDC"}],"standard_charges":[{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE WRAPPER [125001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"69374-925-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE WRAPPER [125001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"0409-4921-20","type":"NDC"}],"standard_charges":[{"gross_charge":42.5,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE WRAPPER [125001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"76329-3316-1","type":"NDC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE WRAPPER [125001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"0409-4921-34","type":"NDC"}],"standard_charges":[{"gross_charge":42.5,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR [124985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"49502-101-02","type":"NDC"}],"standard_charges":[{"gross_charge":768.75,"discounted_cash":645.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG"}]},{"description":"EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR [124985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"49502-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":768.75,"discounted_cash":645.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG"}]},{"description":"EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR [124985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"49502-501-02","type":"NDC"}],"standard_charges":[{"gross_charge":1303.75,"discounted_cash":1095.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6238-25","type":"NDC"}],"standard_charges":[{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6238-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70121-1637-5","type":"NDC"}],"standard_charges":[{"gross_charge":189.75,"discounted_cash":159.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70121-1637-1","type":"NDC"}],"standard_charges":[{"gross_charge":233.25,"discounted_cash":195.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-216-89","type":"NDC"}],"standard_charges":[{"gross_charge":189.75,"discounted_cash":159.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-216-83","type":"NDC"}],"standard_charges":[{"gross_charge":189.75,"discounted_cash":159.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-517-01","type":"NDC"}],"standard_charges":[{"gross_charge":233.25,"discounted_cash":195.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3269-71","type":"NDC"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":204.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3269-95","type":"NDC"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":204.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-216-25","type":"NDC"}],"standard_charges":[{"gross_charge":189.75,"discounted_cash":159.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-216-01","type":"NDC"}],"standard_charges":[{"gross_charge":189.75,"discounted_cash":159.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-415-10","type":"NDC"}],"standard_charges":[{"gross_charge":233.25,"discounted_cash":195.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML INJECTION WRAPPER [180665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-415-01","type":"NDC"}],"standard_charges":[{"gross_charge":233.25,"discounted_cash":195.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENTACAPONE 200 MG TABLET [26547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5578-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ENTACAPONE 200 MG TABLET [26547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-273-03","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ENTACAPONE 200 MG TABLET [26547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9080-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1003-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-0624-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-006-10","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-006-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0703-8530-23","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0703-8530-21","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"63323-568-83","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8013-10","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8013-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0548-5631-00","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1003-10","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0548-5601-00","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-0624-30","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-066-10","type":"NDC"}],"standard_charges":[{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-066-01","type":"NDC"}],"standard_charges":[{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8025-10","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":161.5,"discounted_cash":135.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8025-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":161.5,"discounted_cash":135.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0548-5607-00","type":"NDC"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":113.25,"discounted_cash":95.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-2915-01","type":"NDC"}],"standard_charges":[{"gross_charge":125.25,"discounted_cash":105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":187.75,"discounted_cash":157.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-2912-00","type":"NDC"}],"standard_charges":[{"gross_charge":194.75,"discounted_cash":163.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1012-01","type":"NDC"}],"standard_charges":[{"gross_charge":167.5,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-056-10","type":"NDC"}],"standard_charges":[{"gross_charge":156.25,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-056-01","type":"NDC"}],"standard_charges":[{"gross_charge":156.25,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-0620-40","type":"NDC"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0548-5602-00","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1004-10","type":"NDC"}],"standard_charges":[{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8014-01","type":"NDC"}],"standard_charges":[{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENTACAPONE 200 MG TABLET [26547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64679-781-02","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ENTACAPONE 200 MG TABLET [26547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0327-05","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1008-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-0622-01","type":"NDC"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":135.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-036-10","type":"NDC"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-036-01","type":"NDC"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8018-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8018-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1008-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0548-5604-00","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-0622-80","type":"NDC"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":135.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1006-01","type":"NDC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-0621-01","type":"NDC"}],"standard_charges":[{"gross_charge":120.75,"discounted_cash":101.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-026-10","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION [2850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"42023-159-25","type":"NDC"}],"standard_charges":[{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":606.5,"discounted_cash":509.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-026-01","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8016-01","type":"NDC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1006-10","type":"NDC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0548-5603-00","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-0621-60","type":"NDC"}],"standard_charges":[{"gross_charge":120.75,"discounted_cash":101.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288-433-83","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288-433-82","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1004-01","type":"NDC"}],"standard_charges":[{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-0620-01","type":"NDC"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-016-10","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-016-01","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0703-8540-23","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0703-8540-21","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"63323-568-87","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8014-10","type":"NDC"}],"standard_charges":[{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8016-10","type":"NDC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8022-10","type":"NDC"}],"standard_charges":[{"gross_charge":167.5,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION [2850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"42023-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/2 ML INJECTION SOLUTION [186995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"59353-220-01","type":"NDC"}],"standard_charges":[{"gross_charge":348.75,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":261.75,"discounted_cash":219.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [178915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1305-10","type":"NDC"}],"standard_charges":[{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [178915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1305-01","type":"NDC"}],"standard_charges":[{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [178918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-1308-10","type":"NDC"}],"standard_charges":[{"gross_charge":542.75,"discounted_cash":455.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [178918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1308-10","type":"NDC"}],"standard_charges":[{"gross_charge":418.5,"discounted_cash":351.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":209.25,"discounted_cash":175.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":314.0,"discounted_cash":263.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [178918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-1308-01","type":"NDC"}],"standard_charges":[{"gross_charge":542.75,"discounted_cash":455.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [178918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1308-01","type":"NDC"}],"standard_charges":[{"gross_charge":418.5,"discounted_cash":351.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":209.25,"discounted_cash":175.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":314.0,"discounted_cash":263.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"59676-340-00","type":"NDC"}],"standard_charges":[{"gross_charge":3899.75,"discounted_cash":3275.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"}]},{"description":"EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-340-00","type":"NDC"}],"standard_charges":[{"gross_charge":751.75,"discounted_cash":631.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":376.0,"discounted_cash":315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"}]},{"description":"EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"59676-340-01","type":"NDC"}],"standard_charges":[{"gross_charge":3899.75,"discounted_cash":3275.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"}]},{"description":"EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-340-01","type":"NDC"}],"standard_charges":[{"gross_charge":751.75,"discounted_cash":631.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":376.0,"discounted_cash":315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"}]},{"description":"EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-148-10","type":"NDC"}],"standard_charges":[{"gross_charge":326.5,"discounted_cash":274.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-148-01","type":"NDC"}],"standard_charges":[{"gross_charge":326.5,"discounted_cash":274.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA 4,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173394]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-304-00","type":"NDC"}],"standard_charges":[{"gross_charge":526.0,"discounted_cash":441.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA 4,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173394]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-304-01","type":"NDC"}],"standard_charges":[{"gross_charge":526.0,"discounted_cash":441.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-267-10","type":"NDC"}],"standard_charges":[{"gross_charge":244.75,"discounted_cash":205.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"}]},{"description":"EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-267-01","type":"NDC"}],"standard_charges":[{"gross_charge":244.75,"discounted_cash":205.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"}]},{"description":"EPOETIN ALFA 3,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-303-00","type":"NDC"}],"standard_charges":[{"gross_charge":394.5,"discounted_cash":331.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"}]},{"description":"EPOETIN ALFA 3,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-303-01","type":"NDC"}],"standard_charges":[{"gross_charge":394.5,"discounted_cash":331.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"}]},{"description":"EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"55513-478-10","type":"NDC"}],"standard_charges":[{"gross_charge":1420.75,"discounted_cash":1193.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-478-10","type":"NDC"}],"standard_charges":[{"gross_charge":547.75,"discounted_cash":460.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":274.0,"discounted_cash":230.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"}]},{"description":"EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"55513-478-01","type":"NDC"}],"standard_charges":[{"gross_charge":1420.75,"discounted_cash":1193.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-478-01","type":"NDC"}],"standard_charges":[{"gross_charge":547.75,"discounted_cash":460.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":274.0,"discounted_cash":230.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/2 ML INJECTION SOLUTION [186995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"59353-220-10","type":"NDC"}],"standard_charges":[{"gross_charge":348.75,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":261.75,"discounted_cash":219.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [133121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1325","type":"HCPCS"},{"code":"66215-402-01","type":"NDC"}],"standard_charges":[{"gross_charge":226.75,"discounted_cash":190.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION [134103]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1325","type":"HCPCS"},{"code":"62756-059-40","type":"NDC"}],"standard_charges":[{"gross_charge":152.75,"discounted_cash":128.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1325","type":"HCPCS"},{"code":"0173-0519-00","type":"NDC"}],"standard_charges":[{"gross_charge":245.25,"discounted_cash":206.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1325","type":"HCPCS"},{"code":"0173-0517-00","type":"NDC"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [178919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-1309-04","type":"NDC"}],"standard_charges":[{"gross_charge":1609.5,"discounted_cash":1351.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [178919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1309-04","type":"NDC"}],"standard_charges":[{"gross_charge":310.25,"discounted_cash":260.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"}]},{"description":"EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [178919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-1309-01","type":"NDC"}],"standard_charges":[{"gross_charge":1609.5,"discounted_cash":1351.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [178919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1309-01","type":"NDC"}],"standard_charges":[{"gross_charge":310.25,"discounted_cash":260.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"}]},{"description":"EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [178916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1306-10","type":"NDC"}],"standard_charges":[{"gross_charge":215.75,"discounted_cash":181.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [178916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1306-01","type":"NDC"}],"standard_charges":[{"gross_charge":215.75,"discounted_cash":181.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [187020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-1311-10","type":"NDC"}],"standard_charges":[{"gross_charge":945.25,"discounted_cash":794.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [187020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1311-10","type":"NDC"}],"standard_charges":[{"gross_charge":364.5,"discounted_cash":306.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":182.25,"discounted_cash":153.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [187020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-1311-01","type":"NDC"}],"standard_charges":[{"gross_charge":945.25,"discounted_cash":794.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [187020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1311-01","type":"NDC"}],"standard_charges":[{"gross_charge":364.5,"discounted_cash":306.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":182.25,"discounted_cash":153.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/2 ML INJECTION SOLUTION [186995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-1318-10","type":"NDC"}],"standard_charges":[{"gross_charge":542.75,"discounted_cash":455.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/2 ML INJECTION SOLUTION [186995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1318-10","type":"NDC"}],"standard_charges":[{"gross_charge":418.5,"discounted_cash":351.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":209.25,"discounted_cash":175.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":314.0,"discounted_cash":263.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/2 ML INJECTION SOLUTION [186995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-1318-01","type":"NDC"}],"standard_charges":[{"gross_charge":542.75,"discounted_cash":455.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/2 ML INJECTION SOLUTION [186995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1318-01","type":"NDC"}],"standard_charges":[{"gross_charge":418.5,"discounted_cash":351.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":209.25,"discounted_cash":175.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":314.0,"discounted_cash":263.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/2 ML INJECTION SOLUTION [186995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59353-220-10","type":"NDC"}],"standard_charges":[{"gross_charge":452.25,"discounted_cash":379.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 20,000 UNIT/2 ML INJECTION SOLUTION [186995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59353-220-01","type":"NDC"}],"standard_charges":[{"gross_charge":452.25,"discounted_cash":379.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA 20,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"59676-320-00","type":"NDC"}],"standard_charges":[{"gross_charge":1950.0,"discounted_cash":1638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"EPOETIN ALFA 20,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-320-00","type":"NDC"}],"standard_charges":[{"gross_charge":751.75,"discounted_cash":631.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":376.0,"discounted_cash":315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"}]},{"description":"EPOETIN ALFA 10,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173381]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-310-00","type":"NDC"}],"standard_charges":[{"gross_charge":882.75,"discounted_cash":741.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":441.5,"discounted_cash":370.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":662.25,"discounted_cash":556.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA 10,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173381]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"59676-310-02","type":"NDC"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":961.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA 10,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173381]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-310-02","type":"NDC"}],"standard_charges":[{"gross_charge":882.75,"discounted_cash":741.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":441.5,"discounted_cash":370.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":662.25,"discounted_cash":556.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA 10,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173381]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"59676-310-01","type":"NDC"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":961.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA 10,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173381]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-310-01","type":"NDC"}],"standard_charges":[{"gross_charge":882.75,"discounted_cash":741.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":441.5,"discounted_cash":370.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":662.25,"discounted_cash":556.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPLERENONE 25 MG TABLET [36983]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-5368-30","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [130338]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"54288-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [130338]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"54288-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"EPINEPHRINE 1 MG/ML NASAL SOLUTION [19604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54288-154-01","type":"NDC"}],"standard_charges":[{"gross_charge":945.25,"discounted_cash":794.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"EPINEPHRINE 1 MG/ML NASAL SOLUTION [19604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54288-123-01","type":"NDC"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":345.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE 1 MG/ML NASAL SOLUTION [19604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42023-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":1076.5,"discounted_cash":904.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"EPINEPHRINE 1 MG/ML INJECTION SOLUTION [121505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"76329-9060-0","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"EPINEPHRINE 1 MG/ML INJECTION SOLUTION [121505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"42023-168-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"EPOETIN ALFA 10,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173381]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"59676-310-00","type":"NDC"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":961.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-144-01","type":"NDC"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":528.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":314.5,"discounted_cash":264.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":471.75,"discounted_cash":396.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA 20,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"59676-320-04","type":"NDC"}],"standard_charges":[{"gross_charge":1950.0,"discounted_cash":1638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"EPOETIN ALFA 20,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-320-04","type":"NDC"}],"standard_charges":[{"gross_charge":751.75,"discounted_cash":631.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":376.0,"discounted_cash":315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"}]},{"description":"EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [129670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"55513-283-10","type":"NDC"}],"standard_charges":[{"gross_charge":815.75,"discounted_cash":685.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [129670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-283-10","type":"NDC"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":528.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":314.5,"discounted_cash":264.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":471.75,"discounted_cash":396.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [129670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"55513-283-01","type":"NDC"}],"standard_charges":[{"gross_charge":815.75,"discounted_cash":685.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [129670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-283-01","type":"NDC"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":528.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":314.5,"discounted_cash":264.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":471.75,"discounted_cash":396.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA 20,000 UNIT/2 ML (PROCRIT) INJECTION SOLUTION [173391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"59676-312-04","type":"NDC"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":961.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA 20,000 UNIT/2 ML (PROCRIT) INJECTION SOLUTION [173391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-312-04","type":"NDC"}],"standard_charges":[{"gross_charge":882.75,"discounted_cash":741.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":441.5,"discounted_cash":370.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":662.25,"discounted_cash":556.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA 20,000 UNIT/2 ML (PROCRIT) INJECTION SOLUTION [173391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"59676-312-00","type":"NDC"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":961.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA 20,000 UNIT/2 ML (PROCRIT) INJECTION SOLUTION [173391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"635","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-312-00","type":"NDC"}],"standard_charges":[{"gross_charge":882.75,"discounted_cash":741.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":441.5,"discounted_cash":370.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":662.25,"discounted_cash":556.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-126-10","type":"NDC"}],"standard_charges":[{"gross_charge":216.25,"discounted_cash":181.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-126-01","type":"NDC"}],"standard_charges":[{"gross_charge":216.25,"discounted_cash":181.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA 2,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-302-00","type":"NDC"}],"standard_charges":[{"gross_charge":263.25,"discounted_cash":221.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA 2,000 UNIT/ML (PROCRIT) INJECTION SOLUTION [173386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-302-01","type":"NDC"}],"standard_charges":[{"gross_charge":263.25,"discounted_cash":221.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"55513-144-10","type":"NDC"}],"standard_charges":[{"gross_charge":815.75,"discounted_cash":685.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"55513-144-10","type":"NDC"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":528.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/KG"},{"gross_charge":314.5,"discounted_cash":264.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/KG"},{"gross_charge":471.75,"discounted_cash":396.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 UNITS/KG"}]},{"description":"EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"634","type":"RC"},{"code":"55513-144-01","type":"NDC"}],"standard_charges":[{"gross_charge":815.75,"discounted_cash":685.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"}]},{"description":"EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [133121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1325","type":"HCPCS"},{"code":"62756-060-40","type":"NDC"}],"standard_charges":[{"gross_charge":230.5,"discounted_cash":193.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8022-01","type":"NDC"}],"standard_charges":[{"gross_charge":167.5,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1012-10","type":"NDC"}],"standard_charges":[{"gross_charge":167.5,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-675-21","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":110.5,"discounted_cash":92.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":165.5,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-675-11","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":110.5,"discounted_cash":92.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":165.5,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-017-60","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2890-06","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-3235-60","type":"NDC"}],"standard_charges":[{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":203.0,"discounted_cash":170.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DTAP-IPV COMPONENT 1OF2(PF) 15 LF-48 MCG-5 LF UNIT/0.5ML IM SUSPENSION [180023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49281-560-05","type":"NDC"}],"standard_charges":[{"gross_charge":343.5,"discounted_cash":288.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DROXIDOPA 100 MG CAPSULE [126113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-014-90","type":"NDC"}],"standard_charges":[{"gross_charge":199.75,"discounted_cash":167.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":399.5,"discounted_cash":335.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"DROXIDOPA 100 MG CAPSULE [126113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-086-90","type":"NDC"}],"standard_charges":[{"gross_charge":199.75,"discounted_cash":167.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":399.25,"discounted_cash":335.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"DROXIDOPA 100 MG CAPSULE [126113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-199-90","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"DROXIDOPA 100 MG CAPSULE [126113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67386-820-19","type":"NDC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":419.75,"discounted_cash":352.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"DROPERIDOL 2.5 MG/ML INJECTION SOLUTION [2654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"0517-9702-25","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2995-6","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-018-90","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-018-30","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-382-81","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2891-03","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-3240-30","type":"NDC"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":101.25,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":151.75,"discounted_cash":127.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-263-60","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-097-06","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DROPERIDOL 2.5 MG/ML INJECTION SOLUTION [2654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"0517-9702-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG TABLET [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-279-15","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG TABLET [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-279-11","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG TABLET [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-0430-04","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG TABLET [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24658-312-20","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG TABLET [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-693-21","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG TABLET [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-120-05","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG TABLET [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-120-02","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG TABLET [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-2112-50","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-130-02","type":"NDC"}],"standard_charges":[{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68382-910-10","type":"NDC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":820.0,"discounted_cash":688.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68382-910-01","type":"NDC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-130-17","type":"NDC"}],"standard_charges":[{"gross_charge":140.5,"discounted_cash":118.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-437-10","type":"NDC"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-437-00","type":"NDC"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-130-11","type":"NDC"}],"standard_charges":[{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323-130-02","type":"NDC"}],"standard_charges":[{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"68382-910-10","type":"NDC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"68382-910-01","type":"NDC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323-130-17","type":"NDC"}],"standard_charges":[{"gross_charge":140.5,"discounted_cash":118.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"67457-437-10","type":"NDC"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"67457-437-00","type":"NDC"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG TABLET [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-491-50","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG TABLET [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-312-50","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DRONEDARONE 400 MG TABLET [98329]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-4142-10","type":"NDC"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"DRONEDARONE 400 MG TABLET [98329]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-4142-60","type":"NDC"}],"standard_charges":[{"gross_charge":109.5,"discounted_cash":91.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"DRONABINOL 5 MG CAPSULE [9905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0167","type":"HCPCS"},{"code":"0051-0022-21","type":"NDC"}],"standard_charges":[{"gross_charge":296.25,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":74.25,"discounted_cash":62.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DRONABINOL 2.5 MG CAPSULE [9904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0167","type":"HCPCS"},{"code":"60687-375-21","type":"NDC"}],"standard_charges":[{"gross_charge":229.5,"discounted_cash":192.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":114.75,"discounted_cash":96.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DRONABINOL 2.5 MG CAPSULE [9904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0167","type":"HCPCS"},{"code":"67877-753-60","type":"NDC"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":147.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DRONABINOL 2.5 MG CAPSULE [9904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0167","type":"HCPCS"},{"code":"60687-375-11","type":"NDC"}],"standard_charges":[{"gross_charge":229.5,"discounted_cash":192.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":114.75,"discounted_cash":96.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-018-99","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DRONABINOL 2.5 MG CAPSULE [9904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0167","type":"HCPCS"},{"code":"42858-867-06","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DRONABINOL 2.5 MG CAPSULE [9904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0167","type":"HCPCS"},{"code":"17478-761-06","type":"NDC"}],"standard_charges":[{"gross_charge":159.25,"discounted_cash":133.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DRONABINOL 10 MG CAPSULE [9903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0167","type":"HCPCS"},{"code":"0051-0023-21","type":"NDC"}],"standard_charges":[{"gross_charge":205.5,"discounted_cash":172.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":102.75,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DP(A)T-POLIO-HIB CONJ-TET (PF) 15 LF UNIT-20 MCG-5 LF /0.5 ML IM KIT [92074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90698","type":"HCPCS"},{"code":"49281-510-05","type":"NDC"}],"standard_charges":[{"gross_charge":507.25,"discounted_cash":426.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DOXYLAMINE SUCCINATE 25 MG TABLET [14847]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4116700607","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1271","type":"HCPCS"},{"code":"68382-910-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0548-5636-00","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"ENALAPRIL MALEATE 2.5 MG TABLET [9925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64679-923-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ENALAPRIL MALEATE 2.5 MG TABLET [9925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5609-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1367-3","type":"NDC"}],"standard_charges":[{"gross_charge":287.25,"discounted_cash":241.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42385-953-30","type":"NDC"}],"standard_charges":[{"gross_charge":287.25,"discounted_cash":241.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [171724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-2002-2","type":"NDC"}],"standard_charges":[{"gross_charge":366.25,"discounted_cash":307.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [171724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-2002-1","type":"NDC"}],"standard_charges":[{"gross_charge":366.25,"discounted_cash":307.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EMTRICITABINE 200 MG-RILPIVIRINE 25 MG-TENOFOVIR ALAFENAM 25 MG TABLET [169432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-2101-1","type":"NDC"}],"standard_charges":[{"gross_charge":634.5,"discounted_cash":532.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EMTRICITABINE 200 MG CAPSULE [36252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-642-02","type":"NDC"}],"standard_charges":[{"gross_charge":130.5,"discounted_cash":109.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"EMTRICITABINE 200 MG CAPSULE [36252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-0601-1","type":"NDC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"EMPAGLIFLOZIN 10 MG-LINAGLIPTIN 5 MG TABLET [165764]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0182-39","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EMPAGLIFLOZIN 10 MG TABLET [126630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0152-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"EMPAGLIFLOZIN 10 MG TABLET [126630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0152-37","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":342.0,"discounted_cash":287.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"EMPAGLIFLOZIN 10 MG TABLET [126630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0152-90","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":342.0,"discounted_cash":287.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"EMPAGLIFLOZIN 10 MG TABLET [126630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0152-30","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":342.0,"discounted_cash":287.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"EMOLLIENT COMBINATION NO.10 TOPICAL EMULSION [42944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0187-5110-90","type":"NDC"}],"standard_charges":[{"gross_charge":246.75,"discounted_cash":207.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 G"}]},{"description":"ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO DISOPRO 300 MG TABLET [117293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-1201-1","type":"NDC"}],"standard_charges":[{"gross_charge":730.5,"discounted_cash":613.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO ALAFENAM 10 MG TABLET [168816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-1901-1","type":"NDC"}],"standard_charges":[{"gross_charge":696.5,"discounted_cash":585.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ELOTUZUMAB 300 MG INTRAVENOUS SOLUTION [168950]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0003-2291-11","type":"NDC"}],"standard_charges":[{"gross_charge":3600369.5,"discounted_cash":3024310.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":1400964.0,"discounted_cash":1176809.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION [168951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0003-4522-11","type":"NDC"}],"standard_charges":[{"gross_charge":2490526.5,"discounted_cash":2092042.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ELITE SENSOR FOR USE WITH REBEL INSULIN PUMP [178592]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0000-4221-42","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ELETRIPTAN 40 MG TABLET [34684]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-2340-45","type":"NDC"}],"standard_charges":[{"gross_charge":203.75,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":402.5,"discounted_cash":338.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ELECTROLYTE-A INTRAVENOUS SOLUTION [28113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0221-04","type":"NDC"}],"standard_charges":[{"gross_charge":189.25,"discounted_cash":158.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":202.75,"discounted_cash":170.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1100 ML"},{"gross_charge":216.25,"discounted_cash":181.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 ML"},{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 ML"},{"gross_charge":175.75,"discounted_cash":147.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 ML"}]},{"description":"ENALAPRIL MALEATE 2.5 MG TABLET [9925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-442-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET [9927]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4038-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET [9927]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64679-924-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0548-5606-00","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-2912-01","type":"NDC"}],"standard_charges":[{"gross_charge":194.75,"discounted_cash":163.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1010-01","type":"NDC"}],"standard_charges":[{"gross_charge":139.25,"discounted_cash":116.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-0623-03","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-046-10","type":"NDC"}],"standard_charges":[{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714-046-01","type":"NDC"}],"standard_charges":[{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8020-10","type":"NDC"}],"standard_charges":[{"gross_charge":139.25,"discounted_cash":116.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-8020-01","type":"NDC"}],"standard_charges":[{"gross_charge":139.25,"discounted_cash":116.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0955-1010-10","type":"NDC"}],"standard_charges":[{"gross_charge":139.25,"discounted_cash":116.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"0075-0623-00","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [184242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51144-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":11110.25,"discounted_cash":9332.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":16665.5,"discounted_cash":13999.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG/KG"},{"gross_charge":22220.5,"discounted_cash":18665.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":27775.75,"discounted_cash":23331.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG/KG"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [184241]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51144-020-01","type":"NDC"}],"standard_charges":[{"gross_charge":16048.25,"discounted_cash":13480.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":24072.25,"discounted_cash":20220.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG/KG"},{"gross_charge":32096.5,"discounted_cash":26961.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":40120.5,"discounted_cash":33701.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG/KG"}]},{"description":"ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-078-58","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-078-11","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9787-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9786-01","type":"NDC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9787-10","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9786-10","type":"NDC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2122-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET [9927]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-546-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET [9927]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-705-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET [9927]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5502-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE [174344]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3590","type":"HCPCS"},{"code":"0024-5914-01","type":"NDC"}],"standard_charges":[{"gross_charge":5918.25,"discounted_cash":4971.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7044-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-264-90","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-380-03","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.0,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-098-09","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6453-61","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2996-3","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-683-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":104.25,"discounted_cash":87.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [174451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"0310-4500-12","type":"NDC"}],"standard_charges":[{"gross_charge":3686.5,"discounted_cash":3096.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 ML"}]},{"description":"DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [174451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"0310-4611-50","type":"NDC"}],"standard_charges":[{"gross_charge":13322.75,"discounted_cash":11191.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":8640.0,"discounted_cash":7257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ELACESTRANT 86 MG TABLET [194428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72187-0101-3","type":"NDC"}],"standard_charges":[{"gross_charge":1966.25,"discounted_cash":1651.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 172 MG"},{"gross_charge":2949.5,"discounted_cash":2477.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 258 MG"},{"gross_charge":3944.0,"discounted_cash":3312.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 345 MG"}]},{"description":"ELACESTRANT 345 MG TABLET [194429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72187-0102-3","type":"NDC"}],"standard_charges":[{"gross_charge":2511.5,"discounted_cash":2109.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 345 MG"}]},{"description":"EFGARTIGIMOD ALFA-FCAB 20 MG/ML INTRAVENOUS SOLUTION [190596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73475-3041-5","type":"NDC"}],"standard_charges":[{"gross_charge":12702.75,"discounted_cash":10670.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"EFAVIRENZ 600 MG-EMTRICITABINE 200 MG-TENOFOVIR DISOPROX 300 MG TABLET [76835]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"15584-0101-1","type":"NDC"}],"standard_charges":[{"gross_charge":491.25,"discounted_cash":412.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EFAVIRENZ 600 MG TABLET [32298]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0056-0510-30","type":"NDC"}],"standard_charges":[{"gross_charge":218.5,"discounted_cash":183.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION [81696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25682-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":53541.0,"discounted_cash":44974.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":13385.25,"discounted_cash":11243.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":13385.25,"discounted_cash":11243.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":26770.5,"discounted_cash":22487.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":40155.75,"discounted_cash":33730.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52565-022-15","type":"NDC"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":375.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-466-35","type":"NDC"}],"standard_charges":[{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-466-11","type":"NDC"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":207.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"ECONAZOLE NITRATE 1 % TOPICAL CREAM [9915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1303-2","type":"NDC"}],"standard_charges":[{"gross_charge":778.25,"discounted_cash":653.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"DUVELISIB 25 MG CAPSULE [180195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71779-125-02","type":"NDC"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":796.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-282-13","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-282-11","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-549-30","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-549-09","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-131-30","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-750-09","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-750-03","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0712-04","type":"NDC"}],"standard_charges":[{"gross_charge":77.5,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0712-15","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"0085-1136-01","type":"NDC"}],"standard_charges":[{"gross_charge":1985.0,"discounted_cash":1667.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"0085-1136-02","type":"NDC"}],"standard_charges":[{"gross_charge":1654.25,"discounted_cash":1389.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"0085-1136-03","type":"NDC"}],"standard_charges":[{"gross_charge":1985.0,"discounted_cash":1667.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-966-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-5728-60","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION [10009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00000-0004-35","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION [10009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"00000-0004-35","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION [10009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323-738-09","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION [10009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323-738-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 10 MG TABLET [15065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2748-94","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 10 MG TABLET [15065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2748-92","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 10 MG TABLET [15065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2748-65","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [124962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323-739-41","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [124962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"70860-751-41","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [124962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"70860-751-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-966-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61442-121-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-397-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-645-41","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-859-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-001-31","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-645-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-303-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-303-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093913844","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61442-121-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [124962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323-739-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [124962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323-739-16","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51660-200-90","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66582-414-54","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":78.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66582-414-31","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":78.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EXENATIDE ER 2 MG/0.85 ML SUBCUTANEOUS AUTO-INJECTOR [177617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-6540-04","type":"NDC"}],"standard_charges":[{"gross_charge":888.75,"discounted_cash":746.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"EXENATIDE ER 2 MG/0.85 ML SUBCUTANEOUS AUTO-INJECTOR [177617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-6540-01","type":"NDC"}],"standard_charges":[{"gross_charge":888.75,"discounted_cash":746.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"EXEMESTANE 25 MG TABLET [26551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-516-30","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":119.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":278.25,"discounted_cash":233.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EXEMESTANE 25 MG TABLET [26551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0595-30","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":119.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":278.25,"discounted_cash":233.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EXEMESTANE 25 MG TABLET [26551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-108-30","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":119.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":278.25,"discounted_cash":233.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EXEMESTANE 25 MG TABLET [26551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0080-13","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":119.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":278.25,"discounted_cash":233.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EXEMESTANE 25 MG TABLET [26551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-7663-04","type":"NDC"}],"standard_charges":[{"gross_charge":255.5,"discounted_cash":214.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ETRAVIRINE 200 MG TABLET [108431]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-571-01","type":"NDC"}],"standard_charges":[{"gross_charge":162.75,"discounted_cash":136.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ETOPOSIDE 50 MG CAPSULE [10001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8560","type":"HCPCS"},{"code":"0378-3266-32","type":"NDC"}],"standard_charges":[{"gross_charge":823.75,"discounted_cash":691.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1235.5,"discounted_cash":1037.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":1647.25,"discounted_cash":1383.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":412.0,"discounted_cash":346.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ETOPOSIDE 50 MG CAPSULE [10001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8560","type":"HCPCS"},{"code":"0378-3266-94","type":"NDC"}],"standard_charges":[{"gross_charge":823.75,"discounted_cash":691.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1235.5,"discounted_cash":1037.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":1647.25,"discounted_cash":1383.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":412.0,"discounted_cash":346.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ETOPOSIDE (VEPESID) WRAPPER [178015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"61269-410-20","type":"NDC"}],"standard_charges":[{"gross_charge":1110.25,"discounted_cash":932.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE (VEPESID) WRAPPER [178015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE (VEPESID) WRAPPER [178015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"0143-9510-01","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE (VEPESID) WRAPPER [178015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"0143-9511-01","type":"NDC"}],"standard_charges":[{"gross_charge":308.25,"discounted_cash":258.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"ETOPOSIDE (VEPESID) WRAPPER [178015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729-114-31","type":"NDC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1154-3","type":"NDC"}],"standard_charges":[{"gross_charge":76.25,"discounted_cash":64.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3713-19","type":"NDC"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3713-30","type":"NDC"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5690-31","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [124962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"67457-433-22","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [124962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"67457-433-00","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [124962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"0641-6022-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [124962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"0641-6022-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [124962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323-739-12","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMCICLOVIR 250 MG TABLET [16081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8118-56","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-595-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION [184247]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65597-406-01","type":"NDC"}],"standard_charges":[{"gross_charge":21530.0,"discounted_cash":18085.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.2 MG/KG"},{"gross_charge":29578.0,"discounted_cash":24845.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.4 MG/KG"},{"gross_charge":36284.5,"discounted_cash":30478.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.4 MG/KG"}]},{"description":"FACTOR XA,INACTIVATED-ZHZO (RECOMBINANT) 200 MG INTRAVENOUS SOLUTION [181364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7169","type":"HCPCS"},{"code":"0310-3200-05","type":"NDC"}],"standard_charges":[{"gross_charge":7410.0,"discounted_cash":6224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":14820.0,"discounted_cash":12448.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":17784.0,"discounted_cash":14938.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MG"}]},{"description":"FACTOR XA,INACTIVATED-ZHZO (RECOMBINANT) 200 MG INTRAVENOUS SOLUTION [181364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7169","type":"HCPCS"},{"code":"0310-3200-04","type":"NDC"}],"standard_charges":[{"gross_charge":7410.0,"discounted_cash":6224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FACTOR XA,INACTIVATED-ZHZO (RECOMBINANT) 200 MG INTRAVENOUS SOLUTION [181364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7169","type":"HCPCS"},{"code":"0310-3200-01","type":"NDC"}],"standard_charges":[{"gross_charge":7410.0,"discounted_cash":6224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7103-04","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-433-15","type":"NDC"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-433-10","type":"NDC"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-298-12","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-298-11","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-373-21","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-373-11","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG TABLET [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6664-04","type":"NDC"}],"standard_charges":[{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"ETOPOSIDE (VEPESID) WRAPPER [178015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-104-50","type":"NDC"}],"standard_charges":[{"gross_charge":1008.25,"discounted_cash":846.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-595-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET [40009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3065-77","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-449-90","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-738-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-458-05","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-311-12","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-311-11","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-132-75","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3066-77","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-636-95","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-636-25","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FEBUXOSTAT 40 MG TABLET [97133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-2244-32","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":167.25,"discounted_cash":140.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET [40009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-599-20","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS WRAPPER [40830807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"69374-523-21","type":"NDC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS WRAPPER [40830807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"69374-523-25","type":"NDC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS WRAPPER [40830807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"70092-1093-37","type":"NDC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":187.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS WRAPPER [40830807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"70092-1506-36","type":"NDC"}],"standard_charges":[{"gross_charge":204.75,"discounted_cash":171.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS WRAPPER [40830807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"70092-1092-36","type":"NDC"}],"standard_charges":[{"gross_charge":134.5,"discounted_cash":112.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENOLDOPAM 10 MG/ML INTRAVENOUS SOLUTION [22133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2304-01","type":"NDC"}],"standard_charges":[{"gross_charge":1454.25,"discounted_cash":1221.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":1448.5,"discounted_cash":1216.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MCG/ML"}]},{"description":"FENOLDOPAM 10 MG/ML INTRAVENOUS SOLUTION [22133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2304-02","type":"NDC"}],"standard_charges":[{"gross_charge":2469.5,"discounted_cash":2074.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FENOFIBRIC ACID (CHOLINE) 135 MG CAPSULE,DELAYED RELEASE [95840]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-3162-90","type":"NDC"}],"standard_charges":[{"gross_charge":73.25,"discounted_cash":61.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 135 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET [40009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-618-21","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET [40009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-618-11","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET [40009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-737-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET [40009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-459-05","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET [40009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-315-75","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FEBUXOSTAT 40 MG TABLET [97133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-059-01","type":"NDC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":158.0,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FAT EMULSION 20 % INTRAVENOUS [10014]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-531-10","type":"NDC"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":124.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":242.0,"discounted_cash":203.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":242.0,"discounted_cash":203.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":523.5,"discounted_cash":439.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FAT EMULSION 20 % INTRAVENOUS [10014]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-531-01","type":"NDC"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":124.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":242.0,"discounted_cash":203.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":242.0,"discounted_cash":203.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":523.5,"discounted_cash":439.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FAT EMULSION 20 % INTRAVENOUS [10014]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0519-58","type":"NDC"}],"standard_charges":[{"gross_charge":156.75,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":259.25,"discounted_cash":217.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":259.25,"discounted_cash":217.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":567.0,"discounted_cash":476.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FAT EMULSION 20 % INTRAVENOUS [10014]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0519-09","type":"NDC"}],"standard_charges":[{"gross_charge":100.75,"discounted_cash":84.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"}]},{"description":"FAT EMULSION 20 % INTRAVENOUS [10014]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-4460-30","type":"NDC"}],"standard_charges":[{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"}]},{"description":"FAMOTODINE 20 MG/10 ML COMPOUNDED SYRINGE [172673]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"S0028","type":"HCPCS"},{"code":"00000-0004-36","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION [10010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72603-171-01","type":"NDC"}],"standard_charges":[{"gross_charge":727.5,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION [10010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-150-01","type":"NDC"}],"standard_charges":[{"gross_charge":727.5,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FAMOTIDINE 40 MG TABLET [10012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-304-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 40 MG TABLET [10012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-304-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-299-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG TABLET [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-299-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAT EMULSION 20 % INTRAVENOUS [10014]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-533-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":271.0,"discounted_cash":227.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FAT EMULSION 20 % INTRAVENOUS [10014]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-533-25","type":"NDC"}],"standard_charges":[{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":271.0,"discounted_cash":227.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FEBUXOSTAT 40 MG TABLET [97133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-206-01","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":167.25,"discounted_cash":140.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FEBUXOSTAT 40 MG TABLET [97133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-028-30","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":136.0,"discounted_cash":114.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FEBUXOSTAT 40 MG TABLET [97133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3925-93","type":"NDC"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FEBUXOSTAT 40 MG TABLET [97133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-190-30","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":167.25,"discounted_cash":140.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FEBUXOSTAT 40 MG TABLET [97133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-918-30","type":"NDC"}],"standard_charges":[{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":178.5,"discounted_cash":149.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ETOPOSIDE (VEPESID) WRAPPER [178015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323-104-05","type":"NDC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE (VEPESID) WRAPPER [178015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"0703-5653-01","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETONOGESTREL 68 MG SUBDERMAL IMPLANT [77012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7307","type":"HCPCS"},{"code":"78206-145-01","type":"NDC"}],"standard_charges":[{"gross_charge":3692.5,"discounted_cash":3101.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 68 MG"}]},{"description":"ESCITALOPRAM 10 MG TABLET [33512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-169-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 10 MG TABLET [33512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-617-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 10 MG TABLET [33512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-374-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 10 MG TABLET [33512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5851-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 10 MG TABLET [33512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-2010-01","type":"NDC"}],"standard_charges":[{"gross_charge":124.75,"discounted_cash":104.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":249.5,"discounted_cash":209.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION [2903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1364","type":"HCPCS"},{"code":"14789-116-07","type":"NDC"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":719.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION [2903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1364","type":"HCPCS"},{"code":"0409-6482-11","type":"NDC"}],"standard_charges":[{"gross_charge":469.75,"discounted_cash":394.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":235.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":362.0,"discounted_cash":304.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"},{"gross_charge":469.75,"discounted_cash":394.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION [2903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1364","type":"HCPCS"},{"code":"0409-6482-01","type":"NDC"}],"standard_charges":[{"gross_charge":469.75,"discounted_cash":394.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 400 MG/5 ML ORAL POWDER FOR SUSPENSION [2900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-130-13","type":"NDC"}],"standard_charges":[{"gross_charge":2413.5,"discounted_cash":2027.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET [2901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-110-13","type":"NDC"}],"standard_charges":[{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET [2901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-100-13","type":"NDC"}],"standard_charges":[{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-295-01","type":"NDC"}],"standard_charges":[{"gross_charge":1451.5,"discounted_cash":1219.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1503-1","type":"NDC"}],"standard_charges":[{"gross_charge":1451.5,"discounted_cash":1219.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ESCITALOPRAM 10 MG TABLET [33512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6426-61","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-440-01","type":"NDC"}],"standard_charges":[{"gross_charge":1451.5,"discounted_cash":1219.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ESCITALOPRAM 10 MG TABLET [33512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-281-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 5 MG TABLET [37635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 5 MG TABLET [37635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-373-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 5 MG TABLET [37635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5850-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 5 MG TABLET [37635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-2005-01","type":"NDC"}],"standard_charges":[{"gross_charge":238.5,"discounted_cash":200.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":477.0,"discounted_cash":400.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":119.25,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 20 MG TABLET [33513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6427-61","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 20 MG TABLET [33513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-375-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 20 MG TABLET [33513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 20 MG TABLET [33513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-704-60","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM 20 MG TABLET [33513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-704-00","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-132-13","type":"NDC"}],"standard_charges":[{"gross_charge":1616.5,"discounted_cash":1357.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-134-02","type":"NDC"}],"standard_charges":[{"gross_charge":1616.5,"discounted_cash":1357.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ERYTHROMYCIN 500 MG TABLET,DELAYED RELEASE [127187]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-126-13","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":92.5,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"0006-3843-71","type":"NDC"}],"standard_charges":[{"gross_charge":633.25,"discounted_cash":531.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"0409-3510-21","type":"NDC"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":372.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":443.0,"discounted_cash":372.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":512.25,"discounted_cash":430.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"},{"gross_charge":221.5,"discounted_cash":186.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ERLOTINIB 25 MG TABLET [126249]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50242-062-01","type":"NDC"}],"standard_charges":[{"gross_charge":1784.75,"discounted_cash":1499.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2677.0,"discounted_cash":2248.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":892.5,"discounted_cash":749.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ERLOTINIB 150 MG TABLET [126251]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50242-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":804.75,"discounted_cash":675.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1207.0,"discounted_cash":1013.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":402.5,"discounted_cash":338.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ERLOTINIB 100 MG TABLET [126250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50242-063-01","type":"NDC"}],"standard_charges":[{"gross_charge":1067.25,"discounted_cash":896.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1600.75,"discounted_cash":1344.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":533.75,"discounted_cash":448.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ERGOLOID 1 MG TABLET [2864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-281-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-297-15","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-297-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-500-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-500-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-151-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-737-06","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"16729-260-03","type":"NDC"}],"standard_charges":[{"gross_charge":535.5,"discounted_cash":449.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MCG/KG"}]},{"description":"EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"70121-1002-1","type":"NDC"}],"standard_charges":[{"gross_charge":342.25,"discounted_cash":287.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MCG/KG"}]},{"description":"EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"55150-219-10","type":"NDC"}],"standard_charges":[{"gross_charge":154.25,"discounted_cash":129.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MCG/KG"}]},{"description":"EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"0085-1177-01","type":"NDC"}],"standard_charges":[{"gross_charge":518.25,"discounted_cash":435.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MCG/KG"}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"70436-027-80","type":"NDC"}],"standard_charges":[{"gross_charge":1678.5,"discounted_cash":1409.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"67457-631-10","type":"NDC"}],"standard_charges":[{"gross_charge":493.25,"discounted_cash":414.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"25021-408-51","type":"NDC"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":902.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"55150-218-99","type":"NDC"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023-221-10","type":"NDC"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":483.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023-221-01","type":"NDC"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":483.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"55150-282-20","type":"NDC"}],"standard_charges":[{"gross_charge":295.25,"discounted_cash":248.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023-221-85","type":"NDC"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":483.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-4024-11","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-4024-50","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-4024-35","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-070-31","type":"NDC"}],"standard_charges":[{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-910-55","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-910-19","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE [127209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-122-13","type":"NDC"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":119.5,"discounted_cash":100.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ERYTHROMYCIN 250 MG TABLET [2889]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1047-3","type":"NDC"}],"standard_charges":[{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":178.75,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ERYTHROMYCIN 250 MG TABLET [2889]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52536-103-03","type":"NDC"}],"standard_charges":[{"gross_charge":84.25,"discounted_cash":70.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":168.5,"discounted_cash":141.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ERYTHROMYCIN 250 MG TABLET [2889]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-102-13","type":"NDC"}],"standard_charges":[{"gross_charge":94.25,"discounted_cash":79.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":188.25,"discounted_cash":158.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ESCITALOPRAM 5 MG TABLET [37635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-249-90","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ERTUGLIFLOZIN 5 MG TABLET [178088]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-5363-03","type":"NDC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":162.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":289.5,"discounted_cash":243.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ERTUGLIFLOZIN 15 MG TABLET [178087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-5364-03","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"0143-9398-10","type":"NDC"}],"standard_charges":[{"gross_charge":260.75,"discounted_cash":219.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"0143-9398-01","type":"NDC"}],"standard_charges":[{"gross_charge":260.75,"discounted_cash":219.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"44567-820-10","type":"NDC"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":573.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"44567-820-01","type":"NDC"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":573.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"0409-3510-22","type":"NDC"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":372.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"60505-6196-4","type":"NDC"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":483.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"60505-6196-0","type":"NDC"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":483.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023-221-89","type":"NDC"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":483.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ESCITALOPRAM 5 MG TABLET [37635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-280-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":112.25,"discounted_cash":94.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ETHANOL (ETHYL ALCOHOL) 98 % INJECTION SOLUTION [127799]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-503-05","type":"NDC"}],"standard_charges":[{"gross_charge":1697.75,"discounted_cash":1426.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETHAMBUTOL 400 MG TABLET [9983]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ETHAMBUTOL 400 MG TABLET [9983]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68850-012-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ETHAMBUTOL 400 MG TABLET [9983]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0923-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ETHAMBUTOL 100 MG TABLET [9982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54879-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ETHAMBUTOL 100 MG TABLET [9982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-280-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ETHACRYNIC ACID 25 MG TABLET [9980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-367-90","type":"NDC"}],"standard_charges":[{"gross_charge":653.75,"discounted_cash":549.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":327.0,"discounted_cash":274.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ETHACRYNIC ACID 25 MG TABLET [9980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1126-1","type":"NDC"}],"standard_charges":[{"gross_charge":653.75,"discounted_cash":549.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":327.0,"discounted_cash":274.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ETHACRYNIC ACID 25 MG TABLET [9980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-405-01","type":"NDC"}],"standard_charges":[{"gross_charge":647.25,"discounted_cash":543.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":323.75,"discounted_cash":271.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ETHACRYNIC ACID 25 MG TABLET [9980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25010-215-15","type":"NDC"}],"standard_charges":[{"gross_charge":637.25,"discounted_cash":535.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":159.5,"discounted_cash":133.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":318.75,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION [9979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25010-210-27","type":"NDC"}],"standard_charges":[{"gross_charge":10290.25,"discounted_cash":8643.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ETANERCEPT 50 MG/ML (1 ML) SUBCUTANEOUS PEN INJECTOR [126193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1438","type":"HCPCS"},{"code":"58406-445-04","type":"NDC"}],"standard_charges":[{"gross_charge":4718.75,"discounted_cash":3963.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.98 ML"}]},{"description":"ETANERCEPT 25 MG/0.5 ML (0.5 ML) SUBCUTANEOUS SYRINGE [126190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1438","type":"HCPCS"},{"code":"58406-455-04","type":"NDC"}],"standard_charges":[{"gross_charge":2359.5,"discounted_cash":1981.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.51 ML"}]},{"description":"ETANERCEPT 25 MG (1 ML) SUBCUTANEOUS POWDER FOR SOLUTION [24276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1438","type":"HCPCS"},{"code":"58406-425-41","type":"NDC"}],"standard_charges":[{"gross_charge":2539.0,"discounted_cash":2132.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ETANERCEPT 25 MG (1 ML) SUBCUTANEOUS POWDER FOR SOLUTION [24276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1438","type":"HCPCS"},{"code":"58406-425-34","type":"NDC"}],"standard_charges":[{"gross_charge":2539.0,"discounted_cash":2132.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ESZOPICLONE 3 MG TABLET [40322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-969-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"ETHANOLAMINE OLEATE 5 % INTRAVENOUS SOLUTION [9984]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1430","type":"HCPCS"},{"code":"67871-4790-6","type":"NDC"}],"standard_charges":[{"gross_charge":1378.75,"discounted_cash":1158.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"},{"gross_charge":1838.25,"discounted_cash":1544.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":4595.75,"discounted_cash":3860.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETHYL ALCOHOL (BULK) LIQUID [16626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"3877906168","type":"NDC"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ETONOGESTREL 68 MG SUBDERMAL IMPLANT [77012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7307","type":"HCPCS"},{"code":"0052-4330-01","type":"NDC"}],"standard_charges":[{"gross_charge":3133.25,"discounted_cash":2631.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 68 MG"}]},{"description":"ETONOGESTREL 0.12 MG-ETHINYL ESTRADIOL 0.015 MG/24 HR VAGINAL RING [31530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7679-02","type":"NDC"}],"standard_charges":[{"gross_charge":760.25,"discounted_cash":638.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ETONOGESTREL 0.12 MG-ETHINYL ESTRADIOL 0.015 MG/24 HR VAGINAL RING [31530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7679-01","type":"NDC"}],"standard_charges":[{"gross_charge":760.25,"discounted_cash":638.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-447-20","type":"NDC"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-447-02","type":"NDC"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-445-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-445-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72266-146-10","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72266-146-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-902-10","type":"NDC"}],"standard_charges":[{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-902-00","type":"NDC"}],"standard_charges":[{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6695-12","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-160-42","type":"NDC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-160-32","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9507-10","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9506-10","type":"NDC"}],"standard_charges":[{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9506-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-222-20","type":"NDC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-221-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0780-10","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6695-02","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6695-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55390-763-20","type":"NDC"}],"standard_charges":[{"gross_charge":81.75,"discounted_cash":68.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55390-762-10","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ETHYL CHLORIDE 100 % TOPICAL SPRAY [2951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"386000111","type":"NDC"}],"standard_charges":[{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 116 ML"}]},{"description":"ETHYL CHLORIDE 100 % TOPICAL SPRAY [2951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"386000103","type":"NDC"}],"standard_charges":[{"gross_charge":199.5,"discounted_cash":167.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 116 ML"}]},{"description":"ETHYL CHLORIDE 100 % TOPICAL SPRAY [2951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"386000102","type":"NDC"}],"standard_charges":[{"gross_charge":174.25,"discounted_cash":146.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 116 ML"}]},{"description":"ETHYL ALCOHOL 99 % INTRA-ARTERIAL SOLUTION [181313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54288-105-15","type":"NDC"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":2552.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETHYL ALCOHOL 99 % INTRA-ARTERIAL SOLUTION [181313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54288-105-02","type":"NDC"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":2552.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9507-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ESZOPICLONE 2 MG TABLET [40321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-968-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68071-1366-0","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-5040-54","type":"NDC"}],"standard_charges":[{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-5040-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE [29745]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-5020-54","type":"NDC"}],"standard_charges":[{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":153.75,"discounted_cash":129.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE [29745]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-5020-31","type":"NDC"}],"standard_charges":[{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":153.75,"discounted_cash":129.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-450-10","type":"NDC"}],"standard_charges":[{"gross_charge":512.5,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-450-01","type":"NDC"}],"standard_charges":[{"gross_charge":512.5,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-420-10","type":"NDC"}],"standard_charges":[{"gross_charge":743.75,"discounted_cash":624.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-420-01","type":"NDC"}],"standard_charges":[{"gross_charge":743.75,"discounted_cash":624.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-308-84","type":"NDC"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":729.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-657-25","type":"NDC"}],"standard_charges":[{"gross_charge":1593.0,"discounted_cash":1338.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10019-055-61","type":"NDC"}],"standard_charges":[{"gross_charge":693.25,"discounted_cash":582.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SYRINGE [132052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"70092-1008-46","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SYRINGE [132052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"15082-827-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION [82085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"55150-194-10","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION [82085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"63323-652-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG/KG"},{"gross_charge":291.0,"discounted_cash":244.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-6451-56","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET [9960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11528-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0430-3754-14","type":"NDC"}],"standard_charges":[{"gross_charge":1481.25,"discounted_cash":1244.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"ESTRAMUSTINE 140 MG CAPSULE [9971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0013-0132-02","type":"NDC"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":114.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ESTRADIOL 1 MG TABLET [9967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-088-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ESTRADIOL 1 MG TABLET [9967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0886-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ESTRADIOL 0.5 MG TABLET [12491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-087-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ESTRADIOL 0.5 MG TABLET [12491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-332-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ESTRADIOL 0.5 MG TABLET [12491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0899-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0346-45","type":"NDC"}],"standard_charges":[{"gross_charge":123.25,"discounted_cash":103.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0346-42","type":"NDC"}],"standard_charges":[{"gross_charge":148.75,"discounted_cash":124.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [28408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-206-04","type":"NDC"}],"standard_charges":[{"gross_charge":149.5,"discounted_cash":125.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [28408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50419-451-04","type":"NDC"}],"standard_charges":[{"gross_charge":154.75,"discounted_cash":129.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [28408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3350-99","type":"NDC"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":131.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7144-58","type":"NDC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4642-16","type":"NDC"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7144-83","type":"NDC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4642-26","type":"NDC"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-426-42","type":"NDC"}],"standard_charges":[{"gross_charge":1208.0,"discounted_cash":1014.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-104-44","type":"NDC"}],"standard_charges":[{"gross_charge":1216.0,"discounted_cash":1021.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1518-66","type":"NDC"}],"standard_charges":[{"gross_charge":1208.0,"discounted_cash":1014.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-8770-35","type":"NDC"}],"standard_charges":[{"gross_charge":1110.75,"discounted_cash":933.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3541-43","type":"NDC"}],"standard_charges":[{"gross_charge":1285.25,"discounted_cash":1079.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124840]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0088-2219-05","type":"NDC"}],"standard_charges":[{"gross_charge":156.25,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-199-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045-009-11","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"63323-852-25","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"63323-852-03","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-09","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045-009-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-31","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION WRAPPER [180640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0641-6206-10","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION WRAPPER [180640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0641-6206-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION WRAPPER [180640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045-009-96","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION WRAPPER [180640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045-009-03","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045-009-00","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045-009-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 2 MG TABLET [3760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-579-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE 2 MG TABLET [3760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE 2 MG TABLET [3760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-301-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE 2 MG TABLET [3760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-301-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE 2 MG TABLET [3760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-3243-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-6075-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0386-63","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-37","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION WRAPPER [180643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-17","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION WRAPPER [180640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045-009-06","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2634-50","type":"NDC"}],"standard_charges":[{"gross_charge":604.25,"discounted_cash":507.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2634-05","type":"NDC"}],"standard_charges":[{"gross_charge":88.25,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE (PF) 0.5 MG/0.5 ML INJECTION SYRINGE [174065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045-009-05","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROCORTISONE-PRAMOXINE 2.5 %-1 % RECTAL CREAM [28848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54766-799-04","type":"NDC"}],"standard_charges":[{"gross_charge":1325.0,"discounted_cash":1113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE-PRAMOXINE 2.5 %-1 % RECTAL CREAM [28848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-472-64","type":"NDC"}],"standard_charges":[{"gross_charge":646.25,"discounted_cash":542.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM [14190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2013-2","type":"NDC"}],"standard_charges":[{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM [14190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-521-72","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM [14190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7623-31","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM [14190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0339-56","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-901-10","type":"NDC"}],"standard_charges":[{"gross_charge":721.25,"discounted_cash":605.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-3007-1","type":"NDC"}],"standard_charges":[{"gross_charge":808.5,"discounted_cash":679.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1292-6","type":"NDC"}],"standard_charges":[{"gross_charge":815.5,"discounted_cash":685.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1292-1","type":"NDC"}],"standard_charges":[{"gross_charge":404.5,"discounted_cash":339.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"HYDROCORTISONE VALERATE 0.2 % TOPICAL CREAM [10218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1290-1","type":"NDC"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":309.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-540-50","type":"NDC"}],"standard_charges":[{"gross_charge":524.25,"discounted_cash":440.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-0110-03","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-0113-03","type":"NDC"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-0113-01","type":"NDC"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION WRAPPER [180640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-04","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION WRAPPER [180640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-05","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE 0.25 MG/0.5 ML INJECTION WRAPPER [408776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1805-10","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"HYDROMORPHONE 0.25 MG/0.5 ML INJECTION WRAPPER [408776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1805-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION SOLUTION [3758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0641-0121-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE (PF) 2 MG/ML INJECTION SYRINGE [173464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045-010-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE (PF) 2 MG/ML INJECTION SYRINGE [173464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION [130586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0641-6151-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION [130586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0641-6151-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2634-25","type":"NDC"}],"standard_charges":[{"gross_charge":88.25,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-851-15","type":"NDC"}],"standard_charges":[{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-851-07","type":"NDC"}],"standard_charges":[{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-0110-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [127328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"0009-0825-01","type":"NDC"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":124.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION SOLUTION [3758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-3365-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-269-11","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-269-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-096-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-296-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0373-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION [111437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50633-310-11","type":"NDC"}],"standard_charges":[{"gross_charge":3640.75,"discounted_cash":3058.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION [111437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"11704-370-01","type":"NDC"}],"standard_charges":[{"gross_charge":2497.0,"discounted_cash":2097.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"HYDROMORPHONE 8 MG TABLET [10226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0265-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE 4 MG/ML INJECTION SYRINGE [3759]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"0409-1304-31","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE 4 MG TABLET [3761]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-590-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE 4 MG TABLET [3761]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-590-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE 4 MG TABLET [3761]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-234-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-057-02","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59212-562-10","type":"NDC"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYUREA 500 MG CAPSULE [10236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-0830-50","type":"NDC"}],"standard_charges":[{"gross_charge":170.75,"discounted_cash":143.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG/KG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG/KG"},{"gross_charge":85.5,"discounted_cash":71.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":136.5,"discounted_cash":114.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG/KG"}]},{"description":"HYDROXYPROGESTERONE(PF)(PREG PRESERV) 275 MG/1.1 ML SUBCUT AUTO-INJECT [178237]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"64011-301-03","type":"NDC"}],"standard_charges":[{"gross_charge":2929.5,"discounted_cash":2460.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 275 MG"}]},{"description":"HYDROXYPROGESTERONE CAPROATE (PREGNANCY PRESERVING) 250 MG/ML IM OIL [168738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"64011-243-01","type":"NDC"}],"standard_charges":[{"gross_charge":2380.25,"discounted_cash":1999.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL [169475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"55150-309-01","type":"NDC"}],"standard_charges":[{"gross_charge":3112.5,"discounted_cash":2614.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL [169475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"69238-1797-1","type":"NDC"}],"standard_charges":[{"gross_charge":2593.75,"discounted_cash":2178.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL [169475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"0517-1767-01","type":"NDC"}],"standard_charges":[{"gross_charge":2593.75,"discounted_cash":2178.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL [169475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"64011-247-02","type":"NDC"}],"standard_charges":[{"gross_charge":2929.5,"discounted_cash":2460.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYCHLOROQUINE 25 MG/ML COMPOUNDED ORAL SUSPENSION [184656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7152-24","type":"NDC"}],"standard_charges":[{"gross_charge":908.0,"discounted_cash":762.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"HYDROXYCHLOROQUINE 25 MG/ML COMPOUNDED ORAL SUSPENSION [184656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7152-08","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 25 MG/ML COMPOUNDED ORAL SUSPENSION [184656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7152-16","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 25 MG/ML COMPOUNDED ORAL SUSPENSION [184656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7152-12","type":"NDC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":381.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-412-15","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-412-11","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-721-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-753-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5994-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3041-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-777-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROMORPHONE 4 MG TABLET [3761]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-3244-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION WRAPPER [180653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0641-0121-21","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION SYRINGE [116807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1312-36","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION SYRINGE [116807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1312-16","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION SYRINGE [116807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1312-09","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION SYRINGE [116807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1312-03","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION SYRINGE [116807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1312-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION WRAPPER [180653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-3365-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE 30 MG/30 ML IN 0.9 % SOD. CHLORIDE PCA INTRAVENOUS SOLN WRAPPER [130372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-3431-30","type":"NDC"}],"standard_charges":[{"gross_charge":261.25,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HYDROMORPHONE 30 MG/30 ML IN 0.9 % SOD. CHLORIDE PCA INTRAVENOUS SOLN WRAPPER [130372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42852-222-53","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HYDROMORPHONE 30 MG/30 ML IN 0.9 % SOD. CHLORIDE PCA INTRAVENOUS SOLN WRAPPER [130372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1117-79","type":"NDC"}],"standard_charges":[{"gross_charge":142.25,"discounted_cash":119.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HYDROMORPHONE 30 MG/30 ML IN 0.9 % SOD. CHLORIDE PCA INTRAVENOUS SOLN WRAPPER [130372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61553-710-68","type":"NDC"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HYDROMORPHONE 30 MG/30 ML IN 0.9 % SOD. CHLORIDE PCA INTRAVENOUS SOLN WRAPPER [130372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61553-510-69","type":"NDC"}],"standard_charges":[{"gross_charge":137.75,"discounted_cash":115.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION WRAPPER [180653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"63323-853-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROMORPHONE 2 MG/ML INJECTION WRAPPER [180653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"63323-853-03","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [132370]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"0009-0016-12","type":"NDC"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-311-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6442-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-735-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-127-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-521-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-521-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-734-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-076-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-328-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET [28384]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0125-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG TABLET [3720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-593-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG TABLET [3720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-593-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG TABLET [3720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-183-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG TABLET [3720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-128-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG TABLET [3720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-2083-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG TABLET [76988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-155-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG TABLET [76988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-182-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG TABLET [76988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2820-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-833-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-833-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-076-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 25 MG TABLET [3700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-327-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 25 MG TABLET [3700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-327-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"0641-6231-25","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"0641-6231-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"0517-0901-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323-614-00","type":"NDC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"67457-291-01","type":"NDC"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"67457-291-00","type":"NDC"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323-614-16","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"39822-0500-4","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"39822-0500-1","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"17478-934-15","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"17478-934-01","type":"NDC"}],"standard_charges":[{"gross_charge":218.25,"discounted_cash":183.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323-614-01","type":"NDC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"0517-0901-25","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE 10 MG TABLET [3698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6440-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 10 MG TABLET [3698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-447-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 25 MG TABLET [3700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-328-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 50 MG TABLET [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-328-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 25 MG TABLET [3700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-126-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 25 MG TABLET [3700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-520-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 25 MG TABLET [3700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-733-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 25 MG TABLET [3700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-075-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET [28384]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0125-23","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET [28384]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0125-62","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-431-30","type":"NDC"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":287.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10631-407-01","type":"NDC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":301.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.35 G"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-301-30","type":"NDC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":301.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-004-03","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0337-30","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0080-31","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE 100 MG/60 ML ENEMA [10210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-138-07","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"HYDROCORTISONE 10 MG TABLET [3733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-406-15","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCORTISONE 10 MG TABLET [3733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-406-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCORTISONE 10 MG TABLET [3733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-582-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCORTISONE 10 MG TABLET [3733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-582-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCORTISONE 10 MG TABLET [3733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72789-094-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCORTISONE 10 MG TABLET [3733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1697-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCORTISONE 10 MG TABLET [3733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42543-141-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCORTISONE 10 MG TABLET [3733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0074-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-324-30","type":"NDC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":301.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-302-30","type":"NDC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":301.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0146-30","type":"NDC"}],"standard_charges":[{"gross_charge":74.25,"discounted_cash":62.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.35 G"}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [132371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"0009-0013-06","type":"NDC"}],"standard_charges":[{"gross_charge":108.5,"discounted_cash":91.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":271.25,"discounted_cash":227.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":542.5,"discounted_cash":455.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [132371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"0009-0013-05","type":"NDC"}],"standard_charges":[{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":208.75,"discounted_cash":175.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":417.5,"discounted_cash":350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [132372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"0009-0011-04","type":"NDC"}],"standard_charges":[{"gross_charge":146.75,"discounted_cash":123.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [132372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"0009-0011-03","type":"NDC"}],"standard_charges":[{"gross_charge":149.5,"discounted_cash":125.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7340-24","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7340-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-411-12","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-411-11","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42494-301-12","type":"NDC"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":153.25,"discounted_cash":128.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0503-06","type":"NDC"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":153.0,"discounted_cash":128.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0503-12","type":"NDC"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":153.0,"discounted_cash":128.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7090-12","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-014-05","type":"NDC"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":200.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 454 G"}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-312-28","type":"NDC"}],"standard_charges":[{"gross_charge":345.25,"discounted_cash":290.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 10 MG TABLET [3733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-0031-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [34544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0124-23","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [34544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0124-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-201-50","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-895-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-895-09","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-895-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0123-62","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0123-23","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0123-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 10 MG-CHLORPHENIRAMINE 8 MG/5 ML ORAL SUSP EXTEND.REL 12HR [106413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1805-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE 10 MG-CHLORPHENIRAMINE 8 MG/5 ML ORAL SUSP EXTEND.REL 12HR [106413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-086-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE 10 MG-CHLORPHENIRAMINE 8 MG/5 ML ORAL SUSP EXTEND.REL 12HR [106413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62542-301-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET [28384]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6825-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET [28384]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-587-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [34544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0124-62","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [34544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-586-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM [28849]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0037-6822-10","type":"NDC"}],"standard_charges":[{"gross_charge":835.25,"discounted_cash":701.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"HYDROCORTISONE 1 % TOPICAL OINTMENT [3731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-522-72","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"HYDROCORTISONE 1 % TOPICAL OINTMENT [3731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-276-03","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 1 % TOPICAL CREAM WRAPPER [179968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0316-0186-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"HYDROCORTISONE 1 % TOPICAL CREAM WRAPPER [179968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093957333","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"HYDROCORTISONE 1 % TOPICAL CREAM WRAPPER [179968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-438-03","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 1 % TOPICAL CREAM WRAPPER [179968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0321-26","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"HYDROCORTISONE 1 % LOTION [3728]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39485932","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 114 G"}]},{"description":"HYDROCORTISONE 0.5 % TOPICAL CREAM [3725]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2010-2","type":"NDC"}],"standard_charges":[{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"HYDROCORTISONE (BULK) POWDER [3735]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0574-0420-01","type":"NDC"}],"standard_charges":[{"gross_charge":2322.5,"discounted_cash":1950.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML ORAL SOLUTION [3724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-043-16","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML ORAL SOLUTION [3724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-455-16","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML ORAL SOLUTION [3724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-1030-16","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML (5 ML) ORAL SOLUTION [134158]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4811-40","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML (5 ML) ORAL SOLUTION [134158]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4811-05","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION [37848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-417-71","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION [37848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-417-44","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION [37848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-2316-40","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION [37848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-2316-15","type":"NDC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION [37848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-6105-15","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION [37848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-023-50","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION [37848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-023-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [34544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6826-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML ORAL SOLUTION [3724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1820-05","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44206-439-93","type":"NDC"}],"standard_charges":[{"gross_charge":19485.0,"discounted_cash":16367.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.7 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206-439-93","type":"NDC"}],"standard_charges":[{"gross_charge":5567.25,"discounted_cash":4676.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 G/KG"},{"gross_charge":13918.0,"discounted_cash":11691.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44206-438-92","type":"NDC"}],"standard_charges":[{"gross_charge":28145.0,"discounted_cash":23641.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.7 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206-438-92","type":"NDC"}],"standard_charges":[{"gross_charge":8041.5,"discounted_cash":6754.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 G/KG"},{"gross_charge":20103.5,"discounted_cash":16886.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44206-437-91","type":"NDC"}],"standard_charges":[{"gross_charge":28145.0,"discounted_cash":23641.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.7 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206-437-91","type":"NDC"}],"standard_charges":[{"gross_charge":8041.5,"discounted_cash":6754.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 G/KG"},{"gross_charge":20103.5,"discounted_cash":16886.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44206-436-90","type":"NDC"}],"standard_charges":[{"gross_charge":34640.0,"discounted_cash":29097.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.7 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206-436-90","type":"NDC"}],"standard_charges":[{"gross_charge":9897.25,"discounted_cash":8313.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 G/KG"},{"gross_charge":24742.75,"discounted_cash":20783.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44206-439-40","type":"NDC"}],"standard_charges":[{"gross_charge":19485.0,"discounted_cash":16367.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.7 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206-439-40","type":"NDC"}],"standard_charges":[{"gross_charge":5567.25,"discounted_cash":4676.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 G/KG"},{"gross_charge":13918.0,"discounted_cash":11691.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44206-438-20","type":"NDC"}],"standard_charges":[{"gross_charge":28145.0,"discounted_cash":23641.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.7 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206-438-20","type":"NDC"}],"standard_charges":[{"gross_charge":8041.5,"discounted_cash":6754.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 G/KG"},{"gross_charge":20103.5,"discounted_cash":16886.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44206-437-10","type":"NDC"}],"standard_charges":[{"gross_charge":28145.0,"discounted_cash":23641.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.7 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206-437-10","type":"NDC"}],"standard_charges":[{"gross_charge":8041.5,"discounted_cash":6754.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 G/KG"},{"gross_charge":20103.5,"discounted_cash":16886.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44206-436-05","type":"NDC"}],"standard_charges":[{"gross_charge":34640.0,"discounted_cash":29097.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.7 G/KG"}]},{"description":"IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [165919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206-436-05","type":"NDC"}],"standard_charges":[{"gross_charge":9897.25,"discounted_cash":8313.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 G/KG"},{"gross_charge":24742.75,"discounted_cash":20783.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G/KG"}]},{"description":"IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [165281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-800-41","type":"NDC"}],"standard_charges":[{"gross_charge":18479.0,"discounted_cash":15522.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG/KG"}]},{"description":"IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [165281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533-800-41","type":"NDC"}],"standard_charges":[{"gross_charge":6929.75,"discounted_cash":5820.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":9239.5,"discounted_cash":7761.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":11549.5,"discounted_cash":9701.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":13859.25,"discounted_cash":11641.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [165918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"0944-2700-04","type":"NDC"}],"standard_charges":[{"gross_charge":14733.25,"discounted_cash":12375.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":19644.25,"discounted_cash":16501.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":24555.25,"discounted_cash":20626.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":29466.5,"discounted_cash":24751.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [165281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-800-40","type":"NDC"}],"standard_charges":[{"gross_charge":18479.0,"discounted_cash":15522.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG/KG"}]},{"description":"IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION - RECONSTITUTED TO 10% STRENGTH [408750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1566","type":"HCPCS"},{"code":"0944-2657-07","type":"NDC"}],"standard_charges":[{"gross_charge":25608.25,"discounted_cash":21510.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":32010.5,"discounted_cash":26888.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":38412.5,"discounted_cash":32266.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION - RECONSTITUTED TO 10% STRENGTH [408750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1566","type":"HCPCS"},{"code":"0944-2656-03","type":"NDC"}],"standard_charges":[{"gross_charge":25608.25,"discounted_cash":21510.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":32010.5,"discounted_cash":26888.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":38412.5,"discounted_cash":32266.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUNE GLOB,GAMMA(IGG) 15 %-18 % RANGE-GLYCINE INTRAMUSCULAR SOLUTION [167923]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1560","type":"HCPCS"},{"code":"13533-635-12","type":"NDC"}],"standard_charges":[{"gross_charge":2604.5,"discounted_cash":2187.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION [167980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1566","type":"HCPCS"},{"code":"0944-2659-08","type":"NDC"}],"standard_charges":[{"gross_charge":20806.75,"discounted_cash":17477.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":26008.5,"discounted_cash":21847.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":31210.25,"discounted_cash":26216.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION [167980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1566","type":"HCPCS"},{"code":"0944-2658-04","type":"NDC"}],"standard_charges":[{"gross_charge":20806.75,"discounted_cash":17477.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":26008.5,"discounted_cash":21847.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":31210.25,"discounted_cash":26216.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [165918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"0944-2700-13","type":"NDC"}],"standard_charges":[{"gross_charge":8287.5,"discounted_cash":6961.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":11050.0,"discounted_cash":9282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":13812.5,"discounted_cash":11602.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":16575.0,"discounted_cash":13923.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [165918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"0944-2700-10","type":"NDC"}],"standard_charges":[{"gross_charge":14733.25,"discounted_cash":12375.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":19644.25,"discounted_cash":16501.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":24555.25,"discounted_cash":20626.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":29466.5,"discounted_cash":24751.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [165918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"0944-2700-07","type":"NDC"}],"standard_charges":[{"gross_charge":8287.5,"discounted_cash":6961.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":11050.0,"discounted_cash":9282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":13812.5,"discounted_cash":11602.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":16575.0,"discounted_cash":13923.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [165281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533-800-40","type":"NDC"}],"standard_charges":[{"gross_charge":6929.75,"discounted_cash":5820.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":9239.5,"discounted_cash":7761.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":11549.5,"discounted_cash":9701.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":13859.25,"discounted_cash":11641.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUN GLOB G (GAMUNEX-C) WRAPPER [172722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533-800-24","type":"NDC"}],"standard_charges":[{"gross_charge":10009.5,"discounted_cash":8407.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":13346.0,"discounted_cash":11210.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":16682.5,"discounted_cash":14013.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":20018.75,"discounted_cash":16815.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUN GLOB G (GAMUNEX-C) WRAPPER [172722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533-800-20","type":"NDC"}],"standard_charges":[{"gross_charge":12319.25,"discounted_cash":10348.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":16425.75,"discounted_cash":13797.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":2663.25,"discounted_cash":2237.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"},{"gross_charge":20532.25,"discounted_cash":17247.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":24638.5,"discounted_cash":20696.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUN GLOB G (GAMUNEX-C) WRAPPER [172722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533-800-15","type":"NDC"}],"standard_charges":[{"gross_charge":14507.75,"discounted_cash":12186.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":19343.5,"discounted_cash":16248.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":24179.25,"discounted_cash":20310.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":29015.25,"discounted_cash":24372.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMIPRAMINE 25 MG TABLET [3861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-331-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMIPRAMINE 25 MG TABLET [3861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-055-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMIPRAMINE 25 MG TABLET [3861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1764-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMIPRAMINE 10 MG TABLET [3860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-133-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMIPRAMINE 10 MG TABLET [3860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60429-095-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMIPRAMINE 10 MG TABLET [3860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-330-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMIPRAMINE 10 MG TABLET [3860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-054-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMMUN GLOB G (GAMUNEX-C) WRAPPER [172722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533-800-16","type":"NDC"}],"standard_charges":[{"gross_charge":14507.75,"discounted_cash":12186.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":19343.5,"discounted_cash":16248.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":24179.25,"discounted_cash":20310.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":29015.25,"discounted_cash":24372.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-800-25","type":"NDC"}],"standard_charges":[{"gross_charge":26691.75,"discounted_cash":22421.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG/KG"}]},{"description":"IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533-800-25","type":"NDC"}],"standard_charges":[{"gross_charge":10009.5,"discounted_cash":8407.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":13346.0,"discounted_cash":11210.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":16682.5,"discounted_cash":14013.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":20018.75,"discounted_cash":16815.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"IMMUN GLOB G (GAMUNEX-C) WRAPPER [172722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-800-24","type":"NDC"}],"standard_charges":[{"gross_charge":26691.75,"discounted_cash":22421.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG/KG"}]},{"description":"IMMUN GLOB G (GAMUNEX-C) WRAPPER [172722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13533-800-16","type":"NDC"}],"standard_charges":[{"gross_charge":1568.25,"discounted_cash":1317.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"IMMUN GLOB G (GAMUNEX-C) WRAPPER [172722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"13533-800-15","type":"NDC"}],"standard_charges":[{"gross_charge":1568.25,"discounted_cash":1317.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"IMMUNE GLOB G 10 GRAM/100 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533-800-72","type":"NDC"}],"standard_charges":[{"gross_charge":5326.25,"discounted_cash":4474.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"IMMUNE GLOB G 10 GRAM/100 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533-800-71","type":"NDC"}],"standard_charges":[{"gross_charge":5326.25,"discounted_cash":4474.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"IMMUN GLOB G (GAMUNEX-C) WRAPPER [172722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533-800-21","type":"NDC"}],"standard_charges":[{"gross_charge":12319.25,"discounted_cash":10348.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG/KG"},{"gross_charge":16425.75,"discounted_cash":13797.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG/KG"},{"gross_charge":2663.25,"discounted_cash":2237.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"},{"gross_charge":20532.25,"discounted_cash":17247.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG/KG"},{"gross_charge":24638.5,"discounted_cash":20696.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG/KG"}]},{"description":"INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [176677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5104","type":"HCPCS"},{"code":"78206-162-99","type":"NDC"}],"standard_charges":[{"gross_charge":21190.0,"discounted_cash":17799.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":6357.0,"discounted_cash":5339.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":10595.0,"discounted_cash":8899.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [176677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5104","type":"HCPCS"},{"code":"78206-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":21190.0,"discounted_cash":17799.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":6357.0,"discounted_cash":5339.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":10595.0,"discounted_cash":8899.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [176677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5104","type":"HCPCS"},{"code":"0006-4305-02","type":"NDC"}],"standard_charges":[{"gross_charge":21190.0,"discounted_cash":17799.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":6357.0,"discounted_cash":5339.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":10595.0,"discounted_cash":8899.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [176677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5104","type":"HCPCS"},{"code":"0006-4305-01","type":"NDC"}],"standard_charges":[{"gross_charge":21190.0,"discounted_cash":17799.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":6357.0,"discounted_cash":5339.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":10595.0,"discounted_cash":8899.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"57894-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":13360.0,"discounted_cash":11222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":4008.0,"discounted_cash":3366.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":6680.0,"discounted_cash":5611.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"57894-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":32846.25,"discounted_cash":27590.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":9854.0,"discounted_cash":8277.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":16423.25,"discounted_cash":13795.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"INDUCTION 4:1 HIGH K (48 MEQ) IN RINGER'S 522.8 ML [177573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"72196-0206-1","type":"NDC"}],"standard_charges":[{"gross_charge":12267.75,"discounted_cash":10304.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":18401.5,"discounted_cash":15457.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":24535.25,"discounted_cash":20609.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"},{"gross_charge":30669.0,"discounted_cash":25761.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":6134.0,"discounted_cash":5152.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"INDUCTION 4:1 HIGH K (48 MEQ) IN RINGER'S 522.8 ML [177573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"71285-0206-1","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"},{"gross_charge":147.5,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"INFLIXIMAB-AXXQ 100 MG INTRAVENOUS SOLUTION [185456]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5121","type":"HCPCS"},{"code":"55513-670-01","type":"NDC"}],"standard_charges":[{"gross_charge":14063.25,"discounted_cash":11813.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":4219.0,"discounted_cash":3543.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":7031.75,"discounted_cash":5906.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"INSULIN DEGLUDEC 100 UNIT-LIRAGLUTIDE 3.6 MG/ML(3 ML) SUBCUTANEOUS PEN [173399]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-2911-15","type":"NDC"}],"standard_charges":[{"gross_charge":1152.25,"discounted_cash":967.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN DEGLUDEC (U-200) 200 UNIT/ML (3 ML) SUBCUTANEOUS PEN [167961]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-2550-13","type":"NDC"}],"standard_charges":[{"gross_charge":873.75,"discounted_cash":733.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN DEGLUDEC (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [167960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-2660-15","type":"NDC"}],"standard_charges":[{"gross_charge":501.75,"discounted_cash":421.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ASPART U-100  100 UNIT/ML SUBCUTANEOUS SOLUTION [28534]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-7501-11","type":"NDC"}],"standard_charges":[{"gross_charge":586.5,"discounted_cash":492.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN ASPART U-100  100 UNIT/ML SUBCUTANEOUS CARTRIDGE [124839]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73070-102-15","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"INSULIN ASPART U-100  100 UNIT/ML SUBCUTANEOUS CARTRIDGE [124839]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73070-102-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73070-103-15","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73070-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-6339-10","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [33666]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-3685-12","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 UNITS"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 UNITS"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 UNITS"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 UNITS"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 UNITS"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 UNITS"}]},{"description":"INSULIN ASPAR PROT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS PEN [124856]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-3696-19","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [173498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5103","type":"HCPCS"},{"code":"0069-0809-01","type":"NDC"}],"standard_charges":[{"gross_charge":26615.25,"discounted_cash":22356.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":7984.75,"discounted_cash":6707.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":13307.75,"discounted_cash":11178.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"INDOMETHACIN 1 MG INTRAVENOUS SOLUTION [10267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-659-03","type":"NDC"}],"standard_charges":[{"gross_charge":14877.25,"discounted_cash":12496.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":29754.25,"discounted_cash":24993.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"}]},{"description":"INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION [10266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-701-02","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"INDIUM-111 CHLORIDE 5 MCI/0.5 ML (185 MBQ) SOLUTION [113145]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9548","type":"HCPCS"},{"code":"00019-9132-06","type":"NDC"}],"standard_charges":[{"gross_charge":10650.0,"discounted_cash":8946.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLICURIE"}]},{"description":"INDIUM IN-111 OXYQUINOLINE 1 MCI/ML (37 MBQ/ML)(1 ML) INTRAVENOUS SOLN [98452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9547","type":"HCPCS"},{"code":"17156-021-01","type":"NDC"}],"standard_charges":[{"gross_charge":4210.0,"discounted_cash":3536.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MILLICURIE"}]},{"description":"INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT [13545]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9572","type":"HCPCS"},{"code":"0019-9050-40","type":"NDC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MICROCURIE"},{"gross_charge":3840.0,"discounted_cash":3225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MILLICURIE"}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION [193042]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"81284-315-05","type":"NDC"}],"standard_charges":[{"gross_charge":687.5,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":1031.25,"discounted_cash":866.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":1718.5,"discounted_cash":1443.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION [193042]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"81284-315-00","type":"NDC"}],"standard_charges":[{"gross_charge":687.5,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":1031.25,"discounted_cash":866.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":1718.5,"discounted_cash":1443.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION [10265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0375-05","type":"NDC"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":272.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":485.75,"discounted_cash":408.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":809.5,"discounted_cash":679.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION [10265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0375-01","type":"NDC"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":272.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":485.75,"discounted_cash":408.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":809.5,"discounted_cash":679.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"INDAPAMIDE 2.5 MG TABLET [3879]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-868-20","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"INDAPAMIDE 2.5 MG TABLET [3879]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0080-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"INDAPAMIDE 2.5 MG TABLET [3879]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2571-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE [190406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0078-1000-60","type":"NDC"}],"standard_charges":[{"gross_charge":10225.25,"discounted_cash":8589.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 284 MG"}]},{"description":"INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION [10266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17238-424-06","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":81.5,"discounted_cash":68.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION [10266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17238-424-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"INDOMETHACIN ER 75 MG CAPSULE,EXTENDED RELEASE [14628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-506-06","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"INDOMETHACIN ER 75 MG CAPSULE,EXTENDED RELEASE [14628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-506-03","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1852-7","type":"NDC"}],"standard_charges":[{"gross_charge":736.5,"discounted_cash":618.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1473.0,"discounted_cash":1237.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1852-6","type":"NDC"}],"standard_charges":[{"gross_charge":736.5,"discounted_cash":618.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1473.0,"discounted_cash":1237.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69344-102-33","type":"NDC"}],"standard_charges":[{"gross_charge":775.25,"discounted_cash":651.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1550.5,"discounted_cash":1302.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOMETHACIN 25 MG CAPSULE [3897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-430-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOMETHACIN 25 MG CAPSULE [3897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-430-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOMETHACIN 25 MG CAPSULE [3897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-542-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOMETHACIN 25 MG CAPSULE [3897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-406-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOMETHACIN 25 MG CAPSULE [3897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOMETHACIN 1 MG INTRAVENOUS SOLUTION [10267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1113-01","type":"NDC"}],"standard_charges":[{"gross_charge":14446.0,"discounted_cash":12134.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":28891.75,"discounted_cash":24269.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"}]},{"description":"INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION [10266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70100-424-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION [10266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70100-424-02","type":"NDC"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"IMIPRAMINE 10 MG TABLET [3860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1762-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51525-0113-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MCG"}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42192-339-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MCG"}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76439-309-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MCG"}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43199-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MCG"}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68220-113-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MCG"}]},{"description":"HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE [124667]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"5846800901","type":"NDC"}],"standard_charges":[{"gross_charge":832.75,"discounted_cash":699.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":1665.5,"discounted_cash":1399.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":2498.25,"discounted_cash":2098.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE [124668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"5846800903","type":"NDC"}],"standard_charges":[{"gross_charge":1665.5,"discounted_cash":1399.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":832.75,"discounted_cash":699.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION [3770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"0517-5602-25","type":"NDC"}],"standard_charges":[{"gross_charge":289.75,"discounted_cash":243.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION [3770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"0517-5601-25","type":"NDC"}],"standard_charges":[{"gross_charge":210.25,"discounted_cash":176.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROXYZINE HCL 50 MG TABLET [3775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"0904-6618-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 50 MG TABLET [3775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"16714-083-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 50 MG TABLET [3775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"0093-5062-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYOSCYAMINE 0.125 MG/ML ORAL DROPS [3782]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-506-15","type":"NDC"}],"standard_charges":[{"gross_charge":217.75,"discounted_cash":182.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYOSCYAMINE 0.125 MG/ML ORAL DROPS [3782]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39328-047-15","type":"NDC"}],"standard_charges":[{"gross_charge":216.5,"discounted_cash":181.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYOSCYAMINE ER 0.375 MG TABLET,EXTENDED RELEASE,12 HR [17010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68047-255-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.375 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG"}]},{"description":"IBUPROFEN 200 MG TABLET [3841]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-196-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 200 MG TABLET [3841]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7914-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 200 MG TABLET [3841]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7912-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-2044-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-2044-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1972-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0918-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1828-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1828-00","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1779-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5256913279","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-876-34","type":"NDC"}],"standard_charges":[{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-952-43","type":"NDC"}],"standard_charges":[{"gross_charge":164.75,"discounted_cash":138.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-503-62","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-503-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-503-59","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-494-62","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-494-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-494-58","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-229-34","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5309-20","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"IBRUTINIB 140 MG CAPSULE [124850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57962-140-09","type":"NDC"}],"standard_charges":[{"gross_charge":863.75,"discounted_cash":725.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"}]},{"description":"HYPROMELLOSE 2.5 % EYE DROPS [38092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17238-610-15","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROXYZINE HCL 25 MG/ML INTRAMUSCULAR SOLUTION [3769]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"0517-4201-25","type":"NDC"}],"standard_charges":[{"gross_charge":190.75,"discounted_cash":160.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"60687-675-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"10702-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION WRAPPER [4083771]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-502-47","type":"NDC"}],"standard_charges":[{"gross_charge":1823.5,"discounted_cash":1531.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION WRAPPER [4083771]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1821-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION WRAPPER [4083771]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-502-80","type":"NDC"}],"standard_charges":[{"gross_charge":322.75,"discounted_cash":271.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION WRAPPER [4083771]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-150-16","type":"NDC"}],"standard_charges":[{"gross_charge":216.25,"discounted_cash":181.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION WRAPPER [4083771]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-150-04","type":"NDC"}],"standard_charges":[{"gross_charge":134.75,"discounted_cash":113.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"HYDROXYZINE HCL 10 MG TABLET [3772]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"16714-081-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 10 MG TABLET [3772]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"63739-483-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 10 MG TABLET [3772]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"68084-253-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYUREA 500 MG CAPSULE [10236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-284-11","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG/KG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG/KG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG/KG"}]},{"description":"HYDROXYUREA 500 MG CAPSULE [10236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-284-01","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG/KG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG/KG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG/KG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"68084-254-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"60687-675-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"43063-962-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"0904-6617-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"23155-501-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"42806-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"16714-082-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"0093-5061-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"63739-486-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 25 MG TABLET [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0177","type":"HCPCS"},{"code":"23155-106-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IBUPROFEN 200 MG TABLET [3841]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-941-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"63323-349-94","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"IMETELSTAT 47 MG INTRAVENOUS SOLUTION [199092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"82959-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":7544.0,"discounted_cash":6336.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IMETELSTAT 188 MG INTRAVENOUS SOLUTION [199094]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"82959-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":20890.5,"discounted_cash":17548.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IMATINIB 400 MG TABLET [36092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0438-15","type":"NDC"}],"standard_charges":[{"gross_charge":1450.5,"discounted_cash":1218.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":2173.25,"discounted_cash":1825.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"IMATINIB 100 MG TABLET [32979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-240-90","type":"NDC"}],"standard_charges":[{"gross_charge":1663.75,"discounted_cash":1397.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":2493.0,"discounted_cash":2094.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"0338-3993-01","type":"NDC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":432.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"10019-926-02","type":"NDC"}],"standard_charges":[{"gross_charge":529.25,"discounted_cash":444.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"10019-925-01","type":"NDC"}],"standard_charges":[{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"63323-142-10","type":"NDC"}],"standard_charges":[{"gross_charge":285.75,"discounted_cash":240.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [168703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0597-0197-05","type":"NDC"}],"standard_charges":[{"gross_charge":15123.75,"discounted_cash":12703.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [100740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"0009-3794-01","type":"NDC"}],"standard_charges":[{"gross_charge":1021.25,"discounted_cash":857.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":2042.5,"discounted_cash":1715.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [100740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"23155-326-31","type":"NDC"}],"standard_charges":[{"gross_charge":667.5,"discounted_cash":560.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":1335.0,"discounted_cash":1121.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [100740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"67457-366-10","type":"NDC"}],"standard_charges":[{"gross_charge":667.5,"discounted_cash":560.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":1335.0,"discounted_cash":1121.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"IBUPROFEN 800 MG TABLET [3845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-691-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG TABLET [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11788-009-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"0409-3508-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"63323-349-25","type":"NDC"}],"standard_charges":[{"gross_charge":143.5,"discounted_cash":120.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"63323-322-01","type":"NDC"}],"standard_charges":[{"gross_charge":396.5,"discounted_cash":333.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":452.75,"discounted_cash":380.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"},{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":195.75,"discounted_cash":164.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":200.75,"discounted_cash":168.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":298.75,"discounted_cash":250.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"44567-705-10","type":"NDC"}],"standard_charges":[{"gross_charge":362.25,"discounted_cash":304.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":183.75,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":273.0,"discounted_cash":229.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"44567-705-01","type":"NDC"}],"standard_charges":[{"gross_charge":362.25,"discounted_cash":304.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":183.75,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":273.0,"discounted_cash":229.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"IBUPROFEN 600 MG TABLET [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-457-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"0409-3507-21","type":"NDC"}],"standard_charges":[{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"63323-322-94","type":"NDC"}],"standard_charges":[{"gross_charge":186.75,"discounted_cash":156.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":141.5,"discounted_cash":118.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"63323-322-25","type":"NDC"}],"standard_charges":[{"gross_charge":396.5,"discounted_cash":333.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":200.75,"discounted_cash":168.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":298.75,"discounted_cash":250.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"0006-3516-59","type":"NDC"}],"standard_charges":[{"gross_charge":431.5,"discounted_cash":362.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":218.25,"discounted_cash":183.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":324.75,"discounted_cash":272.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"HYDRALAZINE 10 MG TABLET [3698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-447-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IBUPROFEN 400 MG TABLET [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-446-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 400 MG TABLET [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-464-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 400 MG TABLET [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-319-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 400 MG TABLET [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483-602-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 400 MG TABLET [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-672-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 400 MG TABLET [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-672-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 400 MG TABLET [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5853-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 400 MG TABLET [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-446-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG TABLET [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-457-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG TABLET [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-808-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG TABLET [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-465-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG TABLET [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-320-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG TABLET [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-684-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG TABLET [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-684-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG TABLET [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5854-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"GLIPIZIDE 5 MG TABLET [10117]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6637-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 5 MG TABLET [10117]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-810-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 5 MG TABLET [10117]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-810-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 5 MG TABLET [10117]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1452-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 5 MG TABLET [10117]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0460-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 10 MG TABLET [10116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-362-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 10 MG TABLET [10116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-362-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 10 MG TABLET [10116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0142-0","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 10 MG TABLET [10116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-811-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 10 MG TABLET [10116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-811-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 10 MG TABLET [10116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1453-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0845-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0540-1","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-0170-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-295-21","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-295-11","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0900-30","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-896-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-281-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0542-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-112-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 10 MG TABLET [10116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1453-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIMEPIRIDE 2 MG TABLET [16356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0039-0222-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 1 MG TABLET [16355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-358-15","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 1 MG TABLET [16355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-358-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 1 MG TABLET [16355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 1 MG TABLET [16355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-320-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 1 MG TABLET [16355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0039-0221-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":86.25,"discounted_cash":72.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLATIRAMER 40 MG/ML SUBCUTANEOUS SYRINGE [125161]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1595","type":"HCPCS"},{"code":"68546-325-12","type":"NDC"}],"standard_charges":[{"gross_charge":1861.75,"discounted_cash":1563.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"GLATIRAMER 20 MG/ML SUBCUTANEOUS SYRINGE [134145]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1595","type":"HCPCS"},{"code":"68546-317-30","type":"NDC"}],"standard_charges":[{"gross_charge":1016.0,"discounted_cash":853.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"GI COCKTAIL [172665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00000-0001-35","type":"NDC"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"GENTIAN VIOLET 1 % TOPICAL SOLUTION [3430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0395-1003-92","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 ML"}]},{"description":"GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION [3425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":833.25,"discounted_cash":699.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION [3425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-173-94","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":66.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLIMEPIRIDE 2 MG TABLET [16356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-321-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 2 MG TABLET [16356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-425-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIPIZIDE 10 MG TABLET [10116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0461-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIMEPIRIDE 4 MG TABLET [16357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-327-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 4 MG TABLET [16357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-327-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 4 MG TABLET [16357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 4 MG TABLET [16357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0039-0223-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 2 MG TABLET [16356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-124-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 2 MG TABLET [16356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-326-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 2 MG TABLET [16356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-326-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 2 MG TABLET [16356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-425-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION [3425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-173-02","type":"NDC"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-279-03","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 2.5 MG TABLET [10126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-584-30","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 2.5 MG TABLET [10126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-057-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 2.5 MG TABLET [10126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-029-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 2.5 MG TABLET [10126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8343-98","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 2.5 MG TABLET [10126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-872-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 2.5 MG TABLET [10126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-872-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 2.5 MG TABLET [10126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-9433-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 2.5 MG TABLET [10126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8343-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 5 MG TABLET [3489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8344-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYCOPYRROLATE (PF) 0.2 MG/ML INJECTION SOLUTION [180003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"51754-6001-1","type":"NDC"}],"standard_charges":[{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE (PF) 0.2 MG/ML INJECTION SOLUTION [180003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"51754-6000-4","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE (PF) 0.2 MG/ML INJECTION SOLUTION [180003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"51754-6000-1","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCINE 1.5 % UROLOGIC SOLUTION FOR IRRIGATION [3493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-2302-70","type":"NDC"}],"standard_charges":[{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"GLYCERIN 99.5 % TOPICAL SOLUTION [82033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093995959","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"GLYCERIN 99.5 % TOPICAL SOLUTION [82033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0395-1031-96","type":"NDC"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"GLYCERIN (CHILD) RECTAL SUPPOSITORY [76974]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58980-409-12","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 EACH"}]},{"description":"GLYCERIN (CHILD) RECTAL SUPPOSITORY [76974]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0132-0081-12","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 EACH"}]},{"description":"GLYCERIN (ADULT) RECTAL SUPPOSITORY [41003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0132-0079-12","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 EACH"}]},{"description":"GLYBURIDE 5 MG TABLET [3489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-058-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 5 MG TABLET [3489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8344-98","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 5 MG TABLET [3489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-119-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 5 MG TABLET [3489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-873-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 5 MG TABLET [3489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8344-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 1.25 MG TABLET [10125]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-9477-53","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-269-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-895-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-280-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-745-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-0174-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0541-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-111-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0844-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-894-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION WRAPPER [181264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1610","type":"HCPCS"},{"code":"0597-0260-10","type":"NDC"}],"standard_charges":[{"gross_charge":367.75,"discounted_cash":308.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":735.25,"discounted_cash":617.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1470.5,"discounted_cash":1235.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GLYBURIDE 1.25 MG TABLET [10125]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8342-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLUCOSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [201496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"0338-9799-12","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"GLUCOSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [201496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"0338-9799-01","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"GLUCOSE 4 GRAM CHEWABLE TABLET [16050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068110000","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 G"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 G"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 G"}]},{"description":"GLUCOSE (TOLERANCE TEST) 100 GRAM/180 ML ORAL LIQUID [27650]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574195906","type":"NDC"}],"standard_charges":[{"gross_charge":68.25,"discounted_cash":57.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"GLUCAGON HCL 1 MG SOLUTION FOR INJECTION [184304]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63323-583-13","type":"NDC"}],"standard_charges":[{"gross_charge":1202.25,"discounted_cash":1009.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GLUCAGON 3 MG/ACTUATION NASAL SPRAY [182913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-6145-27","type":"NDC"}],"standard_charges":[{"gross_charge":1024.5,"discounted_cash":860.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"GLUCAGON 3 MG/ACTUATION NASAL SPRAY [182913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-6145-11","type":"NDC"}],"standard_charges":[{"gross_charge":1206.5,"discounted_cash":1013.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"GLUCAGON 3 MG/ACTUATION NASAL SPRAY [182913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-6145-02","type":"NDC"}],"standard_charges":[{"gross_charge":1206.5,"discounted_cash":1013.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"GLUCAGON 3 MG/ACTUATION NASAL SPRAY [182913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-6145-01","type":"NDC"}],"standard_charges":[{"gross_charge":1206.5,"discounted_cash":1013.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"GLUCAGON 1 MG SOLUTION FOR INJECTION [41569]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1610","type":"HCPCS"},{"code":"0002-8031-01","type":"NDC"}],"standard_charges":[{"gross_charge":601.5,"discounted_cash":505.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":1203.0,"discounted_cash":1010.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":2406.0,"discounted_cash":2021.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION WRAPPER [181264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1610","type":"HCPCS"},{"code":"0548-5850-00","type":"NDC"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":1199.75,"discounted_cash":1007.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":2399.25,"discounted_cash":2015.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION WRAPPER [181264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1611","type":"HCPCS"},{"code":"63323-593-03","type":"NDC"}],"standard_charges":[{"gross_charge":541.25,"discounted_cash":454.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":1082.5,"discounted_cash":909.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":2165.0,"discounted_cash":1818.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GLUCAGON HCL 1 MG SOLUTION FOR INJECTION [184304]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63323-582-82","type":"NDC"}],"standard_charges":[{"gross_charge":1202.25,"discounted_cash":1009.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GLYCOPYRROLATE (PF) 0.2 MG/ML INJECTION SOLUTION [180003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"51754-6001-4","type":"NDC"}],"standard_charges":[{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"0409-1207-03","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK [10106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"0338-0503-48","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483-607-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-774-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-774-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45963-557-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-224-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-663-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-663-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-984-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION [41137]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"0270-5164-15","type":"NDC"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-602-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-602-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51407-049-27","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51407-049-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6667-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-385-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG CAPSULE [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69367-133-04","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION [134056]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4708-06","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-384-50","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-504-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-504-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-236-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483-606-50","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-762-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-762-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657-621-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION [134056]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42192-608-40","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION [134056]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42192-608-06","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-591-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-591-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML(469.01 MG/ML) INTRAVENOUS SOLN [131400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"50419-188-84","type":"NDC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MMOL/KG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51407-048-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71093-121-04","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG CAPSULE [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6666-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GADOPENTETATE DIMEGLUMINE 2.5 MMOL/5 ML(469.01 MG/ML) INTRAVENOUS SOLN [131397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"50419-188-81","type":"NDC"}],"standard_charges":[{"gross_charge":85.5,"discounted_cash":71.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MMOL/KG"}]},{"description":"GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION [124929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67684-2000-2","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":78.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML/KG"}]},{"description":"GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"70860-205-50","type":"NDC"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":186.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":222.0,"discounted_cash":186.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 MG"}]},{"description":"GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"25021-234-10","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":82.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457-464-20","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"63323-102-13","type":"NDC"}],"standard_charges":[{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"55111-686-07","type":"NDC"}],"standard_charges":[{"gross_charge":656.25,"discounted_cash":551.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"16729-092-03","type":"NDC"}],"standard_charges":[{"gross_charge":260.75,"discounted_cash":219.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION [112788]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"71288-117-54","type":"NDC"}],"standard_charges":[{"gross_charge":219.5,"discounted_cash":184.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 52.6 ML"}]},{"description":"GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION [112788]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"0409-0182-01","type":"NDC"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":375.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 52.6 ML"}]},{"description":"GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [178042]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9196","type":"HCPCS"},{"code":"16729-391-30","type":"NDC"}],"standard_charges":[{"gross_charge":217.25,"discounted_cash":182.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION [112787]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"60505-6114-0","type":"NDC"}],"standard_charges":[{"gross_charge":220.25,"discounted_cash":185.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26.3 ML"}]},{"description":"GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION [112787]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457-617-30","type":"NDC"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":220.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26.3 ML"}]},{"description":"GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION [112787]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"45963-624-58","type":"NDC"}],"standard_charges":[{"gross_charge":220.25,"discounted_cash":185.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26.3 ML"}]},{"description":"GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION [112787]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"0409-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":223.5,"discounted_cash":187.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26.3 ML"}]},{"description":"GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"71288-114-50","type":"NDC"}],"standard_charges":[{"gross_charge":226.75,"discounted_cash":190.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"25021-235-50","type":"NDC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457-462-01","type":"NDC"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"63323-125-53","type":"NDC"}],"standard_charges":[{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"55111-687-25","type":"NDC"}],"standard_charges":[{"gross_charge":2432.75,"discounted_cash":2043.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"16729-117-11","type":"NDC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"0409-0186-01","type":"NDC"}],"standard_charges":[{"gross_charge":250.5,"discounted_cash":210.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE [28024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"6371301973","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE [28024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0323-01","type":"NDC"}],"standard_charges":[{"gross_charge":182.75,"discounted_cash":153.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":365.25,"discounted_cash":306.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE [28018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"6371301972","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE [28018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63713-019-72","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE [28018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0315-08","type":"NDC"}],"standard_charges":[{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"GEMFIBROZIL 600 MG TABLET [3378]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-101-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-010-42","type":"NDC"}],"standard_charges":[{"gross_charge":178.75,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-010-41","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-010-03","type":"NDC"}],"standard_charges":[{"gross_charge":225.25,"discounted_cash":189.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"0409-1207-13","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-010-95","type":"NDC"}],"standard_charges":[{"gross_charge":178.75,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-010-94","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-010-20","type":"NDC"}],"standard_charges":[{"gross_charge":225.25,"discounted_cash":189.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323-010-02","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN 100 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK [10108]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"0338-0505-48","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"GENTAMICIN 0.3 % EYE DROPS [3428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-633-05","type":"NDC"}],"standard_charges":[{"gross_charge":146.5,"discounted_cash":123.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GENTAMICIN 0.3 % EYE DROPS [3428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-188-05","type":"NDC"}],"standard_charges":[{"gross_charge":129.5,"discounted_cash":108.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GENTAMICIN 0.3 % EYE DROPS [3428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-580-60","type":"NDC"}],"standard_charges":[{"gross_charge":233.25,"discounted_cash":195.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GENTAMICIN 0.3 % EYE DROPS [3428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-283-10","type":"NDC"}],"standard_charges":[{"gross_charge":129.5,"discounted_cash":108.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GENTAMICIN 0.1 % TOPICAL OINTMENT [3424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52565-090-15","type":"NDC"}],"standard_charges":[{"gross_charge":268.75,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"GENTAMICIN 0.1 % TOPICAL OINTMENT [3424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0682-15","type":"NDC"}],"standard_charges":[{"gross_charge":268.75,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"GENTAMICIN 0.1 % TOPICAL OINTMENT [3424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-046-35","type":"NDC"}],"standard_charges":[{"gross_charge":268.75,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"GENTAMICIN 0.1 % TOPICAL OINTMENT [3424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-046-11","type":"NDC"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":341.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"GENTAMICIN 0.1 % TOPICAL CREAM [3423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52565-085-15","type":"NDC"}],"standard_charges":[{"gross_charge":268.75,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"GENTAMICIN 0.1 % TOPICAL CREAM [3423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0683-15","type":"NDC"}],"standard_charges":[{"gross_charge":268.75,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"GENTAMICIN 0.1 % TOPICAL CREAM [3423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-056-35","type":"NDC"}],"standard_charges":[{"gross_charge":268.75,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN [176951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9203","type":"HCPCS"},{"code":"0008-4510-01","type":"NDC"}],"standard_charges":[{"gross_charge":20612.5,"discounted_cash":17314.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMFIBROZIL 600 MG TABLET [3378]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72603-206-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"GEMFIBROZIL 600 MG TABLET [3378]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-224-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE [28025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"6371301974","type":"NDC"}],"standard_charges":[{"gross_charge":178.75,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":357.5,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"GALANTAMINE 4 MG TABLET [29806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2542-6","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALANTAMINE 4 MG TABLET [29806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-458-60","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALANTAMINE 4 MG TABLET [29806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-852-03","type":"NDC"}],"standard_charges":[{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALANTAMINE 4 MG TABLET [29806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-852-01","type":"NDC"}],"standard_charges":[{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALANTAMINE 12 MG TABLET [29808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436-006-06","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALANTAMINE 12 MG TABLET [29808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-051-60","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALANTAMINE 12 MG TABLET [29808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2544-6","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALANTAMINE 12 MG TABLET [29808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-460-60","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALANTAMINE 12 MG TABLET [29808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-398-60","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION [93574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9581","type":"HCPCS"},{"code":"50419-320-05","type":"NDC"}],"standard_charges":[{"gross_charge":131.5,"discounted_cash":110.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.025 MMOL/KG"}]},{"description":"GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION [10100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"0270-1111-03","type":"NDC"}],"standard_charges":[{"gross_charge":399.75,"discounted_cash":335.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MMOL/KG"},{"gross_charge":799.5,"discounted_cash":671.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MMOL/KG"}]},{"description":"GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION [124929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67684-2000-3","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":78.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML/KG"}]},{"description":"GALANTAMINE 4 MG TABLET [29806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-049-60","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE [28025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0342-01","type":"NDC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":412.0,"discounted_cash":346.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"GELATIN SPONGE,ABSORBABLE TOPICAL SYRINGE [181391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-1040-06","type":"NDC"}],"standard_charges":[{"gross_charge":600.5,"discounted_cash":504.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1200.75,"discounted_cash":1008.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"GELATIN SPONGE,ABSORBABLE TOPICAL SYRINGE [181391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-1040-01","type":"NDC"}],"standard_charges":[{"gross_charge":600.5,"discounted_cash":504.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1200.75,"discounted_cash":1008.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"GELATIN ABSORBABLE MUCOSAL POWDER [28017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63713-019-78","type":"NDC"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":523.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"GELATIN ABSORBABLE MUCOSAL POWDER [28017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0433-04","type":"NDC"}],"standard_charges":[{"gross_charge":374.5,"discounted_cash":314.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"GELATIN ABSORBABLE EYE FILM [28028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9029703","type":"NDC"}],"standard_charges":[{"gross_charge":1062.25,"discounted_cash":892.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":2124.5,"discounted_cash":1784.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 EACH"}]},{"description":"GEL DRESSING TOPICAL [127908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4056511527","type":"NDC"}],"standard_charges":[{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION [10101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"63323-315-01","type":"NDC"}],"standard_charges":[{"gross_charge":478.75,"discounted_cash":402.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION [10101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"70436-089-55","type":"NDC"}],"standard_charges":[{"gross_charge":216.5,"discounted_cash":181.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION [10101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"42023-173-25","type":"NDC"}],"standard_charges":[{"gross_charge":354.25,"discounted_cash":297.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION [124929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67684-2000-1","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":78.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML/KG"}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION [10101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"42023-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":354.25,"discounted_cash":297.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":273.25,"discounted_cash":229.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"GANCICLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [178763]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"25021-185-11","type":"NDC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GANCICLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [178763]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"25021-185-10","type":"NDC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GALLIUM CITRATE GA 67 [40840060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9556","type":"HCPCS"},{"code":"00019-9180-06","type":"NDC"}],"standard_charges":[{"gross_charge":1630.0,"discounted_cash":1369.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MILLICURIE"},{"gross_charge":652.0,"discounted_cash":547.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MILLICURIE"},{"gross_charge":978.0,"discounted_cash":821.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MILLICURIE"},{"gross_charge":1304.0,"discounted_cash":1095.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MILLICURIE"}]},{"description":"GALANTAMINE 4 MG TABLET [29806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436-004-06","type":"NDC"}],"standard_charges":[{"gross_charge":64.75,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION [10101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"63323-315-10","type":"NDC"}],"standard_charges":[{"gross_charge":478.75,"discounted_cash":402.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"0517-4601-25","type":"NDC"}],"standard_charges":[{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"0517-4602-25","type":"NDC"}],"standard_charges":[{"gross_charge":156.5,"discounted_cash":131.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"0517-4605-25","type":"NDC"}],"standard_charges":[{"gross_charge":226.25,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457-374-99","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457-374-12","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2723-31","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2723-30","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021-402-66","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739-901-14","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739-953-25","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739-953-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739-901-28","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0641-0400-37","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288-403-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288-403-02","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION - INITIAL BOLUS [183606]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021-402-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION - INITIAL BOLUS [176879]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-262-55","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION - INITIAL BOLUS [176879]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-262-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [172747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288-403-11","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [172747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288-403-10","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0781-3545-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0781-3545-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288-422-96","type":"NDC"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS/ML"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25000 UNITS"},{"gross_charge":65.75,"discounted_cash":55.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30000 UNITS"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS/ML"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288-422-95","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0641-0400-12","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN [15849]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7650-05","type":"NDC"}],"standard_charges":[{"gross_charge":175.75,"discounted_cash":147.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN [15849]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-517-01","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN [15849]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-517-74","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN [15849]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7650-52","type":"NDC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN [15849]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7650-62","type":"NDC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [172743]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-523-01","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [172743]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-523-74","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [172743]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7793-52","type":"NDC"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":110.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [172743]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7793-62","type":"NDC"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":110.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [172743]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0264-9587-20","type":"NDC"}],"standard_charges":[{"gross_charge":180.75,"discounted_cash":151.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"72603-234-25","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"72603-234-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"72603-179-25","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"72603-179-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"81952-112-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"81952-112-05","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-540-36","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288-420-96","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288-420-95","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-540-15","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-540-05","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288-402-11","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288-402-10","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457-385-99","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN [15849]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7650-30","type":"NDC"}],"standard_charges":[{"gross_charge":175.75,"discounted_cash":147.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0069-0059-04","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0069-0059-03","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0069-0059-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0069-0059-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021-402-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2723-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2723-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-047-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UNITS/KG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 UNITS/KG"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457-385-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [165496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90651","type":"HCPCS"},{"code":"0006-4121-02","type":"NDC"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":1109.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [165496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90651","type":"HCPCS"},{"code":"0006-4121-01","type":"NDC"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":1109.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT (PF) 0.5 ML IM SUSPENSION [165495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90651","type":"HCPCS"},{"code":"0006-4119-01","type":"NDC"}],"standard_charges":[{"gross_charge":978.75,"discounted_cash":822.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT (PF) 0.5 ML IM SUSPENSION [165495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90651","type":"HCPCS"},{"code":"0006-4119-03","type":"NDC"}],"standard_charges":[{"gross_charge":978.75,"discounted_cash":822.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HUM PROTHROMBIN CPLX, 4-FACTOR 1,000 UNIT (800-1,240 UNIT) IV SOLUTION [135302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-397-01","type":"NDC"}],"standard_charges":[{"gross_charge":3140.0,"discounted_cash":2637.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 INT'L UNITS"},{"gross_charge":4710.0,"discounted_cash":3956.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 INT'L UNITS"},{"gross_charge":6052.5,"discounted_cash":5084.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":8473.5,"discounted_cash":7117.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 INT'L UNITS/KG"},{"gross_charge":12104.75,"discounted_cash":10167.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"},{"gross_charge":1570.0,"discounted_cash":1318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 INT'L UNITS"}]},{"description":"HUM PROTHROMBIN CPLX, 4-FACTOR 1,000 UNIT (800-1,240 UNIT) IV SOLUTION [135302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-387-02","type":"NDC"}],"standard_charges":[{"gross_charge":3140.0,"discounted_cash":2637.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 INT'L UNITS"},{"gross_charge":4710.0,"discounted_cash":3956.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 INT'L UNITS"},{"gross_charge":6052.5,"discounted_cash":5084.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":8473.5,"discounted_cash":7117.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 INT'L UNITS/KG"},{"gross_charge":12104.75,"discounted_cash":10167.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"},{"gross_charge":1570.0,"discounted_cash":1318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 INT'L UNITS"}]},{"description":"HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7248-13","type":"NDC"}],"standard_charges":[{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7248-03","type":"NDC"}],"standard_charges":[{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-1965-10","type":"NDC"}],"standard_charges":[{"gross_charge":192.75,"discounted_cash":161.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [130502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160-821-52","type":"NDC"}],"standard_charges":[{"gross_charge":355.75,"discounted_cash":298.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP [130547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160-821-01","type":"NDC"}],"standard_charges":[{"gross_charge":355.75,"discounted_cash":298.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP [130547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160-821-11","type":"NDC"}],"standard_charges":[{"gross_charge":355.75,"discounted_cash":298.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [130543]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90744","type":"HCPCS"},{"code":"58160-820-43","type":"NDC"}],"standard_charges":[{"gross_charge":190.25,"discounted_cash":159.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [130543]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90744","type":"HCPCS"},{"code":"58160-820-52","type":"NDC"}],"standard_charges":[{"gross_charge":190.25,"discounted_cash":159.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [179564]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43528-003-05","type":"NDC"}],"standard_charges":[{"gross_charge":1338.25,"discounted_cash":1124.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [179564]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90739","type":"HCPCS"},{"code":"43528-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":1338.25,"discounted_cash":1124.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN-MALTOSE >312 UNIT/ML INJECTION SOLUTION [88654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1571","type":"HCPCS"},{"code":"70257-052-51","type":"NDC"}],"standard_charges":[{"gross_charge":3852.5,"discounted_cash":3236.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 ML/KG"},{"gross_charge":2498.5,"discounted_cash":2098.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":4164.0,"discounted_cash":3497.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN-MALTOSE >312 UNIT/ML INJECTION SOLUTION [88654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1571","type":"HCPCS"},{"code":"70257-052-11","type":"NDC"}],"standard_charges":[{"gross_charge":3852.5,"discounted_cash":3236.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 ML/KG"},{"gross_charge":2498.5,"discounted_cash":2098.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":4164.0,"discounted_cash":3497.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN-MALTOSE >312 UNIT/ML (5 ML) INJECTION SOLN [130083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1571","type":"HCPCS"},{"code":"70257-051-51","type":"NDC"}],"standard_charges":[{"gross_charge":2863.5,"discounted_cash":2405.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 ML/KG"},{"gross_charge":1857.0,"discounted_cash":1559.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":3095.0,"discounted_cash":2599.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HUMAN PROTHROMBIN COMPLEX (KCENTRA) INJECTION [172712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-386-02","type":"NDC"}],"standard_charges":[{"gross_charge":3140.0,"discounted_cash":2637.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 INT'L UNITS"},{"gross_charge":4710.0,"discounted_cash":3956.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 INT'L UNITS"},{"gross_charge":6052.5,"discounted_cash":5084.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":8473.5,"discounted_cash":7117.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 INT'L UNITS/KG"},{"gross_charge":12104.75,"discounted_cash":10167.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"},{"gross_charge":1570.0,"discounted_cash":1318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 INT'L UNITS"}]},{"description":"HYDRALAZINE 10 MG TABLET [3698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 10 MG TABLET [3698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-074-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE 10 MG TABLET [3698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-398-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"18657-117-04","type":"NDC"}],"standard_charges":[{"gross_charge":275.25,"discounted_cash":231.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYALURONIDASE (OVINE) 200 UNIT/ML INJECTION SOLUTION [40449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24208-002-02","type":"NDC"}],"standard_charges":[{"gross_charge":496.75,"discounted_cash":417.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 UNITS"}]},{"description":"HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE [125669]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7327","type":"HCPCS"},{"code":"5967682001","type":"NDC"}],"standard_charges":[{"gross_charge":5472.0,"discounted_cash":4596.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [135226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-396-01","type":"NDC"}],"standard_charges":[{"gross_charge":3140.0,"discounted_cash":2637.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 INT'L UNITS"},{"gross_charge":4710.0,"discounted_cash":3956.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 INT'L UNITS"},{"gross_charge":6052.5,"discounted_cash":5084.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":8473.5,"discounted_cash":7117.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 INT'L UNITS/KG"},{"gross_charge":12104.75,"discounted_cash":10167.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"},{"gross_charge":1570.0,"discounted_cash":1318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 INT'L UNITS"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN-MALTOSE >312 UNIT/ML (5 ML) INJECTION SOLN [130083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1571","type":"HCPCS"},{"code":"70257-051-05","type":"NDC"}],"standard_charges":[{"gross_charge":2863.5,"discounted_cash":2405.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 ML/KG"},{"gross_charge":1857.0,"discounted_cash":1559.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":3095.0,"discounted_cash":2599.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [105460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290036003","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION [128632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"63323-545-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS"}]},{"description":"HEPARIN IN NACL 1,000 UNIT/500 ML IRRIGATION SOLUTION (INTRA-OP ONLY) [189763]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-519-77","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"HEPARIN IN NACL 1,000 UNIT/500 ML IRRIGATION SOLUTION (INTRA-OP ONLY) [189763]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-519-02","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"HEPARIN IN NACL 1,000 UNIT/500 ML IRRIGATION SOLUTION (INTRA-OP ONLY) [189763]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0338-0424-18","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"HEPARIN IN NACL 1,000 UNIT/500 ML IRRIGATION SOLUTION (INTRA-OP ONLY) [189763]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7620-13","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"HEPARIN IN NACL 1,000 UNIT/500 ML IRRIGATION SOLUTION (INTRA-OP ONLY) [189763]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7620-03","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"HEPARIN IN NACL 1,000 UNIT/500 ML IRRIGATION SOLUTION (INTRA-OP ONLY) [189763]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0264-9872-10","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"HEPARIN FOR LINE PLACEMENT MIXTURE 0.25 UNITS/ML (NEO/PED) [400492]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7009-00","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [105460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"6425322235","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [105460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290306413","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [105460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290306414","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [105460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290306521","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN GREATR THAN 312 UNIT/ML INTRAMUSCULAR SOLN [10183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"59730-4202-1","type":"NDC"}],"standard_charges":[{"gross_charge":3696.5,"discounted_cash":3105.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 ML/KG"},{"gross_charge":2397.25,"discounted_cash":2013.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":3995.5,"discounted_cash":3356.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"69800-4203-2","type":"NDC"}],"standard_charges":[{"gross_charge":2540.75,"discounted_cash":2134.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 ML/KG"},{"gross_charge":1647.75,"discounted_cash":1384.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":2746.0,"discounted_cash":2306.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"69800-4203-1","type":"NDC"}],"standard_charges":[{"gross_charge":2667.75,"discounted_cash":2240.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 ML/KG"},{"gross_charge":1730.0,"discounted_cash":1453.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":2883.5,"discounted_cash":2422.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"59730-4203-1","type":"NDC"}],"standard_charges":[{"gross_charge":2262.75,"discounted_cash":1900.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 ML/KG"},{"gross_charge":1467.5,"discounted_cash":1232.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":2445.5,"discounted_cash":2054.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML (5 ML) INTRAMUSCULAR SOLUTION [130420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"13533-636-50","type":"NDC"}],"standard_charges":[{"gross_charge":3642.75,"discounted_cash":3059.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 ML/KG"},{"gross_charge":393.75,"discounted_cash":330.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML (5 ML) INTRAMUSCULAR SOLUTION [130420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"13533-636-05","type":"NDC"}],"standard_charges":[{"gross_charge":3642.75,"discounted_cash":3059.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 ML/KG"},{"gross_charge":393.75,"discounted_cash":330.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML INTRAMUSCULAR SYRINGE [130421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"13533-636-03","type":"NDC"}],"standard_charges":[{"gross_charge":436.25,"discounted_cash":366.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 110 UNITS"}]},{"description":"HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE [91033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90633","type":"HCPCS"},{"code":"58160-825-52","type":"NDC"}],"standard_charges":[{"gross_charge":254.75,"discounted_cash":213.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 UNITS"}]},{"description":"HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [130591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"58160-826-52","type":"NDC"}],"standard_charges":[{"gross_charge":424.5,"discounted_cash":356.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [130591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"58160-826-43","type":"NDC"}],"standard_charges":[{"gross_charge":424.5,"discounted_cash":356.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [130745]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-815-52","type":"NDC"}],"standard_charges":[{"gross_charge":650.5,"discounted_cash":546.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN, PORCINE (PF) 5,000 UNIT/ML INJECTION SYRINGE [183107]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0641-6199-10","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN, PORCINE (PF) 5,000 UNIT/ML INJECTION SYRINGE [183107]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0641-6199-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [130029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"0000-0002-26","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS"}]},{"description":"HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [130029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290306424","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS"}]},{"description":"HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [130029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290306423","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS"}]},{"description":"HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [130029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"6380760055","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS"}]},{"description":"HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [130029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"6425333335","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 UNITS/ML"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS"}]},{"description":"HEPARIN, PORCINE (PF) 100 UNIT/ML (1 ML) INTRAVENOUS SOLUTION [130032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"6332354901","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457-384-99","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457-384-31","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457-372-99","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR [135037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824-008-34","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR [135037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824-008-50","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-1186-2","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2053-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1155-00","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1488-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1488-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6056906304","type":"NDC"}],"standard_charges":[{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-063-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-063-12","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1744-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-117-70","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID [3542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-117-40","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"GRANISETRON 3.1 MG/24 HOUR WEEKLY TRANSDERMAL PATCH [93997]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42747-726-01","type":"NDC"}],"standard_charges":[{"gross_charge":2516.5,"discounted_cash":2113.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT [10137]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9202","type":"HCPCS"},{"code":"70720-950-36","type":"NDC"}],"standard_charges":[{"gross_charge":3835.75,"discounted_cash":3222.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.6 MG"}]},{"description":"GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR [135037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824-008-15","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR [135037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-572-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"HALOPERIDOL 0.5 MG TABLET [3578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1391-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 0.5 MG TABLET [3578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0351-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 0.5 MG TABLET [3578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0351-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90648","type":"HCPCS"},{"code":"58160-818-11","type":"NDC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90648","type":"HCPCS"},{"code":"49281-545-03","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90648","type":"HCPCS"},{"code":"49281-547-58","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HAEMOPH B POLYSAC CONJ-MENING (PF) 7.5 MCG/0.5 ML INTRAMUSCULAR SOLN [126228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-4897-01","type":"NDC"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR [99835]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-924-01","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":146.75,"discounted_cash":123.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":217.5,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":288.5,"discounted_cash":242.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"GUANFACINE 1 MG TABLET [10149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-458-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GUANFACINE 1 MG TABLET [10149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-748-95","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GUANFACINE 1 MG TABLET [10149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-748-25","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GUANFACINE 1 MG TABLET [10149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-711-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GUANFACINE 1 MG TABLET [10149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0444-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR [135037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6718-39","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"GOSERELIN 10.8 MG SUBCUTANEOUS IMPLANT [16254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9202","type":"HCPCS"},{"code":"70720-951-30","type":"NDC"}],"standard_charges":[{"gross_charge":8655.0,"discounted_cash":7270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.8 MG"}]},{"description":"GLYCOPYRROLATE 9 MCG-FORMOTEROL 4.8 MCG HFA AEROSOL INHALER [172796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-4600-39","type":"NDC"}],"standard_charges":[{"gross_charge":908.75,"discounted_cash":763.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.9 G"}]},{"description":"GLYCOPYRROLATE 9 MCG-FORMOTEROL 4.8 MCG HFA AEROSOL INHALER [172796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-4600-12","type":"NDC"}],"standard_charges":[{"gross_charge":1622.5,"discounted_cash":1362.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.7 G"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION PF AND NON-PF WRAPPER [408119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"7700-5390-00","type":"NDC"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION PF AND NON-PF WRAPPER [408119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"0143-9682-25","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION PF AND NON-PF WRAPPER [408119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"0143-9680-25","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION PF AND NON-PF WRAPPER [408119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"0143-9680-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"60505-6180-5","type":"NDC"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"60505-6180-0","type":"NDC"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"0781-3827-96","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"0781-3827-72","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"0781-3825-96","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"0781-3825-71","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"66794-203-02","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"66794-202-42","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"63323-578-42","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"63323-578-41","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"63323-578-12","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"63323-578-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70121-1395-5","type":"NDC"}],"standard_charges":[{"gross_charge":117.5,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70121-1395-1","type":"NDC"}],"standard_charges":[{"gross_charge":117.5,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70069-012-25","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70069-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70069-011-25","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [119135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70069-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE 1 MG TABLET [10130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6709-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GLYCOPYRROLATE 1 MG TABLET [10130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-270-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GLYCOPYRROLATE 1 MG TABLET [10130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-270-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GLYCOPYRROLATE 1 MG TABLET [10130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-014-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GLYCOPYRROLATE 1 MG TABLET [10130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-648-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GLYCOPYRROLATE 1 MG TABLET [10130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-065-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML RIVA INJECTION SOLUTION [408037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00000-0002-98","type":"NDC"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HALOPERIDOL 0.5 MG TABLET [3578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-733-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90723","type":"HCPCS"},{"code":"58160-811-52","type":"NDC"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":426.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION [176195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55292-702-55","type":"NDC"}],"standard_charges":[{"gross_charge":7857461.25,"discounted_cash":6600267.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MG"}]},{"description":"HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION [176195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55292-702-54","type":"NDC"}],"standard_charges":[{"gross_charge":7857461.25,"discounted_cash":6600267.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MG"}]},{"description":"HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION [176195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1640","type":"HCPCS"},{"code":"55292-702-54","type":"NDC"}],"standard_charges":[{"gross_charge":1730886.5,"discounted_cash":1453944.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"63323-474-00","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"0143-9501-25","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"67457-426-12","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"25021-806-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"10147-0911-1","type":"NDC"}],"standard_charges":[{"gross_charge":99.75,"discounted_cash":83.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"63323-474-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE [3585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1241-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE [3585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-501-15","type":"NDC"}],"standard_charges":[{"gross_charge":217.75,"discounted_cash":182.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE [3585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0581-05","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV [131457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0338-0433-04","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV [131457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7620-59","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457-372-12","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2720-32","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2720-31","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2720-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 UNITS"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00000-0004-46","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"99999-0005-03","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739-931-28","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739-931-14","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021-400-66","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739-920-25","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739-920-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021-400-67","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0641-0391-37","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0641-0391-12","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"70069-030-03","type":"NDC"}],"standard_charges":[{"gross_charge":339.5,"discounted_cash":285.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":169.75,"discounted_cash":142.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0069-0058-02","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021-400-30","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021-400-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021-400-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2720-03","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2720-02","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2720-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-540-31","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-540-11","type":"NDC"}],"standard_charges":[{"gross_charge":61.5,"discounted_cash":51.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-540-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV [131457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2222-12","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV [131457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-2222-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV [131457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-519-10","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV [131457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-519-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV [131457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7620-49","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0069-0058-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"0703-7011-01","type":"NDC"}],"standard_charges":[{"gross_charge":310.25,"discounted_cash":260.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HALOPERIDOL 2 MG TABLET [3581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1530-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 2 MG TABLET [3581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-735-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 2 MG TABLET [3581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1393-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 2 MG TABLET [3581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0214-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 1 MG TABLET [3579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-734-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 1 MG TABLET [3579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1392-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 1 MG TABLET [3579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0257-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 0.5 MG TABLET [3578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-733-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 5 MG TABLET [3583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1396-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"10147-0921-3","type":"NDC"}],"standard_charges":[{"gross_charge":337.5,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"63323-469-01","type":"NDC"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":307.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":91.5,"discounted_cash":76.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":183.0,"discounted_cash":153.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"0703-7011-03","type":"NDC"}],"standard_charges":[{"gross_charge":310.25,"discounted_cash":260.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HALOPERIDOL 5 MG TABLET [3583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-161-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 5 MG TABLET [3583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-161-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 5 MG TABLET [3583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-079-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 5 MG TABLET [3583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-736-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 5 MG TABLET [3583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-736-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 5 MG TABLET [3583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1396-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MINOCYCLINE 50 MG CAPSULE [5111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5694-60","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SITAGLIPTIN PHOSPHATE 25 MG TABLET [77615]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0221-01","type":"NDC"}],"standard_charges":[{"gross_charge":361.5,"discounted_cash":303.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":94.25,"discounted_cash":79.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":183.25,"discounted_cash":153.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SITAGLIPTIN PHOSPHATE 25 MG TABLET [77615]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0221-28","type":"NDC"}],"standard_charges":[{"gross_charge":361.5,"discounted_cash":303.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":94.25,"discounted_cash":79.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":183.25,"discounted_cash":153.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SITAGLIPTIN PHOSPHATE 25 MG TABLET [77615]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0221-54","type":"NDC"}],"standard_charges":[{"gross_charge":361.5,"discounted_cash":303.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":94.25,"discounted_cash":79.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":183.25,"discounted_cash":153.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SITAGLIPTIN PHOSPHATE 25 MG TABLET [77615]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0221-31","type":"NDC"}],"standard_charges":[{"gross_charge":361.5,"discounted_cash":303.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":94.25,"discounted_cash":79.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":183.25,"discounted_cash":153.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SIROLIMUS 1 MG TABLET [28958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"50268-718-13","type":"NDC"}],"standard_charges":[{"gross_charge":100.5,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":386.75,"discounted_cash":324.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"SIROLIMUS 1 MG TABLET [28958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"50268-718-11","type":"NDC"}],"standard_charges":[{"gross_charge":100.5,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":386.75,"discounted_cash":324.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"SIROLIMUS 1 MG TABLET [28958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"59762-1002-1","type":"NDC"}],"standard_charges":[{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":119.5,"discounted_cash":100.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":234.0,"discounted_cash":196.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"SIROLIMUS 1 MG TABLET [28958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"0008-1041-10","type":"NDC"}],"standard_charges":[{"gross_charge":117.25,"discounted_cash":98.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":229.5,"discounted_cash":192.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":454.0,"discounted_cash":381.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"SIROLIMUS 1 MG TABLET [28958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"0008-1041-05","type":"NDC"}],"standard_charges":[{"gross_charge":108.75,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":212.5,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":420.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"SIROLIMUS 0.5 MG TABLET [104764]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"68084-956-25","type":"NDC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":279.75,"discounted_cash":234.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"SINCALIDE 5 MCG SOLUTION FOR INJECTION [11368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2805","type":"HCPCS"},{"code":"72266-248-05","type":"NDC"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":566.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SINCALIDE 5 MCG SOLUTION FOR INJECTION [11368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2805","type":"HCPCS"},{"code":"72266-248-01","type":"NDC"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":566.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SITAGLIPTIN PHOSPHATE 50 MG TABLET [77616]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0112-31","type":"NDC"}],"standard_charges":[{"gross_charge":183.25,"discounted_cash":153.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":94.25,"discounted_cash":79.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SODIUM BICARBONATE 10 MEQ/10 ML (8.4 %) INTRAVENOUS SYRINGE [133799]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4900-34","type":"NDC"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION [127274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6625-22","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION [127274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6625-14","type":"NDC"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":200.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MEQ"},{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION [127274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-5011-4","type":"NDC"}],"standard_charges":[{"gross_charge":186.5,"discounted_cash":156.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":372.75,"discounted_cash":313.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION [127274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-5011-1","type":"NDC"}],"standard_charges":[{"gross_charge":186.5,"discounted_cash":156.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":372.75,"discounted_cash":313.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION [127274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-5001-5","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION [127274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-5001-1","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION [127274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-089-50","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION [127274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-890-50","type":"NDC"}],"standard_charges":[{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":161.5,"discounted_cash":135.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION [127274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6625-02","type":"NDC"}],"standard_charges":[{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69784-231-10","type":"NDC"}],"standard_charges":[{"gross_charge":162.75,"discounted_cash":136.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69784-230-10","type":"NDC"}],"standard_charges":[{"gross_charge":147.25,"discounted_cash":123.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69784-230-20","type":"NDC"}],"standard_charges":[{"gross_charge":147.25,"discounted_cash":123.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3299-45","type":"NDC"}],"standard_charges":[{"gross_charge":127.75,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3299-16","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7299-83","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3299-25","type":"NDC"}],"standard_charges":[{"gross_charge":127.75,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3299-06","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7299-73","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"SINCALIDE 5 MCG SOLUTION FOR INJECTION [11368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2805","type":"HCPCS"},{"code":"0270-0556-15","type":"NDC"}],"standard_charges":[{"gross_charge":643.5,"discounted_cash":540.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SIMVASTATIN 40 MG TABLET [11366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-573-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMVASTATIN 20 MG TABLET [11365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-683-02","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":133.5,"discounted_cash":112.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMVASTATIN 20 MG TABLET [11365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-683-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMVASTATIN 20 MG TABLET [11365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-052-90","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMVASTATIN 20 MG TABLET [11365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-455-20","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMVASTATIN 20 MG TABLET [11365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-455-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMPLE SYRUP [7242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"395266116","type":"NDC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":577.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333-812-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333-812-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMVASTATIN 20 MG TABLET [11365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-512-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMVASTATIN 40 MG TABLET [11366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-684-03","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMVASTATIN 40 MG TABLET [11366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-684-02","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMVASTATIN 40 MG TABLET [11366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-053-90","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SODIUM BICARBONATE 325 MG TABLET [7311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1046-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"SIMVASTATIN 40 MG TABLET [11366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-456-20","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMVASTATIN 20 MG TABLET [11365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-572-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-225-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) INTRAVENOUS SYRINGE [7306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-5534-34","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MEQ"},{"gross_charge":87.75,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MEQ"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7984-37","type":"NDC"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":65.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7984-13","type":"NDC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7983-02","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"76297-001-32","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"76297-001-22","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"76297-001-21","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"17271-701-03","type":"NDC"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7800-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"7700-1159-01","type":"NDC"}],"standard_charges":[{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"76297-001-02","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-623-76","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-623-75","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-623-74","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-623-61","type":"NDC"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":65.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-9579-96","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-9550-50","type":"NDC"}],"standard_charges":[{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-9525-72","type":"NDC"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"7700-0851-01","type":"NDC"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"7700-0865-01","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"7700-0864-05","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"7700-0837-02","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-9543-04","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-9543-02","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7984-11","type":"NDC"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7983-25","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7984-37","type":"NDC"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7984-20","type":"NDC"}],"standard_charges":[{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7983-61","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7984-36","type":"NDC"}],"standard_charges":[{"gross_charge":78.25,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7983-55","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7983-61","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7983-55","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS [400291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0049-18","type":"NDC"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":270.25,"discounted_cash":227.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS [400291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0049-11","type":"NDC"}],"standard_charges":[{"gross_charge":479.75,"discounted_cash":402.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"},{"gross_charge":267.0,"discounted_cash":224.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS [400291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0049-04","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS [400291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0049-03","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS [400291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0049-02","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":125.25,"discounted_cash":105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS [400291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7800-10","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS [400291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7800-00","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-9543-03","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-9791-40","type":"NDC"}],"standard_charges":[{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-9791-01","type":"NDC"}],"standard_charges":[{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"70512-841-11","type":"NDC"}],"standard_charges":[{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-470-30","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-470-05","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-472-20","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-472-05","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7983-03","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7984-20","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7983-25","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7983-03","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0049-48","type":"NDC"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"7700-1162-01","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0043-04","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0043-03","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7802-00","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM BORATE-BORIC ACID-SODIUM CHLORIDE-WATER EYE WASH SOLN [10782]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1011900252","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE [7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6637-24","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":137.75,"discounted_cash":115.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE [7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6637-14","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":137.75,"discounted_cash":115.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE [7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3352-1","type":"NDC"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":159.75,"discounted_cash":134.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE [7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6637-34","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":87.75,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 650 MG TABLET [7312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66553-008-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"SODIUM BICARBONATE 4.2 % INTRAVENOUS SOLUTION [127297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-5555-12","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MEQ"},{"gross_charge":125.5,"discounted_cash":105.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MEQ"}]},{"description":"SODIUM BICARBONATE 4.2 % INTRAVENOUS SOLUTION [127297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-5555-02","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MEQ"},{"gross_charge":125.5,"discounted_cash":105.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MEQ"}]},{"description":"SODIUM BICARBONATE 4.2 % INTRAVENOUS SOLUTION [127297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-083-05","type":"NDC"}],"standard_charges":[{"gross_charge":153.75,"discounted_cash":129.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MEQ"},{"gross_charge":307.25,"discounted_cash":258.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MEQ"}]},{"description":"SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) INTRAVENOUS SYRINGE [7306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-5534-24","type":"NDC"}],"standard_charges":[{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MEQ"},{"gross_charge":144.5,"discounted_cash":121.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MEQ"}]},{"description":"SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) INTRAVENOUS SYRINGE [7306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-5534-14","type":"NDC"}],"standard_charges":[{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MEQ"},{"gross_charge":144.5,"discounted_cash":121.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MEQ"}]},{"description":"SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7985-09","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"7700-0000-07","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0049-41","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0049-38","type":"NDC"}],"standard_charges":[{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0049-31","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7800-20","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-1800-31","type":"NDC"}],"standard_charges":[{"gross_charge":76.25,"discounted_cash":64.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK [129938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7101-04","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK [129938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7101-02","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK [129938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0553-18","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % FOR NEBULIZATION [7325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7620430003","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % FOR NEBULIZATION [7325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0487-9301-33","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % FOR NEBULIZATION [7325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0487-9301-03","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL [29676]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-357-58","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL [29676]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0904-3865-75","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 44 ML"}]},{"description":"SODIUM CHLORIDE 0.45 % IV BOLUS [400292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7985-09","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7206-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SERTRALINE 100 MG TABLET [11350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-4910-1","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 100 MG TABLET [11350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-4910-41","type":"NDC"}],"standard_charges":[{"gross_charge":120.75,"discounted_cash":101.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39328-120-50","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39328-120-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4967-40","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4967-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-731-24","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-731-11","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54859-808-08","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433-219-40","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433-219-05","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-462-08","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433-211-05","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [127228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4454-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.6 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 MG"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-432-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SERTRALINE 100 MG TABLET [11350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-4910-3","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 25 MG TABLET [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-149-01","type":"NDC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 25 MG TABLET [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-149-20","type":"NDC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 25 MG TABLET [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-611-05","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 25 MG TABLET [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-611-04","type":"NDC"}],"standard_charges":[{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 25 MG TABLET [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-351-09","type":"NDC"}],"standard_charges":[{"gross_charge":77.25,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 100 MG TABLET [11350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-253-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 100 MG TABLET [11350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-253-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 100 MG TABLET [11350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-214-90","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 100 MG TABLET [11350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-613-04","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 100 MG TABLET [11350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-4910-4","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-622-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6725-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-0058-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-454-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-0041-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-165-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6522-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5789645101","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645-851-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645-851-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67618-300-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SEMAGLUTIDE 0.25 MG OR 0.5 MG (2 MG/1.5 ML) SUBCUTANEOUS PEN INJECTOR [177740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-4132-11","type":"NDC"}],"standard_charges":[{"gross_charge":426.75,"discounted_cash":358.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":853.5,"discounted_cash":716.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"SEMAGLUTIDE 0.25 MG OR 0.5 MG (2 MG/1.5 ML) SUBCUTANEOUS PEN INJECTOR [177740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-4132-12","type":"NDC"}],"standard_charges":[{"gross_charge":426.75,"discounted_cash":358.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":853.5,"discounted_cash":716.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"SELINEXOR 80 MG TWICE WEEKLY (160 MG/WEEK) (20 MG X 8) TABLET [182571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72237-101-14","type":"NDC"}],"standard_charges":[{"gross_charge":24918.25,"discounted_cash":20931.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"SELINEXOR 80 MG TWICE WEEKLY (160 MG/WEEK) (20 MG X 8) TABLET [182571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72237-101-04","type":"NDC"}],"standard_charges":[{"gross_charge":24918.25,"discounted_cash":20931.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"SELENIUM SULFIDE 2.5 % LOTION [168945]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-528-04","type":"NDC"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"SELENIUM SULFIDE 2.5 % LOTION [168945]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-040-64","type":"NDC"}],"standard_charges":[{"gross_charge":133.75,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"SELENIUM 40 MCG/ML INTRAVENOUS SOLUTION [77308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-6510-25","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG TABLET [11349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7252-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-622-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-555-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-065-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-304-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1248-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1247-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-458-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-458-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-669-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-0042-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6961804901","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-303-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-013-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-432-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-432-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SERTRALINE 25 MG TABLET [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-833-05","type":"NDC"}],"standard_charges":[{"gross_charge":76.25,"discounted_cash":64.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61570-131-55","type":"NDC"}],"standard_charges":[{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61570-131-25","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-210-85","type":"NDC"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":120.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-210-55","type":"NDC"}],"standard_charges":[{"gross_charge":100.75,"discounted_cash":84.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-210-50","type":"NDC"}],"standard_charges":[{"gross_charge":100.75,"discounted_cash":84.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-210-40","type":"NDC"}],"standard_charges":[{"gross_charge":261.5,"discounted_cash":219.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 G"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-210-25","type":"NDC"}],"standard_charges":[{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-124-85","type":"NDC"}],"standard_charges":[{"gross_charge":178.5,"discounted_cash":149.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61570-131-40","type":"NDC"}],"standard_charges":[{"gross_charge":243.5,"discounted_cash":204.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 G"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61570-131-20","type":"NDC"}],"standard_charges":[{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"}]},{"description":"SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK [11359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"12870-0001-2","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK [11359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"12870-0001-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"SILVER NITRATE 0.5 % TOPICAL SOLUTION [28001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-9614-13","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"SILVER ER TOPICAL GEL,EXTENDED RELEASE - WOUND CARE [181302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8327030909","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"},{"gross_charge":166.25,"discounted_cash":139.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 44.4 ML"}]},{"description":"SILTUXIMAB 400 MG INTRAVENOUS SOLUTION [125721]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2860","type":"HCPCS"},{"code":"73090-421-01","type":"NDC"}],"standard_charges":[{"gross_charge":13130.25,"discounted_cash":11029.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SILTUXIMAB 400 MG INTRAVENOUS SOLUTION [125721]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2860","type":"HCPCS"},{"code":"57894-421-01","type":"NDC"}],"standard_charges":[{"gross_charge":8863.25,"discounted_cash":7445.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SILTUXIMAB 100 MG INTRAVENOUS SOLUTION [125720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2860","type":"HCPCS"},{"code":"73090-420-01","type":"NDC"}],"standard_charges":[{"gross_charge":5893.0,"discounted_cash":4950.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":49463.5,"discounted_cash":41549.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11 MG/KG"}]},{"description":"SILTUXIMAB 100 MG INTRAVENOUS SOLUTION [125720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2860","type":"HCPCS"},{"code":"57894-420-01","type":"NDC"}],"standard_charges":[{"gross_charge":3990.25,"discounted_cash":3351.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [41832]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5517-98","type":"NDC"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [41832]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-351-09","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [41832]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0033-1","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [41832]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-4190-68","type":"NDC"}],"standard_charges":[{"gross_charge":309.5,"discounted_cash":259.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION [126857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-059-76","type":"NDC"}],"standard_charges":[{"gross_charge":15211.25,"discounted_cash":12777.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 ML"}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION [126857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1574-1","type":"NDC"}],"standard_charges":[{"gross_charge":15211.25,"discounted_cash":12777.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 ML"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6707-82","type":"NDC"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM - WOUND CARE [181303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49999-143-20","type":"NDC"}],"standard_charges":[{"gross_charge":125.5,"discounted_cash":105.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-720-15","type":"NDC"}],"standard_charges":[{"gross_charge":120.25,"discounted_cash":101.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-188-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093979444","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-033-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-791-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3786486001","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645-860-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-225-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24385-118-78","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5068-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1303-75","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-059-51","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5618412041","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1990301022","type":"NDC"}],"standard_charges":[{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1990301021","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1990301020","type":"NDC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-740-27","type":"NDC"}],"standard_charges":[{"gross_charge":55.5,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093960244","type":"NDC"}],"standard_charges":[{"gross_charge":55.5,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5894-30","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-2220-75","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-720-11","type":"NDC"}],"standard_charges":[{"gross_charge":120.25,"discounted_cash":101.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SERTRALINE 50 MG TABLET [11351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-242-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 50 MG TABLET [11351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-216-15","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 50 MG TABLET [11351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-213-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 50 MG TABLET [11351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-612-04","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 50 MG TABLET [11351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-612-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 50 MG TABLET [11351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-012-30","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 50 MG TABLET [11351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-4900-3","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 50 MG TABLET [11351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-4900-41","type":"NDC"}],"standard_charges":[{"gross_charge":241.5,"discounted_cash":202.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":120.75,"discounted_cash":101.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 25 MG TABLET [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-231-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 25 MG TABLET [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-231-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE 50 MG TABLET [11351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-242-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-789-48","type":"NDC"}],"standard_charges":[{"gross_charge":120.5,"discounted_cash":101.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-789-11","type":"NDC"}],"standard_charges":[{"gross_charge":120.5,"discounted_cash":101.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-058-27","type":"NDC"}],"standard_charges":[{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-789-27","type":"NDC"}],"standard_charges":[{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-328-33","type":"NDC"}],"standard_charges":[{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-328-31","type":"NDC"}],"standard_charges":[{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-921-27","type":"NDC"}],"standard_charges":[{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58468-0130-1","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0955-1054-90","type":"NDC"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2400 MG"}]},{"description":"SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET [99695]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0955-1054-01","type":"NDC"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2400 MG"}]},{"description":"SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1365-30","type":"NDC"}],"standard_charges":[{"gross_charge":260.25,"discounted_cash":218.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":130.25,"discounted_cash":109.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1365-29","type":"NDC"}],"standard_charges":[{"gross_charge":260.25,"discounted_cash":218.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":130.25,"discounted_cash":109.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0955-1052-90","type":"NDC"}],"standard_charges":[{"gross_charge":153.5,"discounted_cash":128.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0955-1052-01","type":"NDC"}],"standard_charges":[{"gross_charge":153.5,"discounted_cash":128.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-930-90","type":"NDC"}],"standard_charges":[{"gross_charge":247.25,"discounted_cash":207.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":123.75,"discounted_cash":103.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET [99694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-930-08","type":"NDC"}],"standard_charges":[{"gross_charge":247.25,"discounted_cash":207.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":123.75,"discounted_cash":103.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-148-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-732-12","type":"NDC"}],"standard_charges":[{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-732-11","type":"NDC"}],"standard_charges":[{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-043-62","type":"NDC"}],"standard_charges":[{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-043-61","type":"NDC"}],"standard_charges":[{"gross_charge":73.25,"discounted_cash":61.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-043-59","type":"NDC"}],"standard_charges":[{"gross_charge":73.25,"discounted_cash":61.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0747-40","type":"NDC"}],"standard_charges":[{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-790-01","type":"NDC"}],"standard_charges":[{"gross_charge":87.75,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-790-50","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0747-10","type":"NDC"}],"standard_charges":[{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 1 GRAM TABLET [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72578-081-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"SUCRALFATE 1 GRAM TABLET [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0401-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"SUCRALFATE 1 GRAM TABLET [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-753-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"SUCRALFATE 1 GRAM TABLET [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2210-98","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"SUCRALFATE 1 GRAM TABLET [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29033-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"SUCRALFATE 1 GRAM TABLET [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58914-171-10","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"SUCRALFATE 1 GRAM TABLET [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2210-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"SUCRALFATE 1 GRAM TABLET [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2210-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918-700-05","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-148-19","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0974-00","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION [167970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-5423-12","type":"NDC"}],"standard_charges":[{"gross_charge":4141.5,"discounted_cash":3478.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG/KG"},{"gross_charge":517.75,"discounted_cash":434.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":1035.5,"discounted_cash":869.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION [167970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-5423-02","type":"NDC"}],"standard_charges":[{"gross_charge":4141.5,"discounted_cash":3478.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG/KG"},{"gross_charge":517.75,"discounted_cash":434.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":1035.5,"discounted_cash":869.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"SUFENTANIL CITRATE 50 MCG/ML INTRAVENOUS SOLUTION [11443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MCG"},{"gross_charge":112.25,"discounted_cash":94.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"},{"gross_charge":280.5,"discounted_cash":235.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"SUCROFERRIC OXYHYDROXIDE 500 MG CHEWABLE TABLET [125030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49230-645-51","type":"NDC"}],"standard_charges":[{"gross_charge":149.75,"discounted_cash":125.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-041-62","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-041-59","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7269-66","type":"NDC"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7269-18","type":"NDC"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-745-14","type":"NDC"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-745-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0974-94","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0974-50","type":"NDC"}],"standard_charges":[{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0974-40","type":"NDC"}],"standard_charges":[{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0974-10","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"73177-116-03","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"0781-3411-70","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":93.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70092-1087-46","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":78.75,"discounted_cash":66.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"0409-6629-02","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCIMER 100 MG CAPSULE [11438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55292-201-11","type":"NDC"}],"standard_charges":[{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":287.25,"discounted_cash":241.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":430.75,"discounted_cash":361.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":574.5,"discounted_cash":482.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":718.0,"discounted_cash":603.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION [7508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3000","type":"HCPCS"},{"code":"39822-0706-2","type":"NDC"}],"standard_charges":[{"gross_charge":384.5,"discounted_cash":322.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [178642]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62327-444-44","type":"NDC"}],"standard_charges":[{"gross_charge":698.75,"discounted_cash":586.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [178642]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62327-444-04","type":"NDC"}],"standard_charges":[{"gross_charge":698.75,"discounted_cash":586.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":698.75,"discounted_cash":586.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER [178641]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62327-333-43","type":"NDC"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":526.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER [178641]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62327-333-03","type":"NDC"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":526.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"STERILE TALC 2 GRAM INTRAPLEURAL SUSPENSION [178640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62327-222-42","type":"NDC"}],"standard_charges":[{"gross_charge":488.25,"discounted_cash":410.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"STERILE TALC 2 GRAM INTRAPLEURAL SUSPENSION [178640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62327-222-02","type":"NDC"}],"standard_charges":[{"gross_charge":488.25,"discounted_cash":410.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"STAVUDINE 40 MG CAPSULE [13311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-047-60","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"STAVUDINE 30 MG CAPSULE [13310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-046-60","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"SPIRONOLACTONE 25 MG TABLET [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6927-61","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"0781-3411-95","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":93.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69374-919-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918-700-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069-301-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069-301-25","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069-301-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"0409-6629-12","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918-700-25","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918-700-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70710-1377-2","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":93.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION WRAPPER [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70710-1377-1","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":93.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION [167970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-5425-05","type":"NDC"}],"standard_charges":[{"gross_charge":2643.0,"discounted_cash":2220.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG/KG"},{"gross_charge":330.5,"discounted_cash":277.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":660.75,"discounted_cash":555.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"SUMATRIPTAN 25 MG TABLET [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-531-10","type":"NDC"}],"standard_charges":[{"gross_charge":587.75,"discounted_cash":493.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":294.0,"discounted_cash":246.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 25 MG TABLET [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-531-11","type":"NDC"}],"standard_charges":[{"gross_charge":587.75,"discounted_cash":493.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":294.0,"discounted_cash":246.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 25 MG TABLET [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-520-88","type":"NDC"}],"standard_charges":[{"gross_charge":587.75,"discounted_cash":493.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":294.0,"discounted_cash":246.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 25 MG TABLET [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-520-69","type":"NDC"}],"standard_charges":[{"gross_charge":587.75,"discounted_cash":493.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":294.0,"discounted_cash":246.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 25 MG TABLET [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-291-36","type":"NDC"}],"standard_charges":[{"gross_charge":587.75,"discounted_cash":493.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":294.0,"discounted_cash":246.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 25 MG TABLET [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-291-09","type":"NDC"}],"standard_charges":[{"gross_charge":587.75,"discounted_cash":493.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":294.0,"discounted_cash":246.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 25 MG TABLET [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0735-00","type":"NDC"}],"standard_charges":[{"gross_charge":905.5,"discounted_cash":760.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":226.5,"discounted_cash":190.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":452.75,"discounted_cash":380.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 100 MG TABLET [13369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-798-01","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 100 MG TABLET [13369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-533-11","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 100 MG TABLET [13369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-148-36","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 100 MG TABLET [13369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-522-88","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 25 MG TABLET [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-796-01","type":"NDC"}],"standard_charges":[{"gross_charge":587.75,"discounted_cash":493.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":294.0,"discounted_cash":246.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUTIMLIMAB-JOME 50 MG/ML INTRAVENOUS SOLUTION [191073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"80203-347-01","type":"NDC"}],"standard_charges":[{"gross_charge":34593.75,"discounted_cash":29058.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6500 MG"},{"gross_charge":39916.0,"discounted_cash":33529.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7500 MG"}]},{"description":"SURGICAL LUBRICANT JELLY TOPICAL [127837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"281020545","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"SURGICAL LUBRICANT JELLY TOPICAL [127837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"281020537","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120.49 G"}]},{"description":"SURGICAL LUBRICANT JELLY TOPICAL [127837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"281020536","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120.49 G"}]},{"description":"SURGICAL LUBRICANT JELLY TOPICAL [127837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"281020543","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"SURGICAL LUBRICANT JELLY TOPICAL [127837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"281020502","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56.7 G"}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION [97342]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"0143-9638-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION [97342]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"63323-273-01","type":"NDC"}],"standard_charges":[{"gross_charge":251.75,"discounted_cash":211.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"SUMATRIPTAN 50 MG TABLET [15328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-532-11","type":"NDC"}],"standard_charges":[{"gross_charge":273.25,"discounted_cash":229.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 50 MG TABLET [15328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-147-36","type":"NDC"}],"standard_charges":[{"gross_charge":273.25,"discounted_cash":229.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 50 MG TABLET [15328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-521-88","type":"NDC"}],"standard_charges":[{"gross_charge":273.25,"discounted_cash":229.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 50 MG TABLET [15328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0736-01","type":"NDC"}],"standard_charges":[{"gross_charge":745.25,"discounted_cash":626.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":186.5,"discounted_cash":156.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":372.75,"discounted_cash":313.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 25 MG TABLET [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-344-72","type":"NDC"}],"standard_charges":[{"gross_charge":641.0,"discounted_cash":538.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":320.5,"discounted_cash":269.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 25 MG TABLET [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-344-60","type":"NDC"}],"standard_charges":[{"gross_charge":641.0,"discounted_cash":538.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":320.5,"discounted_cash":269.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 100 MG TABLET [13369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-522-69","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET [7555]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-228-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET [7555]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-272-05","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET [7555]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-272-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET [7555]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-146-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET [7555]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-2725-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-232-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-728-15","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-728-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-271-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13310-145-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET [7557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-145-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION [22560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1802-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION [22560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-496-47","type":"NDC"}],"standard_charges":[{"gross_charge":770.5,"discounted_cash":647.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"SULFADIAZINE 500 MG TABLET [7554]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0757-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.25,"discounted_cash":61.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SULFACETAMIDE-PREDNISOLONE 10 %-0.23 % (0.25 %) EYE DROPS [70392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-317-05","type":"NDC"}],"standard_charges":[{"gross_charge":126.75,"discounted_cash":106.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SULFACETAMIDE-PREDNISOLONE 10 %-0.2 % EYE OINTMENT [11448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-0313-04","type":"NDC"}],"standard_charges":[{"gross_charge":753.5,"discounted_cash":632.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"SULFACETAMIDE SODIUM 10 % EYE OINTMENT [15870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-4190-35","type":"NDC"}],"standard_charges":[{"gross_charge":270.75,"discounted_cash":227.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"SULFACETAMIDE SODIUM 10 % EYE DROPS [7359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-018-05","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SULFACETAMIDE SODIUM 10 % EYE DROPS [7359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-701-01","type":"NDC"}],"standard_charges":[{"gross_charge":228.75,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SULFACETAMIDE SODIUM 10 % EYE DROPS [7359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-670-04","type":"NDC"}],"standard_charges":[{"gross_charge":250.75,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION [167970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-5425-15","type":"NDC"}],"standard_charges":[{"gross_charge":2643.0,"discounted_cash":2220.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG/KG"},{"gross_charge":330.5,"discounted_cash":277.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":660.75,"discounted_cash":555.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET [7555]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-420-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET [7555]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-759-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SUMATRIPTAN 100 MG TABLET [13369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-293-36","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 100 MG TABLET [13369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-293-09","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN 100 MG TABLET [13369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0737-01","type":"NDC"}],"standard_charges":[{"gross_charge":372.75,"discounted_cash":313.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":93.25,"discounted_cash":78.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":186.5,"discounted_cash":156.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SULFASALAZINE 500 MG TABLET,DELAYED RELEASE [7563]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0104-6","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SULFASALAZINE 500 MG TABLET,DELAYED RELEASE [7563]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0013-0102-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SULFASALAZINE 500 MG TABLET [7562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5000-5","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SULFASALAZINE 500 MG TABLET [7562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-730-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SULFASALAZINE 500 MG TABLET [7562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-730-15","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SULFASALAZINE 500 MG TABLET [7562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0796-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2865","type":"HCPCS"},{"code":"0703-9503-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-362-10","type":"NDC"}],"standard_charges":[{"gross_charge":102.75,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":247.75,"discounted_cash":208.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG OF TRIMETHOPRIM"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-362-01","type":"NDC"}],"standard_charges":[{"gross_charge":102.75,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2865","type":"HCPCS"},{"code":"67457-778-00","type":"NDC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-9514-03","type":"NDC"}],"standard_charges":[{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-9514-01","type":"NDC"}],"standard_charges":[{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2865","type":"HCPCS"},{"code":"0703-9503-03","type":"NDC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SPIRONOLACTONE 25 MG TABLET [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-225-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [15706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5865731016","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [15706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"121059530","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SODIUM CHLORIDE-ALOE VERA NASAL GEL [129703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"225052547","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.1 G"}]},{"description":"SODIUM CHLORIDE 7 % FOR NEBULIZATION [82134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"487900760","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"SODIUM CHLORIDE 5 % EYE DROPS [7332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1254-94","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM CHLORIDE 5 % EYE DROPS [7332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-623-12","type":"NDC"}],"standard_charges":[{"gross_charge":99.75,"discounted_cash":83.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML ORAL SOLUTION (NEO/PED) [171499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1141-02","type":"NDC"}],"standard_charges":[{"gross_charge":106.75,"discounted_cash":89.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML ORAL SOLUTION (NEO/PED) [171499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-187-30","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML ORAL SOLUTION (NEO/PED) [171499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-088-61","type":"NDC"}],"standard_charges":[{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION [7322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73177-128-05","type":"NDC"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION [7322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-095-61","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION [7322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-095-02","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION [7322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1141-12","type":"NDC"}],"standard_charges":[{"gross_charge":106.75,"discounted_cash":89.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION [7322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00000-0000-41","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SODIUM CHLORIDE 3% IV BOLUS [408721]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0054-03","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 3% IV BOLUS [408721]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"0338-0054-03","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION [7321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-530-75","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION [7321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-530-21","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION [7321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-7805-10","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 3 % FOR NEBULIZATION [7327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7620402260","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"SODIUM CHLORIDE 3 % FOR NEBULIZATION [7327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"487900330","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"SODIUM CHLORIDE 3 % FOR NEBULIZATION [7327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"487900360","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"SODIUM CHLORIDE 3 % FOR NEBULIZATION [7327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5019014263","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"SODIUM CHLORIDE 3 % FOR NEBULIZATION [7327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378699789","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"SODIUM CHLORIDE 2.5 MEQ/ML INTRAVENOUS SOLUTION [7320]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6660-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [15706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1947-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [15706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"121119000","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SODIUM HYPOCHLORITE 0.5 % SOLUTION [2110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0436-0946-16","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"SODIUM HYPOCHLORITE 0.25 % SOLUTION [15950]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39328-063-25","type":"NDC"}],"standard_charges":[{"gross_charge":124.75,"discounted_cash":104.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"SODIUM HYALURONATE 30 MG/2 ML INTRA-ARTICULAR SYRINGE [126166]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7324","type":"HCPCS"},{"code":"5967636001","type":"NDC"}],"standard_charges":[{"gross_charge":1743.75,"discounted_cash":1464.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"SODIUM HYALURONATE 18 MG/ML INTRAOCULAR SYRINGE [183074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"5047-4651-65","type":"NDC"}],"standard_charges":[{"gross_charge":550.75,"discounted_cash":462.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.85 ML"}]},{"description":"SODIUM HYALURONATE 10 MG/ML(MW 2.4-3.6 MILLION)INTRA-ARTICULAR SYRINGE [173518]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7323","type":"HCPCS"},{"code":"5556641001","type":"NDC"}],"standard_charges":[{"gross_charge":1549.5,"discounted_cash":1301.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE [28913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"5047-5636-98","type":"NDC"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":465.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.85 ML"}]},{"description":"SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE [28913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"8544636981","type":"NDC"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":465.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.85 ML"}]},{"description":"SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE [28913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"8544636971","type":"NDC"}],"standard_charges":[{"gross_charge":216.75,"discounted_cash":182.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.55 ML"}]},{"description":"SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE [28913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"05047-4508-42","type":"NDC"}],"standard_charges":[{"gross_charge":553.75,"discounted_cash":465.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.85 ML"}]},{"description":"SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE [28913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"8065183004","type":"NDC"}],"standard_charges":[{"gross_charge":726.25,"discounted_cash":610.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"SODIUM HYALURONATE 10 MG/ML INTRA-ARTICULAR SYRINGE [108111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7321","type":"HCPCS"},{"code":"89130-4444-1","type":"NDC"}],"standard_charges":[{"gross_charge":1550.25,"discounted_cash":1302.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"SODIUM HYALURONATE 10 MG/ML INTRA-ARTICULAR SYRINGE [108111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7321","type":"HCPCS"},{"code":"8913044441","type":"NDC"}],"standard_charges":[{"gross_charge":1019.25,"discounted_cash":856.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"FLUDEOXYGLUCOSE F-18 20 MCI TO 300 MCI/ML INTRAVENOUS SOLUTION WRAPPER [186167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"65857-300-30","type":"NDC"}],"standard_charges":[{"gross_charge":5432.5,"discounted_cash":4563.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SODIUM FLUORIDE 1.1 %-POTASSIUM NITRATE 5 % DENTAL PASTE [76540]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0126-0022-92","type":"NDC"}],"standard_charges":[{"gross_charge":154.75,"discounted_cash":129.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS [24932]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"0143-9570-01","type":"NDC"}],"standard_charges":[{"gross_charge":415.25,"discounted_cash":348.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.5 MG"}]},{"description":"SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET [11067]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6954326810","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET [11067]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6498010401","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET [11067]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"486112505","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET [11067]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"486112501","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [15706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026818330","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [15706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026818311","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [15706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"121119030","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SODIUM CHLORIDE 2.5 MEQ/ML INTRAVENOUS SOLUTION [7320]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6657-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"SODIUM CHLORIDE 2.5 MEQ/ML INTRAVENOUS SOLUTION [7320]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6657-73","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"SODIUM CHLORIDE 2.5 MEQ/ML INTRAVENOUS SOLUTION [7320]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6660-75","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"SODIUM CHLORIDE 2.5 MEQ/ML INTRAVENOUS SOLUTION [7320]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-139-40","type":"NDC"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"SODIUM CHLORIDE 2 % EYE DROPS [11404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-276-15","type":"NDC"}],"standard_charges":[{"gross_charge":123.25,"discounted_cash":103.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET [130060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333-844-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET [130060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904723961","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SODIUM CHLORIDE 1 GRAM TABLET WRAPPER [4087328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4843312810","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SODIUM CHLORIDE 1 GRAM TABLET WRAPPER [4087328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433-128-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SODIUM CHLORIDE 1 GRAM TABLET WRAPPER [4087328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733383525","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SODIUM CHLORIDE 1 GRAM TABLET WRAPPER [4087328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733383510","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SODIUM CHLORIDE 1 GRAM TABLET WRAPPER [4087328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6936722001","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SODIUM IODIDE-123 7.4 MBQ (200 MICROCI) CAPSULE [98463]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9516","type":"HCPCS"},{"code":"48815-1002-1","type":"NDC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":301.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MICROCURIE"},{"gross_charge":718.0,"discounted_cash":603.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MICROCURIE"}]},{"description":"SODIUM CHLORIDE 1 GRAM TABLET WRAPPER [4087328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0223-1760-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SODIUM IODIDE-123 7.4 MBQ (200 MICROCI) CAPSULE [98463]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9516","type":"HCPCS"},{"code":"48815-1002-5","type":"NDC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":301.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MICROCURIE"},{"gross_charge":718.0,"discounted_cash":603.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MICROCURIE"}]},{"description":"SOTALOL 80 MG TABLET [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0012-89","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 80 MG TABLET [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0222-1","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 80 MG TABLET [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0080-0","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 80 MG TABLET [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0012-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 80 MG TABLET [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1061-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 120 MG TABLET [15723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-725-15","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 120 MG TABLET [15723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-725-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 120 MG TABLET [15723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69584-842-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":42.5,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 120 MG TABLET [15723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0013-89","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 120 MG TABLET [15723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0159-0","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 80 MG TABLET [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-654-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 80 MG TABLET [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-114-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SPIRONOLACTONE 25 MG TABLET [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-225-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 25 MG TABLET [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-216-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 25 MG TABLET [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-511-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 25 MG TABLET [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-544-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 25 MG TABLET [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-103-20","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 25 MG TABLET [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 25 MG TABLET [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-2146-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SOTALOL 80 MG TABLET [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-724-15","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 80 MG TABLET [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69584-841-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SELEGILINE 5 MG TABLET [11340]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-3438-3","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"SOTALOL 120 MG TABLET [15723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0013-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11534-166-15","type":"NDC"}],"standard_charges":[{"gross_charge":106.75,"discounted_cash":89.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"SODIUM POLYSTYRENE SULFONATE ORAL POWDER [7356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-036-15","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP [172944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46287-006-60","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"},{"gross_charge":337.5,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA [130497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0132-0202-20","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ENEMA"}]},{"description":"SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [11395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-186-20","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ENEMA"}]},{"description":"SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [11395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093976744","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ENEMA"}]},{"description":"SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [11395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-7415-51","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ENEMA"}]},{"description":"SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [11395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0132-0201-40","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ENEMA"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7391-72","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MMOL"},{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-884-06","type":"NDC"}],"standard_charges":[{"gross_charge":157.25,"discounted_cash":132.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-884-01","type":"NDC"}],"standard_charges":[{"gross_charge":157.25,"discounted_cash":132.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7391-82","type":"NDC"}],"standard_charges":[{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-170-15","type":"NDC"}],"standard_charges":[{"gross_charge":215.75,"discounted_cash":181.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [7351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-170-05","type":"NDC"}],"standard_charges":[{"gross_charge":130.75,"discounted_cash":109.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SODIUM PERTECHNETATE TC 99M INJECTION [40840066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9512","type":"HCPCS"},{"code":"9999-4084-45","type":"NDC"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":204.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"SODIUM OXYBATE 500 MG/ML ORAL SOLUTION [33556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68727-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":37847.0,"discounted_cash":31791.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 ML"}]},{"description":"SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-105-01","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-261-01","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG/ML"}]},{"description":"SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-839-02","type":"NDC"}],"standard_charges":[{"gross_charge":1158.75,"discounted_cash":973.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42571-265-75","type":"NDC"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"14789-012-02","type":"NDC"}],"standard_charges":[{"gross_charge":394.75,"discounted_cash":331.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-310-02","type":"NDC"}],"standard_charges":[{"gross_charge":641.25,"discounted_cash":538.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0187-4302-02","type":"NDC"}],"standard_charges":[{"gross_charge":1289.0,"discounted_cash":1082.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SODIUM IODINE-123 (HOT CAPS)  [174184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9509","type":"HCPCS"},{"code":"0000-0001-23","type":"NDC"}],"standard_charges":[{"gross_charge":219.5,"discounted_cash":184.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":438.75,"discounted_cash":368.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MILLICURIE"},{"gross_charge":658.25,"discounted_cash":552.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MILLICURIE"}]},{"description":"SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-163-02","type":"NDC"}],"standard_charges":[{"gross_charge":385.5,"discounted_cash":323.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-163-00","type":"NDC"}],"standard_charges":[{"gross_charge":385.5,"discounted_cash":323.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24201-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION [41793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24201-201-05","type":"NDC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SOTALOL 120 MG TABLET [15723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0170-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL 120 MG TABLET [15723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1060-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":42.5,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SORBITOL 70 % SOLUTION [7413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4628750030","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SOMATROPIN 5 MG/1.5 ML (3.3 MG/ML) SUBCUTANEOUS PEN INJECTOR [129677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0169-7704-21","type":"NDC"}],"standard_charges":[{"gross_charge":3085.25,"discounted_cash":2591.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"SOMATROPIN 30 MG/3 ML (10 MG/ML) SUBCUTANEOUS PEN INJECTOR [98155]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0169-7703-21","type":"NDC"}],"standard_charges":[{"gross_charge":10412.5,"discounted_cash":8746.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SOMATROPIN 15 MG/1.5 ML (10 MG/ML) SUBCUTANEOUS PEN INJECTOR [129679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0169-7708-21","type":"NDC"}],"standard_charges":[{"gross_charge":7520.0,"discounted_cash":6316.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"SOMATROPIN 10 MG/1.5 ML (6.7 MG/ML) SUBCUTANEOUS PEN INJECTOR [129678]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0169-7705-21","type":"NDC"}],"standard_charges":[{"gross_charge":5013.5,"discounted_cash":4211.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"SOMATROPIN 0.2 MG/0.25 ML SUBCUTANEOUS SYRINGE [26404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J2941","type":"HCPCS"},{"code":"0013-2649-02","type":"NDC"}],"standard_charges":[{"gross_charge":202.75,"discounted_cash":170.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SOLIFENACIN 5 MG TABLET [40392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51248-150-52","type":"NDC"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":135.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"SOLIFENACIN 5 MG TABLET [40392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51248-150-03","type":"NDC"}],"standard_charges":[{"gross_charge":213.25,"discounted_cash":179.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":109.25,"discounted_cash":91.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"SOLIFENACIN 5 MG TABLET [40392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51248-150-01","type":"NDC"}],"standard_charges":[{"gross_charge":213.25,"discounted_cash":179.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":109.25,"discounted_cash":91.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"SODIUM,POTASSIUM,MAG SULFATES 17.5 GRAM-3.13 GRAM-1.6 GRAM ORAL SOLN [106061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10572-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"SODIUM,POTASSIUM,MAG SULFATES 17.5 GRAM-3.13 GRAM-1.6 GRAM ORAL SOLN [106061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10572-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":430.75,"discounted_cash":361.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 354 ML"}]},{"description":"SODIUM,POTASSIUM,MAG SULFATES 17.5 GRAM-3.13 GRAM-1.6 GRAM ORAL SOLN [106061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52268-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":246.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"SODIUM,POTASSIUM,MAG SULFATES 17.5 GRAM-3.13 GRAM-1.6 GRAM ORAL SOLN [106061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52268-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":493.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 354 ML"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [179409]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-1105-39","type":"NDC"}],"standard_charges":[{"gross_charge":123.5,"discounted_cash":103.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [179409]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-1105-30","type":"NDC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [179409]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-1105-01","type":"NDC"}],"standard_charges":[{"gross_charge":187.5,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [179411]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-1110-39","type":"NDC"}],"standard_charges":[{"gross_charge":123.5,"discounted_cash":103.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [179411]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-1110-30","type":"NDC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [179411]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-1110-01","type":"NDC"}],"standard_charges":[{"gross_charge":187.5,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION [7364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60267-705-50","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.6 ML"},{"gross_charge":440.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"}]},{"description":"SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION [91185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2850","type":"HCPCS"},{"code":"67066-005-01","type":"NDC"}],"standard_charges":[{"gross_charge":2324.0,"discounted_cash":1952.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MCG/KG"},{"gross_charge":4648.0,"discounted_cash":3904.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MCG/KG"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-505-01","type":"NDC"}],"standard_charges":[{"gross_charge":136.5,"discounted_cash":114.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"QUINAPRIL 20 MG TABLET [11252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-558-09","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUINAPRIL 20 MG TABLET [11252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5021-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUINAPRIL 20 MG TABLET [11252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0532-40","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUINAPRIL 10 MG TABLET [11251]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-618-90","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUINAPRIL 10 MG TABLET [11251]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-557-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUINAPRIL 10 MG TABLET [11251]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5020-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUINAPRIL 10 MG TABLET [11251]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0530-40","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":109.5,"discounted_cash":91.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUETIAPINE 25 MG TABLET [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-327-11","type":"NDC"}],"standard_charges":[{"gross_charge":102.25,"discounted_cash":85.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":204.25,"discounted_cash":171.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":408.25,"discounted_cash":342.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUINAPRIL 20 MG TABLET [11252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-619-90","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [113082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0487-5901-99","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [131291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"49281-250-51","type":"NDC"}],"standard_charges":[{"gross_charge":1603.0,"discounted_cash":1346.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"50632-013-01","type":"NDC"}],"standard_charges":[{"gross_charge":1773.25,"discounted_cash":1489.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"50632-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":1773.25,"discounted_cash":1489.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"58160-966-01","type":"NDC"}],"standard_charges":[{"gross_charge":1546.5,"discounted_cash":1299.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"58160-964-12","type":"NDC"}],"standard_charges":[{"gross_charge":1546.5,"discounted_cash":1299.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [127281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90377","type":"HCPCS"},{"code":"76125-150-11","type":"NDC"}],"standard_charges":[{"gross_charge":10369.75,"discounted_cash":8710.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS/KG"}]},{"description":"RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [127281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90377","type":"HCPCS"},{"code":"76125-150-10","type":"NDC"}],"standard_charges":[{"gross_charge":10369.75,"discounted_cash":8710.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS/KG"}]},{"description":"RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [127281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90377","type":"HCPCS"},{"code":"76125-150-03","type":"NDC"}],"standard_charges":[{"gross_charge":13981.0,"discounted_cash":11744.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS/KG"}]},{"description":"RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [127281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90377","type":"HCPCS"},{"code":"76125-150-02","type":"NDC"}],"standard_charges":[{"gross_charge":13981.0,"discounted_cash":11744.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS/KG"}]},{"description":"QUININE 324 MG CAPSULE [6781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-238-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 324 MG"},{"gross_charge":99.0,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 648 MG"}]},{"description":"QUININE 324 MG CAPSULE [6781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13310-153-07","type":"NDC"}],"standard_charges":[{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 324 MG"},{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 648 MG"}]},{"description":"QUINIDINE SULFATE 200 MG TABLET [6777]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-4346-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"QUINAPRIL 5 MG TABLET [11254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-617-90","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUINAPRIL 5 MG TABLET [11254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5019-1","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUINAPRIL 5 MG TABLET [11254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0527-40","type":"NDC"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":109.5,"discounted_cash":91.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":219.0,"discounted_cash":183.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUETIAPINE 25 MG TABLET [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-327-01","type":"NDC"}],"standard_charges":[{"gross_charge":102.25,"discounted_cash":85.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":204.25,"discounted_cash":171.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":408.25,"discounted_cash":342.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE 200 MG TABLET [21825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6641-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"QUETIAPINE 200 MG TABLET [21825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-455-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":130.5,"discounted_cash":109.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":174.0,"discounted_cash":146.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":347.75,"discounted_cash":292.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"QUETIAPINE 200 MG TABLET [21825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8163-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":131.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":349.75,"discounted_cash":293.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"QUETIAPINE 200 MG TABLET [21825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-0272-10","type":"NDC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":153.0,"discounted_cash":128.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":408.0,"discounted_cash":342.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"QUETIAPINE 100 MG TABLET [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6640-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUETIAPINE 100 MG TABLET [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-632-15","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":87.25,"discounted_cash":73.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUETIAPINE 100 MG TABLET [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-632-11","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":87.25,"discounted_cash":73.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUETIAPINE 200 MG TABLET [21825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-360-11","type":"NDC"}],"standard_charges":[{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":124.0,"discounted_cash":104.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":165.25,"discounted_cash":138.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":330.25,"discounted_cash":277.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"QUETIAPINE 25 MG TABLET [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6638-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE 25 MG TABLET [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-452-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":214.25,"discounted_cash":179.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":428.5,"discounted_cash":359.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE 25 MG TABLET [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2063-01","type":"NDC"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":432.0,"discounted_cash":362.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE 25 MG TABLET [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-249-01","type":"NDC"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":432.0,"discounted_cash":362.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE 25 MG TABLET [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-145-01","type":"NDC"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":432.0,"discounted_cash":362.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [113082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0487-2784-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-198-99","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"},{"gross_charge":1507.75,"discounted_cash":1266.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-198-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"}]},{"description":"REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9391-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"}]},{"description":"REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9391-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"}]},{"description":"REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-198-03","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"}]},{"description":"REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [185460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61958-2901-2","type":"NDC"}],"standard_charges":[{"gross_charge":2316.0,"discounted_cash":1945.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":2316.0,"discounted_cash":1945.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4632.0,"discounted_cash":3890.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8928.0,"discounted_cash":7499.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION [185460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61958-2901-1","type":"NDC"}],"standard_charges":[{"gross_charge":1897.0,"discounted_cash":1593.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RELUGOLIX 120 MG TABLET [187374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72974-120-01","type":"NDC"}],"standard_charges":[{"gross_charge":458.25,"discounted_cash":384.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":1364.25,"discounted_cash":1145.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"36000-364-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"76329-3321-0","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"16729-477-31","type":"NDC"}],"standard_charges":[{"gross_charge":1075.25,"discounted_cash":903.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"71288-201-85","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"0641-6253-01","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"0469-6501-89","type":"NDC"}],"standard_charges":[{"gross_charge":1107.5,"discounted_cash":930.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-724-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"}]},{"description":"REPAGLINIDE 2 MG TABLET [22585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-672-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"REPAGLINIDE 2 MG TABLET [22585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0242-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"REPAGLINIDE 2 MG TABLET [22585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-747-88","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"REPAGLINIDE 0.5 MG TABLET [22584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-157-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":99.0,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"REPAGLINIDE 0.5 MG TABLET [22584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-670-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"REPAGLINIDE 0.5 MG TABLET [22584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0240-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"REMIMAZOLAM 20 MG INTRAVENOUS SOLUTION [187267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71390-011-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"REMIMAZOLAM 20 MG INTRAVENOUS SOLUTION [187267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71390-011-00","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"REMIFENTANIL 5 MG INTRAVENOUS SOLUTION [18399]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-198-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"}]},{"description":"RASBURICASE 7.5 MG INTRAVENOUS SOLUTION [76868]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"0024-5151-74","type":"NDC"}],"standard_charges":[{"gross_charge":86274.0,"discounted_cash":72470.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":172548.0,"discounted_cash":144940.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"}]},{"description":"RASBURICASE 7.5 MG INTRAVENOUS SOLUTION [76868]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"0024-5151-75","type":"NDC"}],"standard_charges":[{"gross_charge":23006.5,"discounted_cash":19325.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"}]},{"description":"RAMIPRIL 2.5 MG CAPSULE [11260]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-589-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMIPRIL 10 MG CAPSULE [11259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-591-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMIPRIL 10 MG CAPSULE [11259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61570-120-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMIPRIL 1.25 MG CAPSULE [11258]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-222-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMIPRIL 1.25 MG CAPSULE [11258]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-144-06","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMIPRIL 1.25 MG CAPSULE [11258]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61570-110-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":174.75,"discounted_cash":146.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RALTEGRAVIR 400 MG TABLET [88608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0227-61","type":"NDC"}],"standard_charges":[{"gross_charge":231.75,"discounted_cash":194.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"RALOXIFENE 60 MG TABLET [22143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-213-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"RALOXIFENE 60 MG TABLET [22143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-057-03","type":"NDC"}],"standard_charges":[{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"RALOXIFENE 60 MG TABLET [22143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7290-56","type":"NDC"}],"standard_charges":[{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"RAMIPRIL 2.5 MG CAPSULE [11260]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-475-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"0024-5150-11","type":"NDC"}],"standard_charges":[{"gross_charge":61350.5,"discounted_cash":51534.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"}]},{"description":"RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"0024-5150-10","type":"NDC"}],"standard_charges":[{"gross_charge":40900.5,"discounted_cash":34356.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"}]},{"description":"RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-319-60","type":"NDC"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-017-60","type":"NDC"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-423-60","type":"NDC"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-125-02","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-1003-1","type":"NDC"}],"standard_charges":[{"gross_charge":111.25,"discounted_cash":93.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [125686]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7678-01","type":"NDC"}],"standard_charges":[{"gross_charge":23278.25,"discounted_cash":19553.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":18622.75,"discounted_cash":15643.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG/KG"}]},{"description":"RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [125686]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-7669-01","type":"NDC"}],"standard_charges":[{"gross_charge":41383.75,"discounted_cash":34762.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":33107.0,"discounted_cash":27809.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG/KG"}]},{"description":"RAMIPRIL 5 MG CAPSULE [11261]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-146-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMIPRIL 5 MG CAPSULE [11261]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-590-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMIPRIL 2.5 MG CAPSULE [11260]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-223-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUETIAPINE 100 MG TABLET [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-454-01","type":"NDC"}],"standard_charges":[{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":185.25,"discounted_cash":155.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"PROPRANOLOL 40 MG TABLET [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-295-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 40 MG TABLET [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-295-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 40 MG TABLET [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5484-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 40 MG TABLET [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5556-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 40 MG TABLET [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0184-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [6654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3727-63","type":"NDC"}],"standard_charges":[{"gross_charge":271.5,"discounted_cash":228.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-663-15","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-663-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 40 MG TABLET [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-2079-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE [38224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-215-11","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE [38224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-215-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE [38224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-817-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE [38224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2778-11","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 40 MG TABLET [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-664-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 40 MG TABLET [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-664-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-701-15","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-701-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-306-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-306-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5483-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5555-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0183-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6705-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72162-1176-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-2078-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-598-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE [38224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-4116-37","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-598-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 20 MG TABLET [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69292-532-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026885811","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7985420030","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3786490901","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5164590901","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54629-0063-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION [6744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3415","type":"HCPCS"},{"code":"63323-180-00","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":119.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION [6744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3415","type":"HCPCS"},{"code":"63323-180-01","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":119.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE [11240]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-301-30","type":"NDC"}],"standard_charges":[{"gross_charge":167.75,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":335.5,"discounted_cash":281.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2069-05","type":"NDC"}],"standard_charges":[{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-148-10","type":"NDC"}],"standard_charges":[{"gross_charge":4072.25,"discounted_cash":3420.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP [11238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0187-3012-20","type":"NDC"}],"standard_charges":[{"gross_charge":5206.0,"discounted_cash":4373.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-659-06","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-302-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026885815","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733394010","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE 100 MG TABLET [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-186-01","type":"NDC"}],"standard_charges":[{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":185.5,"discounted_cash":155.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUETIAPINE 100 MG TABLET [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8162-01","type":"NDC"}],"standard_charges":[{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":185.5,"discounted_cash":155.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUETIAPINE 100 MG TABLET [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-0271-10","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":216.25,"discounted_cash":181.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUAZEPAM 15 MG TABLET [11249]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71993-265-10","type":"NDC"}],"standard_charges":[{"gross_charge":146.5,"discounted_cash":123.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"PYRIMETHAMINE 25 MG TABLET [11246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72603-262-01","type":"NDC"}],"standard_charges":[{"gross_charge":2422.5,"discounted_cash":2034.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PYRIMETHAMINE 25 MG TABLET [11246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0480-3720-56","type":"NDC"}],"standard_charges":[{"gross_charge":2599.25,"discounted_cash":2183.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PYRIMETHAMINE 25 MG TABLET [11246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-672-30","type":"NDC"}],"standard_charges":[{"gross_charge":2422.5,"discounted_cash":2034.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PYRIMETHAMINE 25 MG TABLET [11246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-672-01","type":"NDC"}],"standard_charges":[{"gross_charge":2422.5,"discounted_cash":2034.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1000670012","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733394025","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0187-3010-30","type":"NDC"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":236.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PROTRIPTYLINE 10 MG TABLET [11163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0211-25","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":77.5,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [6677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323-229-01","type":"NDC"}],"standard_charges":[{"gross_charge":125.5,"discounted_cash":105.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [6677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323-229-41","type":"NDC"}],"standard_charges":[{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [6677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323-229-95","type":"NDC"}],"standard_charges":[{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [6677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323-229-94","type":"NDC"}],"standard_charges":[{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [6677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323-229-30","type":"NDC"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":219.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [6677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323-229-05","type":"NDC"}],"standard_charges":[{"gross_charge":125.5,"discounted_cash":105.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROPYLTHIOURACIL 50 MG TABLET [6662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72162-2072-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROPYLTHIOURACIL 50 MG TABLET [6662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70752-171-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROPYLTHIOURACIL 50 MG TABLET [6662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67253-651-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROPYLTHIOURACIL 50 MG TABLET [6662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2348-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE [38225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-4117-37","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE [38225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-531-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE [38225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2779-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PSEUDOEPHEDRINE 30 MG TABLET [6714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5053-59","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PSEUDOEPHEDRINE 30 MG TABLET [6714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-432-62","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-3511-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION [11237]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3040-95","type":"NDC"}],"standard_charges":[{"gross_charge":402.75,"discounted_cash":338.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG/KG"},{"gross_charge":209.0,"discounted_cash":175.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"PYRAZINAMIDE 500 MG TABLET [6738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-735-60","type":"NDC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":104.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PYRAZINAMIDE 500 MG TABLET [6738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748-012-09","type":"NDC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.5,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PYRAZINAMIDE 500 MG TABLET [6738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748-012-06","type":"NDC"}],"standard_charges":[{"gross_charge":85.5,"discounted_cash":71.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PYRAZINAMIDE 500 MG TABLET [6738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":83.25,"discounted_cash":69.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET [11218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3077205712","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET [11218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3700025445","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET [11218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3700074108","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET [11218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37000-024-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE [6716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6754-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"PSEUDOEPHEDRINE 60 MG TABLET [6715]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6728-52","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PSEUDOEPHEDRINE 60 MG TABLET [6715]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6728-46","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PSEUDOEPHEDRINE 60 MG TABLET [6715]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5125-59","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PSEUDOEPHEDRINE 30 MG TABLET [6714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6990-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PSEUDOEPHEDRINE 30 MG TABLET [6714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093982344","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET [11218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37000-024-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION [195695]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90678","type":"HCPCS"},{"code":"0069-0207-01","type":"NDC"}],"standard_charges":[{"gross_charge":1318.25,"discounted_cash":1107.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION [195695]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90678","type":"HCPCS"},{"code":"0069-0344-05","type":"NDC"}],"standard_charges":[{"gross_charge":1318.25,"discounted_cash":1107.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE [11283]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2790","type":"HCPCS"},{"code":"0562-7805-01","type":"NDC"}],"standard_charges":[{"gross_charge":605.25,"discounted_cash":508.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-198-30","type":"NDC"}],"standard_charges":[{"gross_charge":205.75,"discounted_cash":172.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-081-30","type":"NDC"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-286-38","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-286-35","type":"NDC"}],"standard_charges":[{"gross_charge":147.5,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-286-00","type":"NDC"}],"standard_charges":[{"gross_charge":354.25,"discounted_cash":297.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-286-31","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":119.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71288-732-11","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71288-732-10","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-671-87","type":"NDC"}],"standard_charges":[{"gross_charge":381.5,"discounted_cash":320.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-671-82","type":"NDC"}],"standard_charges":[{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323-285-07","type":"NDC"}],"standard_charges":[{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-196-99","type":"NDC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-285-73","type":"NDC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":227.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-285-68","type":"NDC"}],"standard_charges":[{"gross_charge":165.5,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323-285-23","type":"NDC"}],"standard_charges":[{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323-285-13","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323-285-20","type":"NDC"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":65.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"ROPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [18194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-288-07","type":"NDC"}],"standard_charges":[{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ROPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [18194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-201-20","type":"NDC"}],"standard_charges":[{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ROPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [18194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9303-21","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ROPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [18194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9303-20","type":"NDC"}],"standard_charges":[{"gross_charge":364.75,"discounted_cash":306.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 110 ML"},{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-286-11","type":"NDC"}],"standard_charges":[{"gross_charge":147.5,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [18194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-288-21","type":"NDC"}],"standard_charges":[{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-652-82","type":"NDC"}],"standard_charges":[{"gross_charge":340.25,"discounted_cash":285.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-180-90","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5401-92","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-262-90","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4503-9","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-0751-90","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":149.5,"discounted_cash":125.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":299.0,"discounted_cash":251.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROPIVACAINE (PF) 7.5 MG/ML (0.75 %) INJECTION SOLUTION [18193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-287-20","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":153.25,"discounted_cash":128.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":191.5,"discounted_cash":160.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"ROPIVACAINE (PF) 7.5 MG/ML (0.75 %) INJECTION SOLUTION [18193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323-287-20","type":"NDC"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-064-25","type":"NDC"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-064-10","type":"NDC"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-286-33","type":"NDC"}],"standard_charges":[{"gross_charge":654.25,"discounted_cash":549.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-286-03","type":"NDC"}],"standard_charges":[{"gross_charge":354.25,"discounted_cash":297.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-876-30","type":"NDC"}],"standard_charges":[{"gross_charge":169.75,"discounted_cash":142.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [18194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-288-20","type":"NDC"}],"standard_charges":[{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ROPIVACAINE (PF) 0.5 % (5 MG/ML) EPIDURAL SOLUTION [408133270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7061-10","type":"NDC"}],"standard_charges":[{"gross_charge":235.25,"discounted_cash":197.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE (PF) 0.5 % (5 MG/ML) EPIDURAL SOLUTION [408133270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7062-27","type":"NDC"}],"standard_charges":[{"gross_charge":864.25,"discounted_cash":725.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 270 ML"}]},{"description":"ROPINIROLE 0.25 MG TABLET [21688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-253-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":135.5,"discounted_cash":113.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-222-01","type":"NDC"}],"standard_charges":[{"gross_charge":3484.5,"discounted_cash":2926.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"}]},{"description":"ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2802","type":"HCPCS"},{"code":"55513-222-01","type":"NDC"}],"standard_charges":[{"gross_charge":1742.25,"discounted_cash":1463.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-221-01","type":"NDC"}],"standard_charges":[{"gross_charge":5033.0,"discounted_cash":4227.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"}]},{"description":"ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2802","type":"HCPCS"},{"code":"55513-221-01","type":"NDC"}],"standard_charges":[{"gross_charge":2516.5,"discounted_cash":2113.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [183996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-223-01","type":"NDC"}],"standard_charges":[{"gross_charge":6195.0,"discounted_cash":5203.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/KG"}]},{"description":"ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [183996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2802","type":"HCPCS"},{"code":"55513-223-01","type":"NDC"}],"standard_charges":[{"gross_charge":3097.5,"discounted_cash":2601.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION [100344]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59572-984-01","type":"NDC"}],"standard_charges":[{"gross_charge":9549.5,"discounted_cash":8021.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"ROFLUMILAST 500 MCG TABLET [109401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-275-90","type":"NDC"}],"standard_charges":[{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"ROFLUMILAST 500 MCG TABLET [109401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-623-90","type":"NDC"}],"standard_charges":[{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"ROFLUMILAST 500 MCG TABLET [109401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-623-30","type":"NDC"}],"standard_charges":[{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"ROFLUMILAST 500 MCG TABLET [109401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-0095-90","type":"NDC"}],"standard_charges":[{"gross_charge":123.75,"discounted_cash":103.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"ROFLUMILAST 250 MCG TABLET [178292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-0088-28","type":"NDC"}],"standard_charges":[{"gross_charge":247.25,"discounted_cash":207.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"ROCURONIUM 50 MG/5 ML (10 MG/ML) INTRAVENOUS SYRINGE [132053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73177-159-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ROCURONIUM 50 MG/5 ML (10 MG/ML) INTRAVENOUS SYRINGE [132053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-924-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ROCURONIUM 50 MG/5 ML (10 MG/ML) INTRAVENOUS SYRINGE [132053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-2452-44","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":68.25,"discounted_cash":57.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":68.25,"discounted_cash":57.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ROPINIROLE 0.25 MG TABLET [21688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-268-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROPIVACAINE (PF) 0.5 % (5 MG/ML) EPIDURAL SOLUTION [408133270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71019-155-08","type":"NDC"}],"standard_charges":[{"gross_charge":1731.75,"discounted_cash":1454.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 270 ML"}]},{"description":"ROPIVACAINE (PF) 0.5 % (5 MG/ML) EPIDURAL SOLUTION [408133270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71019-154-02","type":"NDC"}],"standard_charges":[{"gross_charge":399.5,"discounted_cash":335.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE (PF) 0.5 % (5 MG/ML) EPIDURAL SOLUTION [408133270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42852-2704-04","type":"NDC"}],"standard_charges":[{"gross_charge":423.75,"discounted_cash":355.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 270 ML"}]},{"description":"ROPIVACAINE (PF) 0.5 % (5 MG/ML) EPIDURAL SOLUTION [408133270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42852-1004-02","type":"NDC"}],"standard_charges":[{"gross_charge":320.75,"discounted_cash":269.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE (PF) 0.5 % (5 MG/ML) EPIDURAL SOLUTION [408133270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61553-046-35","type":"NDC"}],"standard_charges":[{"gross_charge":1252.75,"discounted_cash":1052.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 270 ML"}]},{"description":"ROPIVACAINE (PF) 0.5 % (5 MG/ML) EPIDURAL SOLUTION [408133270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61553-002-39","type":"NDC"}],"standard_charges":[{"gross_charge":765.25,"discounted_cash":642.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE (PF) 0.2 %-0.9 % NACL 550 ML INFILT,HI VAR RATE ELAST PUMP [408132640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7063-55","type":"NDC"}],"standard_charges":[{"gross_charge":800.25,"discounted_cash":672.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 550 ML"}]},{"description":"ROPIVACAINE (PF) 0.2 %-0.9 % NACL 550 ML INFILT,HI VAR RATE ELAST PUMP [408132640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71019-148-69","type":"NDC"}],"standard_charges":[{"gross_charge":1038.75,"discounted_cash":872.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 550 ML"}]},{"description":"ROPINIROLE 1 MG TABLET [21689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-032-31","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROPINIROLE 1 MG TABLET [21689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6374-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROPINIROLE 1 MG TABLET [21689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-270-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROPINIROLE 1 MG TABLET [21689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-255-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROPINIROLE 0.25 MG TABLET [21688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6373-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-285-15","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-155-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":483.5,"discounted_cash":406.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-234-11","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":193.25,"discounted_cash":162.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":386.25,"discounted_cash":324.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-234-01","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":193.25,"discounted_cash":162.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":386.25,"discounted_cash":324.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-882-90","type":"NDC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":483.5,"discounted_cash":406.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-284-15","type":"NDC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":483.5,"discounted_cash":406.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5400-92","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":78.25,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-261-90","type":"NDC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":483.5,"discounted_cash":406.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4502-9","type":"NDC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":483.5,"discounted_cash":406.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6778-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-505-10","type":"NDC"}],"standard_charges":[{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6470-99","type":"NDC"}],"standard_charges":[{"gross_charge":136.5,"discounted_cash":114.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6470-97","type":"NDC"}],"standard_charges":[{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6470-44","type":"NDC"}],"standard_charges":[{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6470-16","type":"NDC"}],"standard_charges":[{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-580-01","type":"NDC"}],"standard_charges":[{"gross_charge":155.5,"discounted_cash":130.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-208-54","type":"NDC"}],"standard_charges":[{"gross_charge":120.5,"discounted_cash":101.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10019-553-04","type":"NDC"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10019-553-03","type":"NDC"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10019-553-90","type":"NDC"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0067-4345-09","type":"NDC"}],"standard_charges":[{"gross_charge":144.75,"discounted_cash":121.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SAXAGLIPTIN 2.5 MG-METFORMIN ER 1,000 MG TABLET,EXTEND RELEASE 24HR MP [106652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-6125-60","type":"NDC"}],"standard_charges":[{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":136.0,"discounted_cash":114.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SARILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE [174348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0024-5910-01","type":"NDC"}],"standard_charges":[{"gross_charge":6822.75,"discounted_cash":5731.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"SARILUMAB 200 MG/1.14 ML SUBCUTANEOUS PEN INJECTOR [178739]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3590","type":"HCPCS"},{"code":"0024-5922-01","type":"NDC"}],"standard_charges":[{"gross_charge":6822.75,"discounted_cash":5731.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"SALMETEROL 50 MCG/DOSE BLISTER POWDER FOR INHALATION [28246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0173-0521-00","type":"NDC"}],"standard_charges":[{"gross_charge":1544.75,"discounted_cash":1297.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"SALMETEROL 50 MCG/DOSE BLISTER POWDER FOR INHALATION [28246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0173-0520-00","type":"NDC"}],"standard_charges":[{"gross_charge":1042.75,"discounted_cash":875.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 EACH"}]},{"description":"SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY [131517]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"4858200155","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 44.3 ML"}]},{"description":"SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET [168083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0696-20","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET [168082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0777-67","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET [168082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0777-20","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET [168081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0659-20","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION [185136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55135-132-01","type":"NDC"}],"standard_charges":[{"gross_charge":31907.75,"discounted_cash":26802.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"RUCAPARIB 300 MG TABLET [173962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69660-203-91","type":"NDC"}],"standard_charges":[{"gross_charge":285.75,"discounted_cash":240.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ROTAVIRUS VACCINE,LIVE, 89-12 STRAIN G1P(8) 10EXP6 CCID50/ML ORAL SUSP [91822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-851-01","type":"NDC"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":557.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ROTAVIRUS VACCINE,LIVE, 89-12 STRAIN G1P(8) 10EXP6 CCID50/ML ORAL SUSP [91822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-854-52","type":"NDC"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":557.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-168-90","type":"NDC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":483.5,"discounted_cash":406.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 20 MG TABLET [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4504-9","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 20 MG TABLET [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-170-90","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-989-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":117.75,"discounted_cash":98.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":235.25,"discounted_cash":197.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-709-15","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-156-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-245-11","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":193.25,"discounted_cash":162.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 10 MG TABLET [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-245-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":193.25,"discounted_cash":162.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 20 MG TABLET [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-263-90","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 5 MG TABLET [36612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-0755-90","type":"NDC"}],"standard_charges":[{"gross_charge":149.5,"discounted_cash":125.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":299.0,"discounted_cash":251.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":598.0,"discounted_cash":502.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 20 MG TABLET [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-990-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":117.75,"discounted_cash":98.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 20 MG TABLET [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-157-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 20 MG TABLET [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-256-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 20 MG TABLET [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-256-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 20 MG TABLET [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-884-90","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN 20 MG TABLET [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5402-92","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROCURONIUM 50 MG/5 ML (10 MG/ML) INTRAVENOUS SYRINGE [132053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-5738-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"RISPERIDONE 0.25 MG TABLET [25519]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-270-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":210.5,"discounted_cash":176.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"RISPERIDONE 0.25 MG TABLET [25519]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-460-20","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":210.5,"discounted_cash":176.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"RISEDRONATE 35 MG TABLET [32895]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0430-0472-03","type":"NDC"}],"standard_charges":[{"gross_charge":364.5,"discounted_cash":306.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":424.5,"discounted_cash":356.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION [192164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-5015-01","type":"NDC"}],"standard_charges":[{"gross_charge":6385.5,"discounted_cash":5363.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12771.0,"discounted_cash":10727.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":21285.0,"discounted_cash":17879.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIMANTADINE 100 MG TABLET [15440]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1911-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"RILUZOLE 50 MG TABLET [16124]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-286-60","type":"NDC"}],"standard_charges":[{"gross_charge":200.75,"discounted_cash":168.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"RILPIVIRINE HCL 25 MG TABLET [109909]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-278-01","type":"NDC"}],"standard_charges":[{"gross_charge":248.5,"discounted_cash":208.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":491.75,"discounted_cash":413.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"RIFAXIMIN 550 MG TABLET [104604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649-303-03","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":284.0,"discounted_cash":238.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 550 MG"}]},{"description":"RIFAXIMIN 550 MG TABLET [104604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649-303-02","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":284.0,"discounted_cash":238.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 550 MG"}]},{"description":"RIFAXIMIN 200 MG TABLET [39063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649-301-03","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":255.25,"discounted_cash":214.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 550 MG"}]},{"description":"RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0068-0597-01","type":"NDC"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":642.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":382.5,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-445-60","type":"NDC"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":663.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-351-20","type":"NDC"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":632.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55390-123-01","type":"NDC"}],"standard_charges":[{"gross_charge":266.5,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RIFAMPIN 300 MG CAPSULE [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-586-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RISPERIDONE 0.25 MG TABLET [25519]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-270-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":210.5,"discounted_cash":176.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"RISPERIDONE 1 MG TABLET [18313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-037-60","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":61.5,"discounted_cash":51.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":92.25,"discounted_cash":77.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"RISPERIDONE 1 MG TABLET [18313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-037-05","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":61.5,"discounted_cash":51.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":92.25,"discounted_cash":77.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"RISPERIDONE 1 MG TABLET [18313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-300-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":73.25,"discounted_cash":61.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":146.5,"discounted_cash":123.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":219.75,"discounted_cash":184.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":293.0,"discounted_cash":246.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"RISPERIDONE 0.25 MG TABLET [25519]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-339-06","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":105.5,"discounted_cash":88.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":210.75,"discounted_cash":177.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"RISPERIDONE 0.25 MG TABLET [25519]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-002-06","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":105.5,"discounted_cash":88.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"RISPERIDONE 0.25 MG TABLET [25519]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6357-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":97.0,"discounted_cash":81.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":193.75,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"RIFAMPIN 300 MG CAPSULE [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-586-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 150 MG CAPSULE [11292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-357-21","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 150 MG CAPSULE [11292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-357-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 150 MG CAPSULE [11292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1393-30","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":87.75,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 150 MG CAPSULE [11292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748-015-30","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 150 MG CAPSULE [11292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0801-30","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":87.75,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFABUTIN 150 MG CAPSULE [11290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-738-01","type":"NDC"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":65.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"RIFABUTIN 150 MG CAPSULE [11290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-1350-1","type":"NDC"}],"standard_charges":[{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"RIFABUTIN 150 MG CAPSULE [11290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0013-5301-17","type":"NDC"}],"standard_charges":[{"gross_charge":157.75,"discounted_cash":132.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"RIBOCICLIB 600 MG/DAY (200 MG X 3) AND LETROZOLE 2.5 MG TABLET [174486]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0923-61","type":"NDC"}],"standard_charges":[{"gross_charge":3330.5,"discounted_cash":2797.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"RIBOCICLIB 400 MG/DAY (200 MG X 2) AND LETROZOLE 2.5 MG TABLET [174485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0916-61","type":"NDC"}],"standard_charges":[{"gross_charge":2597.75,"discounted_cash":2182.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"RIBOCICLIB 200 MG/DAY (200 MG X 1) AND LETROZOLE 2.5 MG TABLET [174484]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0909-10","type":"NDC"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":380.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RIBOCICLIB 200 MG/DAY (200 MG X 1) AND LETROZOLE 2.5 MG TABLET [174484]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0909-61","type":"NDC"}],"standard_charges":[{"gross_charge":710.5,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RIBAVIRIN 200 MG CAPSULE [11286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66435-101-84","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":100.25,"discounted_cash":84.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIBAVIRIN 200 MG CAPSULE [11286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-260-12","type":"NDC"}],"standard_charges":[{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":139.25,"discounted_cash":116.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":206.25,"discounted_cash":173.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN [70574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2792","type":"HCPCS"},{"code":"70504-3100-2","type":"NDC"}],"standard_charges":[{"gross_charge":5116.25,"discounted_cash":4297.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.4 ML"}]},{"description":"RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN [70574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2792","type":"HCPCS"},{"code":"70504-3100-1","type":"NDC"}],"standard_charges":[{"gross_charge":5116.25,"discounted_cash":4297.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.4 ML"}]},{"description":"RHO(D) IMMUNE GLOBULIN-MALTOSE 2,500 UNIT (500 MCG)/2.2 ML INJECT.SOLN [70573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2792","type":"HCPCS"},{"code":"70504-3500-2","type":"NDC"}],"standard_charges":[{"gross_charge":3148.5,"discounted_cash":2644.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.2 ML"}]},{"description":"RIFAMPIN 150 MG CAPSULE [11292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-575-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 300 MG CAPSULE [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5282-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 300 MG CAPSULE [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1315-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 300 MG CAPSULE [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1315-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 300 MG CAPSULE [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-415-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 300 MG CAPSULE [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748-018-60","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 300 MG CAPSULE [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748-018-30","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 300 MG CAPSULE [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748-018-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 300 MG CAPSULE [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0799-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 150 MG CAPSULE [11292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-575-21","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RISPERIDONE 1 MG TABLET [18313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6359-61","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":61.75,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":92.5,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":123.5,"discounted_cash":103.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-228-05","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-426-05","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9558-49","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9558-10","type":"NDC"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9558-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-897-99","type":"NDC"}],"standard_charges":[{"gross_charge":119.25,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-897-30","type":"NDC"}],"standard_charges":[{"gross_charge":119.25,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-115-02","type":"NDC"}],"standard_charges":[{"gross_charge":117.25,"discounted_cash":98.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-115-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.25,"discounted_cash":98.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9070-16","type":"NDC"}],"standard_charges":[{"gross_charge":119.25,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9070-93","type":"NDC"}],"standard_charges":[{"gross_charge":119.25,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-304-11","type":"NDC"}],"standard_charges":[{"gross_charge":114.5,"discounted_cash":96.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-304-03","type":"NDC"}],"standard_charges":[{"gross_charge":114.5,"discounted_cash":96.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0501-61","type":"NDC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":129.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0501-15","type":"NDC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":129.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVAROXABAN 2.5 MG TABLET [180012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-709-06","type":"NDC"}],"standard_charges":[{"gross_charge":415.75,"discounted_cash":349.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":554.25,"discounted_cash":465.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RIVAROXABAN 2.5 MG TABLET [180012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-577-60","type":"NDC"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":407.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":646.5,"discounted_cash":543.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RIVAROXABAN 15 MG TABLET [112834]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-578-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RIVAROXABAN 15 MG TABLET [112834]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-578-90","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RIVAROXABAN 15 MG TABLET [112834]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-578-30","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-228-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822-4200-5","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822-4200-6","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-573-00","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 50 MG/5 ML (10 MG/ML) INTRAVENOUS SYRINGE [132053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1452-44","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ROCURONIUM 50 MG/5 ML (10 MG/ML) INTRAVENOUS SYRINGE [132053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1073-44","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72611-756-10","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72611-756-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9558-69","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-426-02","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9558-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9250-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43066-007-10","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-226-10","type":"NDC"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":114.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-225-05","type":"NDC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-0057-38","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION WRAPPER [95811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-574-00","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"RIVAROXABAN 15 MG TABLET [112834]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-578-10","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RISPERIDONE 2 MG TABLET [18311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-463-20","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":107.5,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"RISPERIDONE 2 MG TABLET [18311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-463-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":107.5,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"RISPERIDONE 2 MG TABLET [18311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-320-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":137.75,"discounted_cash":115.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5312-06","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"RISPERIDONE 2 MG DISINTEGRATING TABLET [35688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5312-08","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"RISPERIDONE 1 MG/ML ORAL SOLUTION [17377]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-596-01","type":"NDC"}],"standard_charges":[{"gross_charge":600.75,"discounted_cash":504.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"RISPERIDONE 1 MG TABLET [18313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7362-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"RISPERIDONE 2 MG TABLET [18311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6360-61","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":100.5,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"RIVAROXABAN 10 MG TABLET [110250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-580-01","type":"NDC"}],"standard_charges":[{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":242.5,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":323.25,"discounted_cash":271.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RIVAROXABAN 10 MG TABLET [110250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-580-90","type":"NDC"}],"standard_charges":[{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":242.5,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":323.25,"discounted_cash":271.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RIVAROXABAN 10 MG TABLET [110250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-580-30","type":"NDC"}],"standard_charges":[{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":242.5,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":323.25,"discounted_cash":271.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RIVAROXABAN 10 MG TABLET [110250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-580-10","type":"NDC"}],"standard_charges":[{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":242.5,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":323.25,"discounted_cash":271.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [184172]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"0069-0249-01","type":"NDC"}],"standard_charges":[{"gross_charge":10623.0,"discounted_cash":8923.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION [183621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459-104-50","type":"NDC"}],"standard_charges":[{"gross_charge":8675.75,"discounted_cash":7287.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION [183621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":3084.75,"discounted_cash":2591.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242-051-21","type":"NDC"}],"standard_charges":[{"gross_charge":3427.5,"discounted_cash":2879.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [176199]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-109-01","type":"NDC"}],"standard_charges":[{"gross_charge":15346.5,"discounted_cash":12891.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"}]},{"description":"RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [176123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-108-01","type":"NDC"}],"standard_charges":[{"gross_charge":13456.75,"discounted_cash":11303.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1400 MG"}]},{"description":"RITONAVIR 80 MG/ML ORAL SOLUTION [16440]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-1940-63","type":"NDC"}],"standard_charges":[{"gross_charge":5254.0,"discounted_cash":4413.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"RITONAVIR 100 MG TABLET [100995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-687-30","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":125.25,"discounted_cash":105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"RITONAVIR 100 MG TABLET [100995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-597-30","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":125.25,"discounted_cash":105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"RITONAVIR 100 MG TABLET [100995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-3333-30","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"RISPERIDONE MICROSPHERES ER 25 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE [37237]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458-306-11","type":"NDC"}],"standard_charges":[{"gross_charge":2359.25,"discounted_cash":1981.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [22149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242-053-06","type":"NDC"}],"standard_charges":[{"gross_charge":9639.5,"discounted_cash":8097.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"TACROLIMUS 0.03 % TOPICAL OINTMENT [29442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-390-01","type":"NDC"}],"standard_charges":[{"gross_charge":690.5,"discounted_cash":580.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0781-2102-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VASOPRESSIN 0.2 UNIT/ML INTRAVENOUS SOLUTION [191105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023-237-10","type":"NDC"}],"standard_charges":[{"gross_charge":246.75,"discounted_cash":207.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"VASOPRESSIN 0.2 UNIT/ML INTRAVENOUS SOLUTION [191105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023-237-01","type":"NDC"}],"standard_charges":[{"gross_charge":246.75,"discounted_cash":207.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT [177281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90750","type":"HCPCS"},{"code":"58160-823-11","type":"NDC"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":777.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT [177281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90750","type":"HCPCS"},{"code":"58160-819-12","type":"NDC"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":777.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [113088]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90716","type":"HCPCS"},{"code":"0006-4827-01","type":"NDC"}],"standard_charges":[{"gross_charge":783.5,"discounted_cash":658.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [113088]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90716","type":"HCPCS"},{"code":"0006-4827-00","type":"NDC"}],"standard_charges":[{"gross_charge":783.5,"discounted_cash":658.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VARENICLINE TARTRATE 1 MG TABLET [76445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70748-128-49","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"VARENICLINE TARTRATE 1 MG TABLET [76445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-894-56","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"VARENICLINE TARTRATE 1 MG TABLET [76445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4766-6","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"VARENICLINE TARTRATE 1 MG TABLET [76445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-0469-56","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"VARENICLINE TARTRATE 0.5 MG TABLET [76444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-0468-56","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":132.0,"discounted_cash":110.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"72611-765-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1750 MG"},{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"VANCOMYCIN IV SYRINGE 5 MG/ML FROM PREMIX (NEO/PED) [172668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0338-3552-48","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"VANCOMYCIN IV SYRINGE 100 MG/ML [408027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"7700-6219-12","type":"NDC"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [165366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-164-01","type":"NDC"}],"standard_charges":[{"gross_charge":810.75,"discounted_cash":681.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS/ML"}]},{"description":"VANCOMYCIN IV SYRINGE 100 MG/ML [408027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00000-0003-79","type":"NDC"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"VASOPRESSIN 20 UNIT/100 ML (0.2 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV [180905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2601","type":"HCPCS"},{"code":"0338-9640-12","type":"NDC"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-2925-03","type":"NDC"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-781-41","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-781-21","type":"NDC"}],"standard_charges":[{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1632-21","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-235-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-235-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-2914-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-781-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47335-931-44","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47335-931-40","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-438-10","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-438-00","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"41616-931-40","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"41616-931-44","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1632-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55390-037-10","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-2914-03","type":"NDC"}],"standard_charges":[{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [165366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023-164-01","type":"NDC"}],"standard_charges":[{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 UNITS/ML"},{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":405.5,"discounted_cash":340.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS/ML"},{"gross_charge":405.5,"discounted_cash":340.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 UNITS"}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [165366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"63323-930-01","type":"NDC"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [165366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"63323-930-00","type":"NDC"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [165366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"70121-1642-5","type":"NDC"}],"standard_charges":[{"gross_charge":517.25,"discounted_cash":434.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [165366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"70121-1642-1","type":"NDC"}],"standard_charges":[{"gross_charge":517.25,"discounted_cash":434.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [165366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023-164-10","type":"NDC"}],"standard_charges":[{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [165366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023-164-25","type":"NDC"}],"standard_charges":[{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VANCOMYCIN IV SYRINGE 100 MG/ML [408027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00000-0003-74","type":"NDC"}],"standard_charges":[{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"VANCOMYCIN IV SYRINGE 100 MG/ML [408027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00000-0003-75","type":"NDC"}],"standard_charges":[{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"VANCOMYCIN IV SYRINGE 100 MG/ML [408027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00000-0003-78","type":"NDC"}],"standard_charges":[{"gross_charge":124.75,"discounted_cash":104.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"51991-940-99","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"51991-940-17","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70860-104-10","type":"NDC"}],"standard_charges":[{"gross_charge":121.25,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"67457-339-00","type":"NDC"}],"standard_charges":[{"gross_charge":138.25,"discounted_cash":116.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"67457-339-50","type":"NDC"}],"standard_charges":[{"gross_charge":138.25,"discounted_cash":116.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0409-4332-01","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-221-10","type":"NDC"}],"standard_charges":[{"gross_charge":121.25,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 50 MG/ML ORAL SOLUTION [11630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65628-208-10","type":"NDC"}],"standard_charges":[{"gross_charge":1218.0,"discounted_cash":1023.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"VANCOMYCIN 50 MG/ML ORAL SOLUTION [11630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65628-206-05","type":"NDC"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0143-9358-01","type":"NDC"}],"standard_charges":[{"gross_charge":446.25,"discounted_cash":374.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-295-66","type":"NDC"}],"standard_charges":[{"gross_charge":166.75,"discounted_cash":140.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"67457-341-05","type":"NDC"}],"standard_charges":[{"gross_charge":446.25,"discounted_cash":374.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"25021-157-99","type":"NDC"}],"standard_charges":[{"gross_charge":254.25,"discounted_cash":213.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0409-6509-01","type":"NDC"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":380.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-295-61","type":"NDC"}],"standard_charges":[{"gross_charge":399.75,"discounted_cash":335.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 250 MG CAPSULE [11629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-167-11","type":"NDC"}],"standard_charges":[{"gross_charge":118.5,"discounted_cash":99.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":236.75,"discounted_cash":198.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"VANCOMYCIN 250 MG CAPSULE [11629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63323-339-20","type":"NDC"}],"standard_charges":[{"gross_charge":131.5,"discounted_cash":110.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"VANCOMYCIN 250 MG CAPSULE [11629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-730-02","type":"NDC"}],"standard_charges":[{"gross_charge":118.5,"discounted_cash":99.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":236.75,"discounted_cash":198.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"47781-598-07","type":"NDC"}],"standard_charges":[{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"47781-598-91","type":"NDC"}],"standard_charges":[{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN IV SYRINGE 100 MG/ML [408027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00000-0003-77","type":"NDC"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 ML"}]},{"description":"VANCOMYCIN IV SYRINGE 100 MG/ML [408027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0000-0003-76","type":"NDC"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"VANCOMYCIN ENEMA [400467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"99999-5100-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0338-3580-48","type":"NDC"}],"standard_charges":[{"gross_charge":120.25,"discounted_cash":101.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0143-9161-25","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0143-9161-01","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-221-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.25,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55390-039-10","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"72611-761-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"72611-761-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0409-4332-11","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70860-104-41","type":"NDC"}],"standard_charges":[{"gross_charge":121.25,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-221-48","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-221-43","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-221-38","type":"NDC"}],"standard_charges":[{"gross_charge":121.25,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-221-33","type":"NDC"}],"standard_charges":[{"gross_charge":121.25,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"41616-932-44","type":"NDC"}],"standard_charges":[{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [126219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64764-300-20","type":"NDC"}],"standard_charges":[{"gross_charge":19206.75,"discounted_cash":16133.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0008-0837-02","type":"NDC"}],"standard_charges":[{"gross_charge":310.75,"discounted_cash":261.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":155.5,"discounted_cash":130.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0008-0837-03","type":"NDC"}],"standard_charges":[{"gross_charge":310.75,"discounted_cash":261.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":155.5,"discounted_cash":130.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR [27859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6470-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR [27859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7386-98","type":"NDC"}],"standard_charges":[{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 75 MG TABLET [12206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-175-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 75 MG TABLET [12206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-856-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 75 MG TABLET [12206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-856-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 75 MG TABLET [12206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-395-88","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 75 MG TABLET [12206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-482-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7384-56","type":"NDC"}],"standard_charges":[{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-528-90","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-528-30","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0181-3","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7385-98","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7385-56","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0008-0833-22","type":"NDC"}],"standard_charges":[{"gross_charge":310.75,"discounted_cash":261.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":155.5,"discounted_cash":130.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0008-0833-21","type":"NDC"}],"standard_charges":[{"gross_charge":310.75,"discounted_cash":261.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":155.5,"discounted_cash":130.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6468-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-034-16","type":"NDC"}],"standard_charges":[{"gross_charge":112.75,"discounted_cash":94.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-527-90","type":"NDC"}],"standard_charges":[{"gross_charge":112.75,"discounted_cash":94.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-527-30","type":"NDC"}],"standard_charges":[{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7384-98","type":"NDC"}],"standard_charges":[{"gross_charge":112.75,"discounted_cash":94.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 75 MG TABLET [12206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7382-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 25 MG TABLET [12203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-172-90","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 25 MG TABLET [12203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-392-88","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 25 MG TABLET [12203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-545-90","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENETOCLAX 50 MG TABLET [171790]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-0566-11","type":"NDC"}],"standard_charges":[{"gross_charge":645.75,"discounted_cash":542.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":133.25,"discounted_cash":111.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1286.25,"discounted_cash":1080.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2567.25,"discounted_cash":2156.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":325.5,"discounted_cash":273.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"VENETOCLAX 100 MG TABLET [171791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-0576-22","type":"NDC"}],"standard_charges":[{"gross_charge":645.5,"discounted_cash":542.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":133.25,"discounted_cash":111.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1286.0,"discounted_cash":1080.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2567.0,"discounted_cash":2156.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":325.25,"discounted_cash":273.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"VENETOCLAX 10 MG TABLET [171789]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-0561-14","type":"NDC"}],"standard_charges":[{"gross_charge":1035.5,"discounted_cash":869.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":211.25,"discounted_cash":177.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2066.0,"discounted_cash":1735.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4127.0,"discounted_cash":3466.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":520.25,"discounted_cash":437.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"VENLAFAXINE 25 MG TABLET [12203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-655-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 37.5 MG TABLET [12207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-656-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 37.5 MG TABLET [12207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 37.5 MG TABLET [12207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-009-31","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-475-20","type":"NDC"}],"standard_charges":[{"gross_charge":92.5,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VENLAFAXINE 37.5 MG TABLET [12207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-393-88","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 37.5 MG TABLET [12207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-480-20","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 37.5 MG TABLET [12207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-480-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE 37.5 MG TABLET [12207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7380-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-035-16","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VANCOMYCIN 25 MG/ML ORAL SOLUTION [178197]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52536-107-10","type":"NDC"}],"standard_charges":[{"gross_charge":747.25,"discounted_cash":627.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"VANCOMYCIN 25 MG/ML ORAL SOLUTION [178197]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65628-204-05","type":"NDC"}],"standard_charges":[{"gross_charge":663.5,"discounted_cash":557.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-494-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"}]},{"description":"VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-494-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"}]},{"description":"VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9785-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"}]},{"description":"VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9785-10","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"}]},{"description":"VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-494-05","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"}]},{"description":"VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-159-19","type":"NDC"}],"standard_charges":[{"gross_charge":3041.0,"discounted_cash":2554.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 ML"}]},{"description":"VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2579-20","type":"NDC"}],"standard_charges":[{"gross_charge":3041.0,"discounted_cash":2554.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 ML"}]},{"description":"VALGANCICLOVIR 450 MG TABLET [30148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-965-95","type":"NDC"}],"standard_charges":[{"gross_charge":134.25,"discounted_cash":112.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"}]},{"description":"VALGANCICLOVIR 450 MG TABLET [30148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0004-0038-22","type":"NDC"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6565-61","type":"NDC"}],"standard_charges":[{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-215-11","type":"NDC"}],"standard_charges":[{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-215-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-042-90","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":82.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-525-10","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":82.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-093-03","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":82.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-698-03","type":"NDC"}],"standard_charges":[{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5208-92","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":82.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0933-10","type":"NDC"}],"standard_charges":[{"gross_charge":217.75,"discounted_cash":182.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR 500 MG TABLET [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0933-56","type":"NDC"}],"standard_charges":[{"gross_charge":209.75,"discounted_cash":176.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-494-41","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"}]},{"description":"USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE [126168]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3357","type":"HCPCS"},{"code":"57894-061-03","type":"NDC"}],"standard_charges":[{"gross_charge":59819.0,"discounted_cash":50247.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-797-05","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"}]},{"description":"VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [133402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4675-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VALSARTAN 160 MG TABLET [31210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-139-11","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 160 MG TABLET [31210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-139-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 160 MG TABLET [31210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-362-90","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 160 MG TABLET [31210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0359-34","type":"NDC"}],"standard_charges":[{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":165.25,"discounted_cash":138.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9357","type":"HCPCS"},{"code":"67979-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":5484.25,"discounted_cash":4606.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":21936.75,"discounted_cash":18426.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9357","type":"HCPCS"},{"code":"24201-101-04","type":"NDC"}],"standard_charges":[{"gross_charge":5129.25,"discounted_cash":4308.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9357","type":"HCPCS"},{"code":"24201-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":5129.25,"discounted_cash":4308.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VALPROIC ACID 250 MG CAPSULE [8429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-086-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VALPROIC ACID 250 MG CAPSULE [8429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-150-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VALPROIC ACID 250 MG CAPSULE [8429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0310-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VALPROIC ACID 250 MG CAPSULE [8429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-4012-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [133402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4221-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [133402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4675-40","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [133402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4675-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [133402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-193-59","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [133402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-193-62","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"USTEKINUMAB 45 MG/0.5 ML SUBCUTANEOUS SYRINGE [126167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3357","type":"HCPCS"},{"code":"57894-060-03","type":"NDC"}],"standard_charges":[{"gross_charge":29909.5,"discounted_cash":25123.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"USTEKINUMAB 45 MG/0.5 ML SUBCUTANEOUS SOLUTION [99447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J3357","type":"HCPCS"},{"code":"57894-060-02","type":"NDC"}],"standard_charges":[{"gross_charge":29909.5,"discounted_cash":25123.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION [408692]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"57894-054-27","type":"NDC"}],"standard_charges":[{"gross_charge":12565.5,"discounted_cash":10555.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 260 MG"},{"gross_charge":18848.0,"discounted_cash":15832.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 390 MG"},{"gross_charge":25130.75,"discounted_cash":21109.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 520 MG"}]},{"description":"TROLAMINE SALICYLATE 10 % TOPICAL CREAM [27680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-356-53","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"TROLAMINE SALICYLATE 10 % TOPICAL CREAM [27680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0225-0360-35","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 226.8 G"}]},{"description":"TROLAMINE SALICYLATE 10 % TOPICAL CREAM [27680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0225-0360-11","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2865","type":"HCPCS"},{"code":"70069-362-10","type":"NDC"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG OF TRIMETHOPRIM"}]},{"description":"TRIMETHOPRIM 100 MG TABLET [8182]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-486-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION [8178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3250","type":"HCPCS"},{"code":"42023-119-25","type":"NDC"}],"standard_charges":[{"gross_charge":299.25,"discounted_cash":251.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TRILACICLIB 300 MG INTRAVENOUS SOLUTION [187888]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73462-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":5802.5,"discounted_cash":4874.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRIHEXYPHENIDYL 5 MG TABLET [8167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-161-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIHEXYPHENIDYL 5 MG TABLET [8167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5337-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIHEXYPHENIDYL 2 MG TABLET [8166]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5335-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIFLURIDINE 1 % EYE DROPS [11595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-044-75","type":"NDC"}],"standard_charges":[{"gross_charge":877.25,"discounted_cash":736.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"TRIFLUOPERAZINE 5 MG TABLET [8164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-8034-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIFLUOPERAZINE 5 MG TABLET [8164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-574-20","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIFLUOPERAZINE 5 MG TABLET [8164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-574-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TROLAMINE SALICYLATE 10 % TOPICAL CREAM [27680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-883-84","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"TROLAMINE SALICYLATE 10 % TOPICAL CREAM [27680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167-570-03","type":"NDC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"TROPICAMIDE 1 % EYE DROPS [8250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-102-12","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TROPICAMIDE 1 % EYE DROPS [8250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-585-59","type":"NDC"}],"standard_charges":[{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"URSODIOL 300 MG CAPSULE [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-421-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 300 MG CAPSULE [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6221-61","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 300 MG CAPSULE [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51224-151-50","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 300 MG CAPSULE [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-503-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 300 MG CAPSULE [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1326-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 300 MG CAPSULE [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3159-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 250 MG TABLET [22660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-527-21","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"URSODIOL 250 MG TABLET [22660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-527-11","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"URIDINE TRIACETATE 10 GRAM ORAL GRANULES IN PACKET [169020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50633-220-20","type":"NDC"}],"standard_charges":[{"gross_charge":11084.25,"discounted_cash":9310.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"UREA 15 GRAM ORAL POWDER PACKET [176147]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6253000011","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"},{"gross_charge":88.25,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PACKET"},{"gross_charge":117.75,"discounted_cash":98.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 PACKET"}]},{"description":"VALSARTAN 160 MG TABLET [31210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-5814-77","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"UMECLIDINIUM 62.5 MCG-VILANTEROL 25 MCG/ACTUATION POWDR FOR INHALATION [125036]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0869-10","type":"NDC"}],"standard_charges":[{"gross_charge":1784.25,"discounted_cash":1498.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"UMECLIDINIUM 62.5 MCG-VILANTEROL 25 MCG/ACTUATION POWDR FOR INHALATION [125036]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0869-06","type":"NDC"}],"standard_charges":[{"gross_charge":579.75,"discounted_cash":486.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 EACH"}]},{"description":"TUCATINIB 50 MG TABLET [185108]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51144-001-60","type":"NDC"}],"standard_charges":[{"gross_charge":1614.75,"discounted_cash":1356.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":2153.0,"discounted_cash":1808.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2691.25,"discounted_cash":2260.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3229.5,"discounted_cash":2712.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TUCATINIB 150 MG TABLET [185109]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51144-002-60","type":"NDC"}],"standard_charges":[{"gross_charge":1885.0,"discounted_cash":1583.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49281-752-78","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-104-05","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49281-752-22","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION [8259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49281-752-21","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE [88317]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68803-612-10","type":"NDC"}],"standard_charges":[{"gross_charge":395.25,"discounted_cash":332.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VANCOMYCIN 25 MG/ML ORAL SOLUTION [178197]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65628-205-10","type":"NDC"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"72611-765-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0409-6533-11","type":"NDC"}],"standard_charges":[{"gross_charge":139.75,"discounted_cash":117.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70860-105-41","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70594-046-02","type":"NDC"}],"standard_charges":[{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70594-046-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"55150-204-20","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-284-45","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-284-41","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"47781-597-91","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"47781-597-07","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70860-105-20","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"67457-340-00","type":"NDC"}],"standard_charges":[{"gross_charge":137.75,"discounted_cash":115.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"67457-340-01","type":"NDC"}],"standard_charges":[{"gross_charge":137.75,"discounted_cash":115.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0409-6533-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-284-01","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"71288-023-20","type":"NDC"}],"standard_charges":[{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 2 GRAM/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [132455]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70092-9338-07","type":"NDC"}],"standard_charges":[{"gross_charge":213.75,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 MG"}]},{"description":"VANCOMYCIN 2 GRAM IN 500 ML 0.9 % SODIUM CHLORIDE (PREMIX) [179293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"7700-7080-20","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 MG"}]},{"description":"VANCOMYCIN 1750 MG IN 500 ML 0.9 % SODIUM CHLORIDE (PREMIX) [179292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"7700-7080-17","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1750 MG"}]},{"description":"VANCOMYCIN 1500 MG IN 500 ML 0.9 % SODIUM CHLORIDE (PREMIX) [179291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"7700-7080-15","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"VANCOMYCIN 125 MG CAPSULE [11628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-858-78","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 125 MG CAPSULE [11628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-166-13","type":"NDC"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":680.0,"discounted_cash":571.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 125 MG CAPSULE [11628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-166-11","type":"NDC"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":680.0,"discounted_cash":571.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 125 MG CAPSULE [11628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63323-338-20","type":"NDC"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":158.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":756.0,"discounted_cash":635.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 125 MG CAPSULE [11628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-729-02","type":"NDC"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":680.0,"discounted_cash":571.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70594-048-01","type":"NDC"}],"standard_charges":[{"gross_charge":303.75,"discounted_cash":255.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-314-68","type":"NDC"}],"standard_charges":[{"gross_charge":920.5,"discounted_cash":773.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-314-66","type":"NDC"}],"standard_charges":[{"gross_charge":186.75,"discounted_cash":156.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"67457-342-10","type":"NDC"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":778.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"0409-6510-01","type":"NDC"}],"standard_charges":[{"gross_charge":931.75,"discounted_cash":782.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-314-61","type":"NDC"}],"standard_charges":[{"gross_charge":920.5,"discounted_cash":773.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN 1.5 GRAM/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLN [171760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70092-9599-07","type":"NDC"}],"standard_charges":[{"gross_charge":230.5,"discounted_cash":193.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"VANCOMYCIN 1.25 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [132452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70092-9054-05","type":"NDC"}],"standard_charges":[{"gross_charge":205.25,"discounted_cash":172.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"}]},{"description":"VANCOMYCIN 1.25 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [132452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"99999-0016-01","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"71288-023-21","type":"NDC"}],"standard_charges":[{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-284-20","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN 1 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [129653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70092-9053-05","type":"NDC"}],"standard_charges":[{"gross_charge":198.25,"discounted_cash":166.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"VALSARTAN 40 MG TABLET [33541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-044-90","type":"NDC"}],"standard_charges":[{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 40 MG TABLET [33541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-367-03","type":"NDC"}],"standard_charges":[{"gross_charge":108.75,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 40 MG TABLET [33541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-5807-93","type":"NDC"}],"standard_charges":[{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 40 MG TABLET [33541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-570-30","type":"NDC"}],"standard_charges":[{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 40 MG TABLET [33541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-360-30","type":"NDC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 40 MG TABLET [33541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0423-15","type":"NDC"}],"standard_charges":[{"gross_charge":257.25,"discounted_cash":216.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":128.75,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 160 MG TABLET [31210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-153-90","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 160 MG TABLET [31210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-858-90","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 160 MG TABLET [31210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-064-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 40 MG TABLET [33541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-783-15","type":"NDC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VANCOMYCIN 1 GRAM/200 ML IN DILUENT COMBINATION IV PIGGYBACK [181658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70594-042-03","type":"NDC"}],"standard_charges":[{"gross_charge":191.25,"discounted_cash":160.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"VANCOMYCIN 1 GRAM/200 ML IN DILUENT COMBINATION IV PIGGYBACK [181658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70594-042-01","type":"NDC"}],"standard_charges":[{"gross_charge":191.25,"discounted_cash":160.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"VANCOMYCIN 1 GRAM IN 250 ML 0.9 % SODIUM CHLORIDE (PREMIX) [167713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"99999-0015-01","type":"NDC"}],"standard_charges":[{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"VALSARTAN 80 MG TABLET [31209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-063-10","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 80 MG TABLET [31209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-5813-77","type":"NDC"}],"standard_charges":[{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 80 MG TABLET [31209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-128-01","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 80 MG TABLET [31209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55289-825-30","type":"NDC"}],"standard_charges":[{"gross_charge":65.75,"discounted_cash":55.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":131.5,"discounted_cash":110.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 80 MG TABLET [31209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0358-34","type":"NDC"}],"standard_charges":[{"gross_charge":153.75,"discounted_cash":129.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":307.25,"discounted_cash":258.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 40 MG TABLET [33541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-151-30","type":"NDC"}],"standard_charges":[{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 40 MG TABLET [33541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-062-07","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-709-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"ZINC OXIDE 20 % TOPICAL OINTMENT [8874]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-5700-98","type":"NDC"}],"standard_charges":[{"gross_charge":61.5,"discounted_cash":51.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 454 G"}]},{"description":"ZINC OXIDE 16 % TOPICAL OINTMENT [109467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6210333302","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 G"}]},{"description":"ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION [8865]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0102-4","type":"NDC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":129.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION [8865]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0102-1","type":"NDC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":129.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION [8865]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4090-11","type":"NDC"}],"standard_charges":[{"gross_charge":154.75,"discounted_cash":129.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION [8865]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4090-01","type":"NDC"}],"standard_charges":[{"gross_charge":154.75,"discounted_cash":129.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION [11691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3485","type":"HCPCS"},{"code":"49702-213-26","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":110.25,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"}]},{"description":"ZIDOVUDINE 100 MG CAPSULE [11692]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49702-211-20","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":65.75,"discounted_cash":55.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ZIDOVUDINE 100 MG CAPSULE [11692]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65862-107-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ZIDOVUDINE 10 MG/ML ORAL SYRUP [11693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-1838-05","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"ZIDOVUDINE 10 MG/ML ORAL SYRUP [11693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65862-048-24","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":86.5,"discounted_cash":72.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"ZINC OXIDE 20 % TOPICAL OINTMENT [8874]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-170-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"ZINC OXIDE 20 % TOPICAL OINTMENT [8874]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-170-02","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56.7 G"}]},{"description":"ZINC OXIDE 20 % TOPICAL OINTMENT [8874]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1316-28","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"ZIPRASIDONE 20 MG CAPSULE [29778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-103-09","type":"NDC"}],"standard_charges":[{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":114.5,"discounted_cash":96.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":228.75,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 20 MG CAPSULE [29778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2164-60","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":179.75,"discounted_cash":150.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 20 MG CAPSULE [29778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2528-6","type":"NDC"}],"standard_charges":[{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":121.25,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":181.75,"discounted_cash":152.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":242.25,"discounted_cash":203.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 20 MG CAPSULE [29778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-256-60","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":179.75,"discounted_cash":150.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZINC SULFATE 50 MG (220 MG) TABLET/CAPSULE WRAPPER [4088880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1000673027","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZINC SULFATE 50 MG (220 MG) TABLET/CAPSULE WRAPPER [4088880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733398325","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZINC SULFATE 50 MG (220 MG) TABLET/CAPSULE WRAPPER [4088880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733398310","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZINC SULFATE 50 MG (220 MG) TABLET/CAPSULE WRAPPER [4088880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5164599101","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZINC SULFATE 50 MG (220 MG) TABLET/CAPSULE WRAPPER [4088880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39449902","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION [8878]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-6101-25","type":"NDC"}],"standard_charges":[{"gross_charge":200.5,"discounted_cash":168.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION [8878]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-6101-01","type":"NDC"}],"standard_charges":[{"gross_charge":200.5,"discounted_cash":168.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ZINC OXIDE-VITAMIN B5-VIT E 11.3% TOPICAL CREAM [89412]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3010304000","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 G"}]},{"description":"ZINC OXIDE 40 % TOPICAL OINTMENT [131861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0363-6771-57","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"ZINC OXIDE 40 % TOPICAL OINTMENT [131861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1191716771","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"ZINC OXIDE 40 % TOPICAL OINTMENT [131861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1191710108","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"ZINC OXIDE 40 % TOPICAL OINTMENT [131861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6210332304","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"ZINC OXIDE 40 % TOPICAL OINTMENT [131861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6210332302","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"ZINC OXIDE 40 % TOPICAL OINTMENT [131861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0363-7142-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"ZINC OXIDE 20 % TOPICAL OINTMENT [8874]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-5700-28","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"ZANUBRUTINIB 80 MG CAPSULE [183985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72579-011-02","type":"NDC"}],"standard_charges":[{"gross_charge":645.75,"discounted_cash":542.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"WARFARIN SODIUM 0.5 MG PO SPLIT TAB [184643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7151-05","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":349.25,"discounted_cash":293.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":174.75,"discounted_cash":146.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":262.0,"discounted_cash":220.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"WARFARIN 7.5 MG TABLET [8752]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4034-1","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 5 MG TABLET [8751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1721-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 5 MG TABLET [8751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1216-89","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 5 MG TABLET [8751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-994-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 5 MG TABLET [8751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1216-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 5 MG TABLET [8751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-994-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 5 MG TABLET [8751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4032-1","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 3 MG TABLET [19433]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0056-0188-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0013-04","type":"NDC"}],"standard_charges":[{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0013-29","type":"NDC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":187.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 ML"}]},{"description":"WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7990-09","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-178-76","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"ZALEPLON 5 MG CAPSULE [25997]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-131-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":99.75,"discounted_cash":83.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZALEPLON 5 MG CAPSULE [25997]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0084-25","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":99.75,"discounted_cash":83.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAPPER [11371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7214000022","type":"NDC"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAPPER [11371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7214000021","type":"NDC"}],"standard_charges":[{"gross_charge":150.25,"discounted_cash":126.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 454 G"}]},{"description":"WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAPPER [11371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904775127","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 454 G"}]},{"description":"WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT [131461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0518-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT [131080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6488-38","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT [131080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-062-35","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT [132193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-060-76","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT [132193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23066704","type":"NDC"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT [132193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-0240-04","type":"NDC"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"WHITE PETROLATUM TOPICAL OINTMENT IN PACKET [133985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-164-14","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"WHITE PETROLATUM TOPICAL OINTMENT IN PACKET [133985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-164-05","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"WHITE PETROLATUM TOPICAL OINTMENT IN PACKET [133985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67777-211-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"WHITE PETROLATUM TOPICAL OINTMENT IN PACKET [133985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1678411402","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"WHITE PETROLATUM TOPICAL OINTMENT IN PACKET [133985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8080433200","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"WHITE PETROLATUM TOPICAL OINTMENT IN PACKET [133985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0053-45","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"WHITE PETROLATUM TOPICAL OINTMENT [11408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0053-16","type":"NDC"}],"standard_charges":[{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 453.6 G"}]},{"description":"WHITE PETROLATUM TOPICAL JELLY [28809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0521-2345-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 368 G"}]},{"description":"WHITE PETROLATUM 41 % TOPICAL OINTMENT [128807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7214063377","type":"NDC"}],"standard_charges":[{"gross_charge":129.75,"discounted_cash":108.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"WHITE PETROLATUM 41 % TOPICAL OINTMENT [128807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7214045231","type":"NDC"}],"standard_charges":[{"gross_charge":130.75,"discounted_cash":109.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-178-26","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-9782-12","type":"NDC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-9782-01","type":"NDC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT [131206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-0312-04","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":66.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"ZIPRASIDONE 20 MG CAPSULE [29778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-103-11","type":"NDC"}],"standard_charges":[{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":114.5,"discounted_cash":96.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":228.75,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZOLPIDEM ER 6.25 MG TABLET,EXTENDED RELEASE,MULTIPHASE [42677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-5501-31","type":"NDC"}],"standard_charges":[{"gross_charge":285.75,"discounted_cash":240.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":145.5,"discounted_cash":122.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"ZOLPIDEM ER 12.5 MG TABLET,EXTENDED RELEASE,MULTIPHASE [42678]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-5521-31","type":"NDC"}],"standard_charges":[{"gross_charge":145.5,"discounted_cash":122.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"ZOLPIDEM 5 MG/SPRAY (0.1 ML) ORAL SPRAY [107658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69654-510-30","type":"NDC"}],"standard_charges":[{"gross_charge":1555.75,"discounted_cash":1306.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 ML"}]},{"description":"ZOLPIDEM 5 MG TABLET [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-838-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM 5 MG TABLET [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-838-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM 5 MG TABLET [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6082-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM 5 MG TABLET [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-621-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM 5 MG TABLET [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-724-20","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM 5 MG TABLET [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-724-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM 5 MG SUBLINGUAL TABLET [97481]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0037-6050-30","type":"NDC"}],"standard_charges":[{"gross_charge":124.25,"discounted_cash":104.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM 10 MG TABLET [11700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-5421-31","type":"NDC"}],"standard_charges":[{"gross_charge":145.5,"discounted_cash":122.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM 10 MG SUBLINGUAL TABLET [97482]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0037-6010-30","type":"NDC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"ZOLPIDEM 1.75 MG SUBLINGUAL TABLET [113026]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-256-30","type":"NDC"}],"standard_charges":[{"gross_charge":105.75,"discounted_cash":88.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.75 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111-685-07","type":"NDC"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457-619-10","type":"NDC"}],"standard_charges":[{"gross_charge":1009.75,"discounted_cash":848.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM ER 6.25 MG TABLET,EXTENDED RELEASE,MULTIPHASE [42677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-779-04","type":"NDC"}],"standard_charges":[{"gross_charge":87.75,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"ZONISAMIDE 100 MG CAPSULE [27780]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-130-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZONISAMIDE 25 MG CAPSULE [36987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-128-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZONISAMIDE 100 MG CAPSULE [27780]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-230-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZONISAMIDE 100 MG CAPSULE [27780]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-230-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZONISAMIDE 100 MG CAPSULE [27780]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-861-07","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZONISAMIDE 100 MG CAPSULE [27780]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-816-15","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZONISAMIDE 100 MG CAPSULE [27780]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-816-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZONISAMIDE 100 MG CAPSULE [27780]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-260-02","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"63323-966-00","type":"NDC"}],"standard_charges":[{"gross_charge":1289.0,"discounted_cash":1082.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021-830-82","type":"NDC"}],"standard_charges":[{"gross_charge":1503.75,"discounted_cash":1263.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111-688-52","type":"NDC"}],"standard_charges":[{"gross_charge":1289.0,"discounted_cash":1082.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZIPRASIDONE 80 MG CAPSULE [29781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6272-08","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 80 MG CAPSULE [29781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-3990-60","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":76.25,"discounted_cash":64.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":114.25,"discounted_cash":95.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":152.25,"discounted_cash":127.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION [33175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"72266-160-10","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":213.75,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION [33175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"72266-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":213.75,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION [33175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"43598-848-58","type":"NDC"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":231.25,"discounted_cash":194.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION [33175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"0049-3920-83","type":"NDC"}],"standard_charges":[{"gross_charge":158.5,"discounted_cash":133.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":317.0,"discounted_cash":266.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"ZIPRASIDONE 20 MG CAPSULE [29778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-835-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":179.75,"discounted_cash":150.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 20 MG CAPSULE [29778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-702-60","type":"NDC"}],"standard_charges":[{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":121.25,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":181.75,"discounted_cash":152.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":242.25,"discounted_cash":203.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 20 MG CAPSULE [29778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-988-32","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":90.25,"discounted_cash":75.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 80 MG CAPSULE [29781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-259-60","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"23155-186-31","type":"NDC"}],"standard_charges":[{"gross_charge":3022.25,"discounted_cash":2538.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"0409-4215-05","type":"NDC"}],"standard_charges":[{"gross_charge":218.25,"discounted_cash":183.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"0409-4215-01","type":"NDC"}],"standard_charges":[{"gross_charge":220.5,"discounted_cash":185.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457-390-54","type":"NDC"}],"standard_charges":[{"gross_charge":217.25,"discounted_cash":182.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"63323-961-98","type":"NDC"}],"standard_charges":[{"gross_charge":1052.75,"discounted_cash":884.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021-801-66","type":"NDC"}],"standard_charges":[{"gross_charge":773.5,"discounted_cash":649.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK [111464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"0409-4229-01","type":"NDC"}],"standard_charges":[{"gross_charge":297.75,"discounted_cash":250.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK [111464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021-826-82","type":"NDC"}],"standard_charges":[{"gross_charge":773.5,"discounted_cash":649.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLBETUXIMAB-CLZB 100 MG INTRAVENOUS SOLUTION [200064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0469-3425-10","type":"NDC"}],"standard_charges":[{"gross_charge":5837.0,"discounted_cash":4903.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ZIV-AFLIBERCEPT 100 MG/4 ML (25 MG/ML) INTRAVENOUS SOLUTION [117162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0024-5840-01","type":"NDC"}],"standard_charges":[{"gross_charge":18000.75,"discounted_cash":15120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"ZIV-AFLIBERCEPT 200 MG/8 ML (25 MG/ML) INTRAVENOUS SOLUTION [117163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0024-5841-01","type":"NDC"}],"standard_charges":[{"gross_charge":14625.75,"discounted_cash":12285.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"ZIPRASIDONE 80 MG CAPSULE [29781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-838-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 80 MG CAPSULE [29781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-106-11","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 80 MG CAPSULE [29781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-106-09","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE 80 MG CAPSULE [29781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2168-60","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"WARFARIN 3 MG TABLET [19433]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1214-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION [654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-118-50","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 MG"},{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 MG"}]},{"description":"VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE [38978]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1381152501","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE [38978]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6304462201","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE [38978]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6025816201","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"VITAMIN A PALMITATE 50,000 UNIT/ML INTRAMUSCULAR SOLUTION [11641]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70199-026-11","type":"NDC"}],"standard_charges":[{"gross_charge":262.25,"discounted_cash":220.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":2622.0,"discounted_cash":2202.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":1311.0,"discounted_cash":1101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"VITAMIN A PALMITATE 250 MCG-VIT C 50 MG-VIT D3 10 MCG/ML ORAL DROPS [185850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"87040303","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"VITAMIN A AND D TOPICAL OINTMENT WRAPPER [408116493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53329-090-96","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"VITAMIN A AND D TOPICAL OINTMENT WRAPPER [408116493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53329-090-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"VITAMIN A AND D TOPICAL OINTMENT WRAPPER [408116493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4110081124","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"VITAMIN A AND D TOPICAL OINTMENT WRAPPER [408116493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-395-04","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904208560","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8000 UNITS"}]},{"description":"VIT E-WHEAT GERM-ALOE VERA TOPICAL OINTMENT [81693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71661-00974","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"VIT A 300 MCG-C 200 MG-E 27 MG-LUTEIN 2 MG AND MINERALS TABLET [130181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8113174219","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"VIT A 300 MCG-C 200 MG-E 27 MG-LUTEIN 2 MG AND MINERALS TABLET [130181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"2420838762","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"VIT A 300 MCG-C 200 MG-E 27 MG-LUTEIN 2 MG AND MINERALS TABLET [130181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"2420838760","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"VIT A 300 MCG-C 200 MG-E 27 MG-LUTEIN 2 MG AND MINERALS TABLET [130181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536509008","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [131525]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703-309-16","type":"NDC"}],"standard_charges":[{"gross_charge":124.75,"discounted_cash":104.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [131525]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"0703-4412-11","type":"NDC"}],"standard_charges":[{"gross_charge":196.5,"discounted_cash":165.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703-309-06","type":"NDC"}],"standard_charges":[{"gross_charge":287.75,"discounted_cash":241.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"0703-4402-11","type":"NDC"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":204.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"VILAZODONE 40 MG TABLET [109404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1140-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE [108850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536479901","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 INT'L UNITS"}]},{"description":"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE [108850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5789675201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 INT'L UNITS"}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"0781-3416-94","type":"NDC"}],"standard_charges":[{"gross_charge":964.75,"discounted_cash":810.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":1447.0,"discounted_cash":1215.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"0049-3190-28","type":"NDC"}],"standard_charges":[{"gross_charge":457.5,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":686.25,"discounted_cash":576.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"}]},{"description":"VONOPRAZAN 20 MG TABLET [196926]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81520-200-30","type":"NDC"}],"standard_charges":[{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"VITAMINS A,C,E-ZINC-COPPER 2,148 MCG-113 MG-45 MG-17.4 MG TABLET [132602]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068105200","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"VITAMINS A,C,E-ZINC-COPPER 2,148 MCG-113 MG-45 MG-17.4 MG TABLET [132602]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536417841","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT IN A PACKET [116493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1678411502","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"VITAMIN E 100 IU WRAPPER [179305]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"179805202","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 UNITS"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"VITAMIN E 100 IU WRAPPER [179305]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7985490005","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 UNITS"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"VITAMIN E 100 IU WRAPPER [179305]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54629-0100-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 UNITS"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"VITAMIN E 100 IU WRAPPER [179305]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904027060","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 INT'L UNITS"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 UNITS"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"VITAMIN E (DL, ACETATE) 45 MG (100 UNIT) CAPSULE [167918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068113400","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 INT'L UNITS"}]},{"description":"VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE WRAPPER [183964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733395125","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 INT'L UNITS"}]},{"description":"VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE WRAPPER [183964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733395110","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 INT'L UNITS"}]},{"description":"VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE WRAPPER [183964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904027472","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 INT'L UNITS"}]},{"description":"VILAZODONE 10 MG TABLET [109402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-260-30","type":"NDC"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":139.25,"discounted_cash":116.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":278.25,"discounted_cash":233.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE [13184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-292-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL 80 MG TABLET [8530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-026-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VERAPAMIL 80 MG TABLET [8530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-2920-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4011-61","type":"NDC"}],"standard_charges":[{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1144-65","type":"NDC"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-272-01","type":"NDC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-271-25","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-271-05","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-271-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0204-1","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0203-4","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0203-1","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0203-2","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1144-05","type":"NDC"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4011-01","type":"NDC"}],"standard_charges":[{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VERAPAMIL 120 MG TABLET [8528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-486-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VERAPAMIL 120 MG TABLET [8528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-027-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VERAPAMIL 120 MG TABLET [8528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-2924-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-709-11","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE [13184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-116-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE [13184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-320-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VILAZODONE 10 MG TABLET [109402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1110-30","type":"NDC"}],"standard_charges":[{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":197.25,"discounted_cash":165.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":394.5,"discounted_cash":331.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE [13073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE [13073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-260-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE [13073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-1891-31","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-504-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-504-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-158-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-293-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-2180-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"0049-4190-01","type":"NDC"}],"standard_charges":[{"gross_charge":457.5,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":686.25,"discounted_cash":576.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"47781-466-71","type":"NDC"}],"standard_charges":[{"gross_charge":964.75,"discounted_cash":810.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":1447.0,"discounted_cash":1215.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"}]},{"description":"WARFARIN 1.25 MG PO SPLIT TAB [186367]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7166-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"WARFARIN 1 MG TABLET [11664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"WARFARIN 1 MG TABLET [11664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1211-89","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"WARFARIN 1 MG TABLET [11664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0056-0169-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":174.75,"discounted_cash":146.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"WARFARIN 1 MG TABLET [11664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1211-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"WARFARIN 2 MG TABLET [8749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4028-1","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 2 MG TABLET [8749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1212-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 3 MG TABLET [19433]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4030-1","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 3 MG TABLET [19433]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0056-0188-75","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 3 MG TABLET [19433]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0056-0188-70","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 2.5 MG TABLET [8750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1714-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 2.5 MG TABLET [8750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-121-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 2.5 MG TABLET [8750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1213-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 2.5 MG TABLET [8750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1213-00","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 2 MG TABLET [8749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1713-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 2 MG TABLET [8749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1212-89","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN 1 MG TABLET [11664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1211-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"VORICONAZOLE 50 MG TABLET [33008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-514-01","type":"NDC"}],"standard_charges":[{"gross_charge":176.25,"discounted_cash":148.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":352.5,"discounted_cash":296.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":88.25,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"VORICONAZOLE 50 MG TABLET [33008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-572-30","type":"NDC"}],"standard_charges":[{"gross_charge":268.75,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":537.25,"discounted_cash":451.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":134.5,"discounted_cash":112.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"VORICONAZOLE 50 MG TABLET [33008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5289-56","type":"NDC"}],"standard_charges":[{"gross_charge":169.75,"discounted_cash":142.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":339.5,"discounted_cash":285.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0935-3","type":"NDC"}],"standard_charges":[{"gross_charge":3208.25,"discounted_cash":2694.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [38103]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-3160-44","type":"NDC"}],"standard_charges":[{"gross_charge":2046.75,"discounted_cash":1719.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"VORICONAZOLE 200 MG TABLET [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-803-12","type":"NDC"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG TABLET [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-803-11","type":"NDC"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG TABLET [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-008-33","type":"NDC"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG TABLET [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-063-03","type":"NDC"}],"standard_charges":[{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":326.25,"discounted_cash":274.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG TABLET [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-736-06","type":"NDC"}],"standard_charges":[{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":326.25,"discounted_cash":274.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG TABLET [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-573-30","type":"NDC"}],"standard_charges":[{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":326.25,"discounted_cash":274.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG TABLET [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-165-03","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":214.0,"discounted_cash":179.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG TABLET [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-3180-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"39822-1077-1","type":"NDC"}],"standard_charges":[{"gross_charge":418.75,"discounted_cash":351.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":628.0,"discounted_cash":527.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"}]},{"description":"VORICONAZOLE 50 MG TABLET [33008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6596-04","type":"NDC"}],"standard_charges":[{"gross_charge":131.5,"discounted_cash":110.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":262.75,"discounted_cash":220.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":65.75,"discounted_cash":55.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"WARFARIN 1 MG TABLET [11664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4027-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"WARFARIN 1 MG TABLET [11664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0056-0169-75","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":174.75,"discounted_cash":146.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"WARFARIN 1 MG TABLET [11664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0056-0169-70","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":174.75,"discounted_cash":146.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"VORTIOXETINE 10 MG TABLET [124537]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-730-30","type":"NDC"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":278.0,"discounted_cash":233.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0469-0607-73","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRIFLUOPERAZINE 2 MG TABLET [8163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-8032-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"THALLOUS CHLORIDE TL-201 37 MBQ/ML (1 MCI/ML) INTRAVENOUS SOLUTION [98468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9505","type":"HCPCS"},{"code":"11994-0427-06","type":"NDC"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":357.0,"discounted_cash":299.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MILLICURIE"},{"gross_charge":476.0,"discounted_cash":399.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MILLICURIE"}]},{"description":"THALLOUS CHLORIDE TL-201 37 MBQ/ML (1 MCI/ML) INTRAVENOUS SOLUTION [98468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9505","type":"HCPCS"},{"code":"00019-9120-28","type":"NDC"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":357.0,"discounted_cash":299.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MILLICURIE"},{"gross_charge":476.0,"discounted_cash":399.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MILLICURIE"}]},{"description":"THALLOUS CHLORIDE TL-201 37 MBQ/ML (1 MCI/ML) INTRAVENOUS SOLUTION [98468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9505","type":"HCPCS"},{"code":"17156-299-18","type":"NDC"}],"standard_charges":[{"gross_charge":1918.25,"discounted_cash":1611.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":5754.25,"discounted_cash":4833.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MILLICURIE"},{"gross_charge":7672.25,"discounted_cash":6444.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MILLICURIE"}]},{"description":"THALIDOMIDE 50 MG CAPSULE [23599]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59572-205-17","type":"NDC"}],"standard_charges":[{"gross_charge":1615.75,"discounted_cash":1357.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2421.25,"discounted_cash":2033.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":3226.5,"discounted_cash":2710.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":810.5,"discounted_cash":680.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THALIDOMIDE 200 MG CAPSULE [35264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59572-220-16","type":"NDC"}],"standard_charges":[{"gross_charge":681.75,"discounted_cash":572.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1020.0,"discounted_cash":856.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":1358.25,"discounted_cash":1140.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":343.5,"discounted_cash":288.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THALIDOMIDE 100 MG CAPSULE [35263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59572-210-15","type":"NDC"}],"standard_charges":[{"gross_charge":1193.5,"discounted_cash":1002.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1787.75,"discounted_cash":1501.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":2382.0,"discounted_cash":2000.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":599.25,"discounted_cash":503.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE [190805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":11602.5,"discounted_cash":9746.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 210 MG"}]},{"description":"TETRACYCLINE 250 MG CAPSULE [7796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1522-1","type":"NDC"}],"standard_charges":[{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TETRACYCLINE 250 MG CAPSULE [7796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-017-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TETRACAINE HCL (PF) 1 % (10 MG/ML) INJECTION SOLUTION [11517]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54288-127-10","type":"NDC"}],"standard_charges":[{"gross_charge":374.25,"discounted_cash":314.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TETRACAINE HCL (PF) 1 % (10 MG/ML) INJECTION SOLUTION [11517]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54288-127-01","type":"NDC"}],"standard_charges":[{"gross_charge":374.25,"discounted_cash":314.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TETRACAINE HCL (PF) 1 % (10 MG/ML) INJECTION SOLUTION [11517]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-045-32","type":"NDC"}],"standard_charges":[{"gross_charge":374.75,"discounted_cash":314.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TETRACAINE 0.5% EYE DROPS WRAPPER [408688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-920-05","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TETRACAINE 0.5% EYE DROPS WRAPPER [408688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-920-64","type":"NDC"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TETRACAINE 0.5% EYE DROPS WRAPPER [408688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0741-14","type":"NDC"}],"standard_charges":[{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"TETRACAINE 0.5% EYE DROPS WRAPPER [408688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54799-505-05","type":"NDC"}],"standard_charges":[{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION [37504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"13533-131-01","type":"NDC"}],"standard_charges":[{"gross_charge":182.75,"discounted_cash":153.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"THEOPHYLLINE 80 MG/15 ML ORAL SOLUTION [7821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-033-01","type":"NDC"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":385.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"THERAPEUTIC MULTIVITAMIN WITH MINERALS WRAPPER [131854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904549280","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"THERAPEUTIC MULTIVITAMIN WITH MINERALS WRAPPER [131854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904504260","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"THERAPEUTIC MULTIVITAMIN WITH MINERALS WRAPPER [131854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536466110","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR [172758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0486-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR [12098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-025-31","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR [12098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-459-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"THEOPHYLLINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [12097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-482-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"THEOPHYLLINE ER 200 MG CAPSULE,EXTENDED RELEASE 24 HR [27419]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52244-200-10","type":"NDC"}],"standard_charges":[{"gross_charge":46.75,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":93.25,"discounted_cash":78.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"THEOPHYLLINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR [13668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-483-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"}]},{"description":"THEOPHYLLINE ER 100 MG CAPSULE,EXTENDED RELEASE 24 HR [27418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52244-100-10","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":125.5,"discounted_cash":105.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":188.25,"discounted_cash":158.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"THEOPHYLLINE 80 MG/15 ML ORAL SOLUTION WRAPPER [177557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5307-15","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"THEOPHYLLINE 80 MG/15 ML ORAL SOLUTION WRAPPER [177557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4820-40","type":"NDC"}],"standard_charges":[{"gross_charge":84.75,"discounted_cash":71.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"THEOPHYLLINE 80 MG/15 ML ORAL SOLUTION WRAPPER [177557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4820-15","type":"NDC"}],"standard_charges":[{"gross_charge":84.75,"discounted_cash":71.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION [37504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"13533-131-00","type":"NDC"}],"standard_charges":[{"gross_charge":182.75,"discounted_cash":153.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE [131358]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1670","type":"HCPCS"},{"code":"13533-634-20","type":"NDC"}],"standard_charges":[{"gross_charge":2368.25,"discounted_cash":1989.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 UNITS"}]},{"description":"TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE [131358]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1670","type":"HCPCS"},{"code":"13533-634-02","type":"NDC"}],"standard_charges":[{"gross_charge":2368.25,"discounted_cash":1989.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 UNITS"}]},{"description":"TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION [11507]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"63323-665-00","type":"NDC"}],"standard_charges":[{"gross_charge":159.75,"discounted_cash":134.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION [11507]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"0143-9746-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION [11507]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"0143-9746-10","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION [11507]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"63323-665-01","type":"NDC"}],"standard_charges":[{"gross_charge":159.75,"discounted_cash":134.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TERBINAFINE HCL 250 MG TABLET [12724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-795-02","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":180.75,"discounted_cash":151.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"TERBINAFINE HCL 250 MG TABLET [12724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-795-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":171.25,"discounted_cash":143.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"TERBINAFINE HCL 250 MG TABLET [12724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67405-500-03","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":86.5,"discounted_cash":72.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":172.75,"discounted_cash":145.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"TERBINAFINE HCL 250 MG TABLET [12724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-501-02","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":180.75,"discounted_cash":151.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"TERBINAFINE HCL 250 MG TABLET [12724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-501-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":171.25,"discounted_cash":143.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"TERBINAFINE HCL 1 % TOPICAL CREAM [27023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093920444","type":"NDC"}],"standard_charges":[{"gross_charge":86.5,"discounted_cash":72.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"TERBINAFINE HCL 1 % TOPICAL CREAM [27023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2080-1","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION [184329]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"75987-130-15","type":"NDC"}],"standard_charges":[{"gross_charge":110817.0,"discounted_cash":93086.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG/KG"}]},{"description":"TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION [184329]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3241","type":"HCPCS"},{"code":"75987-130-15","type":"NDC"}],"standard_charges":[{"gross_charge":55408.5,"discounted_cash":46543.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-421-30","type":"NDC"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":179.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-714-04","type":"NDC"}],"standard_charges":[{"gross_charge":225.5,"discounted_cash":189.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TERBUTALINE 2.5 MG TABLET [11508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1318-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"TERBUTALINE 2.5 MG TABLET [11508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"TERBUTALINE 2.5 MG TABLET [11508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-721-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"TERBUTALINE 5 MG TABLET [11509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1311-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE [131266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281-215-88","type":"NDC"}],"standard_charges":[{"gross_charge":261.5,"discounted_cash":219.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE [131266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281-215-15","type":"NDC"}],"standard_charges":[{"gross_charge":261.5,"discounted_cash":219.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SUSP [131267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281-215-10","type":"NDC"}],"standard_charges":[{"gross_charge":261.5,"discounted_cash":219.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TESTOSTERONE ENANTHATE 200 MG/ML INTRAMUSCULAR OIL [126227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7258-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":133.25,"discounted_cash":111.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":266.25,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"TESTOSTERONE ENANTHATE 200 MG/ML INTRAMUSCULAR OIL [126227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3121","type":"HCPCS"},{"code":"7700-7258-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TESTOSTERONE ENANTHATE 200 MG/ML INTRAMUSCULAR OIL [126227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9750-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":133.25,"discounted_cash":111.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":266.25,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"TESTOSTERONE ENANTHATE 200 MG/ML INTRAMUSCULAR OIL [126227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3121","type":"HCPCS"},{"code":"0143-9750-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL [126226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62756-015-40","type":"NDC"}],"standard_charges":[{"gross_charge":78.25,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":156.5,"discounted_cash":131.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL [126226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"62756-015-40","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THERAPEUTIC MULTIVITAMIN WITH MINERALS WRAPPER [131854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904549261","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TESTOSTERONE 30 MG/ACTUATION (1.5 ML) TRANSDERM SOLUTION METERED PUMP [108053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-610-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"TESTOSTERONE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [112807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-5990-60","type":"NDC"}],"standard_charges":[{"gross_charge":83.25,"discounted_cash":69.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"TESTOSTERONE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [112807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-5990-02","type":"NDC"}],"standard_charges":[{"gross_charge":83.25,"discounted_cash":69.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"TESTOSTERONE 12.5 MG/1.25 GRAM PER PUMP ACTUATION (1%) TRANSDERMAL GEL [123018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1121-42","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ACTUATION"}]},{"description":"TESTOSTERONE 12.5 MG/1.25 GRAM PER PUMP ACTUATION (1%) TRANSDERMAL GEL [123018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1121-40","type":"NDC"}],"standard_charges":[{"gross_charge":1394.75,"discounted_cash":1171.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 G"}]},{"description":"TESTOSTERONE 10 MG/0.5 GRAM/ACTUATION TRANSDERMAL GEL PUMP [108206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-7831-88","type":"NDC"}],"standard_charges":[{"gross_charge":1466.25,"discounted_cash":1231.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"TESTOSTERONE 10 MG/0.5 GRAM/ACTUATION TRANSDERMAL GEL PUMP [108206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63481-183-16","type":"NDC"}],"standard_charges":[{"gross_charge":1779.25,"discounted_cash":1494.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"TESTOSTERONE 1 % (50 MG/5 GRAM) TRANSDERMAL GEL PACKET [127647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0051-8450-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"TESTOSTERONE 1 % (25 MG/2.5 GRAM) TRANSDERMAL GEL PACKET [108038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0051-8425-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"TERCONAZOLE 80 MG VAGINAL SUPPOSITORY [11512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0552-73","type":"NDC"}],"standard_charges":[{"gross_charge":581.75,"discounted_cash":488.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 EACH"}]},{"description":"TERCONAZOLE 80 MG VAGINAL SUPPOSITORY [11512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-717-08","type":"NDC"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":338.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 EACH"}]},{"description":"TERCONAZOLE 0.4 % VAGINAL CREAM [11510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0346-46","type":"NDC"}],"standard_charges":[{"gross_charge":234.25,"discounted_cash":196.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"TERCONAZOLE 0.4 % VAGINAL CREAM [11510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1304-6","type":"NDC"}],"standard_charges":[{"gross_charge":242.5,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [31684]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-0401-1","type":"NDC"}],"standard_charges":[{"gross_charge":210.75,"discounted_cash":177.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"THIAMINE (VITAMIN B1) 100 MG TABLET WRAPPER [178020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54629-0057-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THROMBIN (RECOMBINANT) 20,000 UNIT TOPICAL SOLUTION [91965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43825-707-41","type":"NDC"}],"standard_charges":[{"gross_charge":1473.75,"discounted_cash":1237.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE [133899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-705-05","type":"NDC"}],"standard_charges":[{"gross_charge":404.5,"discounted_cash":339.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION [131062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-215-05","type":"NDC"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":305.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY SYRINGE [133900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-217-22","type":"NDC"}],"standard_charges":[{"gross_charge":1429.75,"discounted_cash":1200.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY [127280]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-217-21","type":"NDC"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":600.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1429.75,"discounted_cash":1200.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":357.5,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"THROMBIN (BOVINE) 20,000 UNIT TOPICAL SOLUTION [127314]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-217-20","type":"NDC"}],"standard_charges":[{"gross_charge":624.75,"discounted_cash":524.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1249.25,"discounted_cash":1049.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":312.5,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"THIOTHIXENE 5 MG CAPSULE [7906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-016-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"THIOTHIXENE 5 MG CAPSULE [7906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-588-20","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"THIOTHIXENE 5 MG CAPSULE [7906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-588-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"THIOTHIXENE 1 MG CAPSULE [7902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1001-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"THIORIDAZINE 25 MG TABLET [7899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-566-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIORIDAZINE 25 MG TABLET [7899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-566-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THROMBIN (RECOMBINANT) 20,000 UNIT TOPICAL SOLUTION [91965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43825-707-50","type":"NDC"}],"standard_charges":[{"gross_charge":1495.25,"discounted_cash":1256.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THROMBIN (RECOMBINANT) 20,000 UNIT TOPICAL SOLUTION [91965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0326-01","type":"NDC"}],"standard_charges":[{"gross_charge":1473.75,"discounted_cash":1237.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43825-006-41","type":"NDC"}],"standard_charges":[{"gross_charge":423.25,"discounted_cash":355.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION [41652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"55150-228-10","type":"NDC"}],"standard_charges":[{"gross_charge":639.75,"discounted_cash":537.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION [41652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"60505-6098-1","type":"NDC"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":582.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":693.0,"discounted_cash":582.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION [41652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"60505-6098-0","type":"NDC"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":582.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION [41652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"0008-4990-20","type":"NDC"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":413.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION [41652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"0008-4990-19","type":"NDC"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":413.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TICAGRELOR 90 MG TABLET [110427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-368-91","type":"NDC"}],"standard_charges":[{"gross_charge":86.75,"discounted_cash":72.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"TICAGRELOR 90 MG TABLET [110427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0777-60","type":"NDC"}],"standard_charges":[{"gross_charge":130.5,"discounted_cash":109.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"TICAGRELOR 90 MG TABLET [110427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0777-39","type":"NDC"}],"standard_charges":[{"gross_charge":130.5,"discounted_cash":109.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"TICAGRELOR 60 MG TABLET [168432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0776-60","type":"NDC"}],"standard_charges":[{"gross_charge":188.5,"discounted_cash":158.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":94.25,"discounted_cash":79.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION [188738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3240","type":"HCPCS"},{"code":"58468-0030-2","type":"NDC"}],"standard_charges":[{"gross_charge":5993.75,"discounted_cash":5034.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION [188738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3240","type":"HCPCS"},{"code":"58468-0030-1","type":"NDC"}],"standard_charges":[{"gross_charge":5993.75,"discounted_cash":5034.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"THYROID (PORK) 30 MG TABLET [131949]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-0458-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"THYROID (PORK) 15 MG TABLET [131948]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-0457-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"THROMBIN-CALCIUM-CMC-GELATIN-DRESSING, HEMOSTAT 40 CM2 TOPICAL PADS [131075]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-908-04","type":"NDC"}],"standard_charges":[{"gross_charge":401.5,"discounted_cash":337.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"THROMBIN,BOVINE 5,000 UNIT SOLUTION-ABSORBABLE GELATIN POWDER SYRINGE [180200]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-2250-01","type":"NDC"}],"standard_charges":[{"gross_charge":887.5,"discounted_cash":745.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0324-01","type":"NDC"}],"standard_charges":[{"gross_charge":423.25,"discounted_cash":355.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0322-01","type":"NDC"}],"standard_charges":[{"gross_charge":423.25,"discounted_cash":355.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION [89570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43825-606-41","type":"NDC"}],"standard_charges":[{"gross_charge":423.25,"discounted_cash":355.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THROMBIN (RECOMBINANT) 20,000 UNIT TOPICAL SOLUTION [91965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0328-01","type":"NDC"}],"standard_charges":[{"gross_charge":1473.75,"discounted_cash":1237.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THIORIDAZINE 25 MG TABLET [7899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0614-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323-013-41","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323-013-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323-013-26","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"67457-196-02","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"67457-196-00","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323-013-02","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE (VITAMIN B1) 100 MG TABLET WRAPPER [178020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5789685101","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE (VITAMIN B1) 100 MG TABLET WRAPPER [178020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1184505651","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE (VITAMIN B1) 100 MG TABLET WRAPPER [178020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026885111","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE (VITAMIN B1) 100 MG TABLET WRAPPER [178020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026885115","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"25021-500-02","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"0641-6228-25","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIORIDAZINE 10 MG TABLET [7894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-148-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THIORIDAZINE 10 MG TABLET [7894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-565-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THIORIDAZINE 10 MG TABLET [7894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0612-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"THIAMINE HCL (VITAMIN B1) 50 MG TABLET [7879]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068109700","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"70748-347-02","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"70748-347-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"72603-139-25","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"72603-139-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"43598-050-25","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"43598-050-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"55150-273-25","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"55150-273-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"0641-6228-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION [41652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"70121-1647-1","type":"NDC"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":341.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TENECTEPLASE 50 MG INTRAVENOUS SOLUTION (STROKE DOSAGES) [190381]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242-120-47","type":"NDC"}],"standard_charges":[{"gross_charge":6563.75,"discounted_cash":5513.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG/KG"},{"gross_charge":10215.75,"discounted_cash":8581.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11918.25,"discounted_cash":10011.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":13621.0,"discounted_cash":11441.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":15323.5,"discounted_cash":12871.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":17026.0,"discounted_cash":14301.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-294-20","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2076-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2996-11","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMOXIFEN 20 MG TABLET [11498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51407-440-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"TAMOXIFEN 20 MG TABLET [11498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-300-30","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"TAMOXIFEN 10 MG TABLET [7711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51407-439-60","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"TAMOXIFEN 10 MG TABLET [7711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-447-60","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"TAMOXIFEN 10 MG TABLET [7711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2472-60","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"TAMOXIFEN 10 MG TABLET [7711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-269-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"TAMOXIFEN 10 MG TABLET [7711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0144-91","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-132-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TALAZOPARIB 1 MG CAPSULE [180282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-1195-30","type":"NDC"}],"standard_charges":[{"gross_charge":1919.5,"discounted_cash":1612.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-160-88","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAPENTADOL 50 MG TABLET [98253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510-050-10","type":"NDC"}],"standard_charges":[{"gross_charge":197.5,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"TAPENTADOL 50 MG TABLET [98253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-820-02","type":"NDC"}],"standard_charges":[{"gross_charge":113.5,"discounted_cash":95.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"TAPENTADOL 100 MG TABLET [98255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-840-02","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7383-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-740-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-740-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-713-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6401-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6401-61","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-014-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-299-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-567-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2996-50","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TALAZOPARIB 0.25 MG CAPSULE [180281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-0296-30","type":"NDC"}],"standard_charges":[{"gross_charge":751.5,"discounted_cash":631.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION [186209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73535-208-01","type":"NDC"}],"standard_charges":[{"gross_charge":23556.25,"discounted_cash":19787.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG/KG"}]},{"description":"TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"68084-451-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0378-2047-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0781-2104-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0469-0657-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 1 MG ORAL GRANULES IN PACKET [181607]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0469-1330-50","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"16714-099-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"54288-135-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"42291-753-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"64380-721-06","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"16729-042-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"68084-450-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"68084-450-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0378-2046-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0781-2103-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0469-0617-73","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0904-6623-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"16729-041-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"68084-449-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"68084-449-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"51079-817-20","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"55111-525-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"16729-043-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"64380-722-06","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TADALAFIL 5 MG TABLET [37400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-644-30","type":"NDC"}],"standard_charges":[{"gross_charge":180.5,"discounted_cash":151.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":356.0,"discounted_cash":299.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TADALAFIL 5 MG TABLET [37400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-4462-34","type":"NDC"}],"standard_charges":[{"gross_charge":197.25,"discounted_cash":165.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":389.5,"discounted_cash":327.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":101.25,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) [171661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66302-467-60","type":"NDC"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":291.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":689.0,"discounted_cash":578.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"TADALAFIL 20 MG TABLET [36986]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-646-30","type":"NDC"}],"standard_charges":[{"gross_charge":161.25,"discounted_cash":135.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":317.25,"discounted_cash":266.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":83.25,"discounted_cash":69.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TADALAFIL 10 MG TABLET [37401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-076-01","type":"NDC"}],"standard_charges":[{"gross_charge":313.5,"discounted_cash":263.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":621.75,"discounted_cash":522.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":159.25,"discounted_cash":133.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TAPENTADOL 75 MG TABLET [98254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510-075-10","type":"NDC"}],"standard_charges":[{"gross_charge":153.75,"discounted_cash":129.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"TADALAFIL 10 MG TABLET [37401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-645-30","type":"NDC"}],"standard_charges":[{"gross_charge":317.25,"discounted_cash":266.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":629.5,"discounted_cash":528.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":161.25,"discounted_cash":135.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR [168139]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7503","type":"HCPCS"},{"code":"68992-3075-3","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION [12935]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7525","type":"HCPCS"},{"code":"0469-3016-01","type":"NDC"}],"standard_charges":[{"gross_charge":1092.75,"discounted_cash":917.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":273.25,"discounted_cash":229.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/ML"}]},{"description":"TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"0904-6624-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE [12934]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"69452-155-20","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TENECTEPLASE 50 MG INTRAVENOUS SOLUTION (STROKE DOSAGES) [190381]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242-037-06","type":"NDC"}],"standard_charges":[{"gross_charge":6563.75,"discounted_cash":5513.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG/KG"},{"gross_charge":10215.75,"discounted_cash":8581.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11918.25,"discounted_cash":10011.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":13621.0,"discounted_cash":11441.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":15323.5,"discounted_cash":12871.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":17026.0,"discounted_cash":14301.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TAPENTADOL ER 100 MG TABLET,EXTENDED RELEASE,12 HR [110263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510-116-60","type":"NDC"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":235.75,"discounted_cash":198.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":312.75,"discounted_cash":262.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":389.75,"discounted_cash":327.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TEMAZEPAM 15 MG CAPSULE [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-779-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TEMAZEPAM 15 MG CAPSULE [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63629-8602-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TEMAZEPAM 15 MG CAPSULE [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-146-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TEMAZEPAM 15 MG CAPSULE [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-418-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TEMAZEPAM 15 MG CAPSULE [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9916-01","type":"NDC"}],"standard_charges":[{"gross_charge":203.5,"discounted_cash":170.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":305.25,"discounted_cash":256.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":407.0,"discounted_cash":341.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TEMAZEPAM 15 MG CAPSULE [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2076-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION [193575]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"57894-450-01","type":"NDC"}],"standard_charges":[{"gross_charge":15626.75,"discounted_cash":13126.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"}]},{"description":"TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION [193576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9380","type":"HCPCS"},{"code":"57894-449-01","type":"NDC"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":758.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.06 MG/KG"},{"gross_charge":4514.5,"discounted_cash":3792.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG/KG"}]},{"description":"TECHNETIUM TC 99M-LABELED RED BLOOD CELLS [40840062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9560","type":"HCPCS"},{"code":"65174-0270-00","type":"NDC"}],"standard_charges":[{"gross_charge":207.5,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLICURIE"},{"gross_charge":259.25,"discounted_cash":217.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MILLICURIE"}]},{"description":"TEMAZEPAM 15 MG CAPSULE [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-779-15","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TECHNETIUM TC 99M SULFUR COLLOID [40840061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9541","type":"HCPCS"},{"code":"9999-4084-40","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MICROCURIE"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MICROCURIE"},{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MICROCURIE"}]},{"description":"TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN [82228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9330","type":"HCPCS"},{"code":"0008-1179-01","type":"NDC"}],"standard_charges":[{"gross_charge":10261.75,"discounted_cash":8619.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12314.0,"discounted_cash":10343.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"TEMOZOLOMIDE 250 MG CAPSULE [25895]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8700","type":"HCPCS"},{"code":"0085-1417-02","type":"NDC"}],"standard_charges":[{"gross_charge":4155.25,"discounted_cash":3490.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TEMOZOLOMIDE 180 MG CAPSULE [81462]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8700","type":"HCPCS"},{"code":"0085-1430-04","type":"NDC"}],"standard_charges":[{"gross_charge":2996.75,"discounted_cash":2517.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TEMOZOLOMIDE 140 MG CAPSULE [81461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8700","type":"HCPCS"},{"code":"0085-1425-03","type":"NDC"}],"standard_charges":[{"gross_charge":1623.75,"discounted_cash":1363.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TEMOZOLOMIDE 100 MG CAPSULE [25894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8700","type":"HCPCS"},{"code":"0085-1366-03","type":"NDC"}],"standard_charges":[{"gross_charge":1667.25,"discounted_cash":1400.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TEMAZEPAM 7.5 MG CAPSULE [11500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6436-60","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TEMAZEPAM 7.5 MG CAPSULE [11500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-003-33","type":"NDC"}],"standard_charges":[{"gross_charge":78.25,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TEMAZEPAM 7.5 MG CAPSULE [11500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6436-04","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TEMAZEPAM 7.5 MG CAPSULE [11500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9960-01","type":"NDC"}],"standard_charges":[{"gross_charge":134.5,"discounted_cash":112.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TEMAZEPAM 30 MG CAPSULE [7754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9917-01","type":"NDC"}],"standard_charges":[{"gross_charge":220.5,"discounted_cash":185.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"TEMAZEPAM 22.5 MG CAPSULE [40414]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9959-03","type":"NDC"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION [198745]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"55513-069-01","type":"NDC"}],"standard_charges":[{"gross_charge":30780.0,"discounted_cash":25855.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION [198745]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"55513-077-01","type":"NDC"}],"standard_charges":[{"gross_charge":30780.0,"discounted_cash":25855.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":30780.0,"discounted_cash":25855.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION [198746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"55513-059-01","type":"NDC"}],"standard_charges":[{"gross_charge":5472.0,"discounted_cash":4596.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":5472.0,"discounted_cash":4596.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION [198746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"55513-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":5472.0,"discounted_cash":4596.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TAPENTADOL ER 50 MG TABLET,EXTENDED RELEASE,12 HR [110262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510-058-60","type":"NDC"}],"standard_charges":[{"gross_charge":211.5,"discounted_cash":177.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":314.75,"discounted_cash":264.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":418.0,"discounted_cash":351.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":521.0,"discounted_cash":437.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TAPENTADOL ER 250 MG TABLET,EXTENDED RELEASE,12 HR [110266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510-291-60","type":"NDC"}],"standard_charges":[{"gross_charge":100.25,"discounted_cash":84.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":147.75,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":195.25,"discounted_cash":164.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":242.75,"discounted_cash":203.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"TAPENTADOL ER 200 MG TABLET,EXTENDED RELEASE,12 HR [110265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510-232-60","type":"NDC"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":257.0,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":320.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TAPENTADOL ER 150 MG TABLET,EXTENDED RELEASE,12 HR [110264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510-174-60","type":"NDC"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":203.5,"discounted_cash":170.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":269.75,"discounted_cash":226.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":335.75,"discounted_cash":282.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE [124716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63459-910-11","type":"NDC"}],"standard_charges":[{"gross_charge":1073.5,"discounted_cash":901.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":1379.5,"discounted_cash":1158.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"TECHNETIUM TC 99M SESTAMIBI - CARDIOLITE [40840057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9500","type":"HCPCS"},{"code":"65857-0500-30","type":"NDC"}],"standard_charges":[{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MILLICURIE"},{"gross_charge":179.0,"discounted_cash":150.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLICURIE"},{"gross_charge":268.25,"discounted_cash":225.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M SESTAMIBI - CARDIOLITE [40840057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9500","type":"HCPCS"},{"code":"65857-0500-20","type":"NDC"}],"standard_charges":[{"gross_charge":134.25,"discounted_cash":112.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MILLICURIE"},{"gross_charge":268.25,"discounted_cash":225.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLICURIE"},{"gross_charge":402.5,"discounted_cash":338.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M SESTAMIBI - CARDIOLITE [40840057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9500","type":"HCPCS"},{"code":"65857-0500-10","type":"NDC"}],"standard_charges":[{"gross_charge":268.25,"discounted_cash":225.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MILLICURIE"},{"gross_charge":536.5,"discounted_cash":450.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLICURIE"},{"gross_charge":804.75,"discounted_cash":675.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M MERTIATIDE [40840068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9562","type":"HCPCS"},{"code":"00019-9096-20","type":"NDC"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":489.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M MEBROFENIN [40840063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9537","type":"HCPCS"},{"code":"9999-4084-42","type":"NDC"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":149.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLICURIE"}]},{"description":"TEBENTAFUSP-TEBN 100 MCG/0.5 ML INTRAVENOUS SOLUTION [190855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"80446-401-01","type":"NDC"}],"standard_charges":[{"gross_charge":8405.0,"discounted_cash":7060.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"},{"gross_charge":12607.5,"discounted_cash":10590.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MCG"},{"gross_charge":28577.0,"discounted_cash":24004.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 68 MCG"}]},{"description":"TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE [124717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63459-912-01","type":"NDC"}],"standard_charges":[{"gross_charge":1718.0,"discounted_cash":1443.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MCG"},{"gross_charge":1379.75,"discounted_cash":1158.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE [124717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63459-912-12","type":"NDC"}],"standard_charges":[{"gross_charge":1718.0,"discounted_cash":1443.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MCG"},{"gross_charge":1379.75,"discounted_cash":1158.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE [124717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63459-912-15","type":"NDC"}],"standard_charges":[{"gross_charge":1718.0,"discounted_cash":1443.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MCG"},{"gross_charge":1379.75,"discounted_cash":1158.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE [124717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63459-912-11","type":"NDC"}],"standard_charges":[{"gross_charge":1718.0,"discounted_cash":1443.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MCG"},{"gross_charge":1379.75,"discounted_cash":1158.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE [124716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63459-910-01","type":"NDC"}],"standard_charges":[{"gross_charge":1073.5,"discounted_cash":901.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":1379.5,"discounted_cash":1158.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE [124716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63459-910-17","type":"NDC"}],"standard_charges":[{"gross_charge":1287.25,"discounted_cash":1081.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":1654.0,"discounted_cash":1389.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE [124716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63459-910-15","type":"NDC"}],"standard_charges":[{"gross_charge":1073.5,"discounted_cash":901.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":1379.5,"discounted_cash":1158.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/KG"}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION [41652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"70121-1647-7","type":"NDC"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":341.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION [182491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5117","type":"HCPCS"},{"code":"55513-132-01","type":"NDC"}],"standard_charges":[{"gross_charge":5989.75,"discounted_cash":5031.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":11979.5,"discounted_cash":10062.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":17969.0,"discounted_cash":15093.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"},{"gross_charge":23958.75,"discounted_cash":20125.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG/KG"}]},{"description":"TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION [182491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5117","type":"HCPCS"},{"code":"55513-164-01","type":"NDC"}],"standard_charges":[{"gross_charge":5989.75,"discounted_cash":5031.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":11979.5,"discounted_cash":10062.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":17969.0,"discounted_cash":15093.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"},{"gross_charge":23958.75,"discounted_cash":20125.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG/KG"}]},{"description":"TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION [183706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5117","type":"HCPCS"},{"code":"55513-141-01","type":"NDC"}],"standard_charges":[{"gross_charge":5095.5,"discounted_cash":4280.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":10190.75,"discounted_cash":8560.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":15286.25,"discounted_cash":12840.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"},{"gross_charge":20381.5,"discounted_cash":17120.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG/KG"}]},{"description":"TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [173473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9355","type":"HCPCS"},{"code":"50242-132-01","type":"NDC"}],"standard_charges":[{"gross_charge":986223.5,"discounted_cash":828427.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":1479335.25,"discounted_cash":1242641.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"},{"gross_charge":1972447.0,"discounted_cash":1656855.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG/KG"}]},{"description":"TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION [181753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9356","type":"HCPCS"},{"code":"50242-077-01","type":"NDC"}],"standard_charges":[{"gross_charge":9593.75,"discounted_cash":8058.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [173473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9355","type":"HCPCS"},{"code":"50242-132-10","type":"NDC"}],"standard_charges":[{"gross_charge":11688.5,"discounted_cash":9818.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"},{"gross_charge":17532.5,"discounted_cash":14727.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"},{"gross_charge":23376.75,"discounted_cash":19636.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG/KG"}]},{"description":"TRANYLCYPROMINE 10 MG TABLET [11574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-739-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TRANYLCYPROMINE 10 MG TABLET [11574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60429-210-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TRANYLCYPROMINE 10 MG TABLET [11574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-032-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION [183620]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"83257-004-12","type":"NDC"}],"standard_charges":[{"gross_charge":12915.0,"discounted_cash":10848.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":9483.5,"discounted_cash":7966.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-166-31","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"}]},{"description":"TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION [183620]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"83257-003-11","type":"NDC"}],"standard_charges":[{"gross_charge":12915.25,"discounted_cash":10848.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"TRAZODONE 150 MG TABLET [8084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-608-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE 100 MG TABLET [8083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6869-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE 100 MG TABLET [8083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-806-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE 100 MG TABLET [8083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-434-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION [184681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5116","type":"HCPCS"},{"code":"0069-0306-01","type":"NDC"}],"standard_charges":[{"gross_charge":201023.5,"discounted_cash":168859.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":147608.75,"discounted_cash":123991.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION [184681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5116","type":"HCPCS"},{"code":"0069-0305-01","type":"NDC"}],"standard_charges":[{"gross_charge":201023.5,"discounted_cash":168859.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION [184680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5113","type":"HCPCS"},{"code":"63459-307-41","type":"NDC"}],"standard_charges":[{"gross_charge":11639.75,"discounted_cash":9777.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":4273.5,"discounted_cash":3589.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"}]},{"description":"TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION [184680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5113","type":"HCPCS"},{"code":"63459-305-47","type":"NDC"}],"standard_charges":[{"gross_charge":16823.5,"discounted_cash":14131.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"TRASTUZUMAB-PKRB 150 MG INTRAVENOUS SOLUTION [184814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5113","type":"HCPCS"},{"code":"63459-303-43","type":"NDC"}],"standard_charges":[{"gross_charge":5116.5,"discounted_cash":4297.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRANEXAMIC ACID 650 MG TABLET [104576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-265-30","type":"NDC"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1300 MG"}]},{"description":"TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [183123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0108-3","type":"NDC"}],"standard_charges":[{"gross_charge":191.25,"discounted_cash":160.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"TRAMADOL 50 MG TABLET [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888-080-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL 50 MG TABLET [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6365-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL 50 MG TABLET [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-627-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL 50 MG TABLET [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-377-13","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL 50 MG TABLET [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-377-08","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL 50 MG TABLET [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-991-20","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL 50 MG TABLET [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4151-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL 37.5 MG-ACETAMINOPHEN 325 MG TABLET [31288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2644-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"TRAMADOL 37.5 MG-ACETAMINOPHEN 325 MG TABLET [31288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-617-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"TRAMADOL 37.5 MG-ACETAMINOPHEN 325 MG TABLET [31288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"TRAMADOL 37.5 MG-ACETAMINOPHEN 325 MG TABLET [31288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-334-05","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"TRAMADOL 50 MG TABLET [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-795-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL 50 MG TABLET [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-795-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [183123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0108-1","type":"NDC"}],"standard_charges":[{"gross_charge":191.25,"discounted_cash":160.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-510-10","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":78.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-510-01","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":78.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67850-042-10","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67850-042-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61990-0611-2","type":"NDC"}],"standard_charges":[{"gross_charge":893.5,"discounted_cash":750.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61990-0611-0","type":"NDC"}],"standard_charges":[{"gross_charge":893.5,"discounted_cash":750.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-400-41","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-400-10","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-166-41","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-188-10","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0960-01","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42192-605-10","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRAZODONE 150 MG TABLET [8084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-807-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42192-605-01","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-563-97","type":"NDC"}],"standard_charges":[{"gross_charge":289.5,"discounted_cash":243.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-197-10","type":"NDC"}],"standard_charges":[{"gross_charge":356.75,"discounted_cash":299.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-197-00","type":"NDC"}],"standard_charges":[{"gross_charge":356.75,"discounted_cash":299.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0960-10","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRAMETINIB 2 MG TABLET [122212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0668-15","type":"NDC"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":720.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1284.25,"discounted_cash":1078.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":1710.75,"discounted_cash":1437.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TRAMETINIB 0.5 MG TABLET [122211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0666-15","type":"NDC"}],"standard_charges":[{"gross_charge":1156.25,"discounted_cash":971.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1731.75,"discounted_cash":1454.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":2307.25,"discounted_cash":1938.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [11573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822-1000-1","type":"NDC"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRAMADOL 37.5 MG-ACETAMINOPHEN 325 MG TABLET [31288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-334-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET [8134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1355-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMTERENE 50 MG CAPSULE [11588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-831-02","type":"NDC"}],"standard_charges":[{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRIAMTERENE 50 MG CAPSULE [11588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59212-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":120.5,"discounted_cash":101.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [8132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-856-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [8132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5068-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [8132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-750-95","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [8132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-750-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [8132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0464-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [8132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2656-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [8132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1352-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMCINOLONE ACETONIDE ER 32 MG INTRA-ARTICULAR SUSPENSION EXT.RELEAS [177222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3304","type":"HCPCS"},{"code":"70801-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":2079.5,"discounted_cash":1746.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE ER 32 MG INTRA-ARTICULAR SUSPENSION EXT.RELEAS [177222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3304","type":"HCPCS"},{"code":"70801-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":2079.5,"discounted_cash":1746.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"16714-130-25","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"16714-130-01","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"0703-0243-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":100.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":133.25,"discounted_cash":111.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121-1049-2","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121-1168-1","type":"NDC"}],"standard_charges":[{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":105.5,"discounted_cash":88.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":140.75,"discounted_cash":118.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121-1049-5","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET [8134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-433-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET [8134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-433-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET [8134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-857-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIFLUOPERAZINE 2 MG TABLET [8163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-573-20","type":"NDC"}],"standard_charges":[{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIFLUOPERAZINE 1 MG TABLET [8161]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-8028-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIFLUOPERAZINE 1 MG TABLET [8161]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"35356-823-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIFLUOPERAZINE 1 MG TABLET [8161]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-572-20","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":90.75,"discounted_cash":76.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIFLUOPERAZINE 1 MG TABLET [8161]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-572-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":90.75,"discounted_cash":76.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIFLUOPERAZINE 1 MG TABLET [8161]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-2401-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIAZOLAM 0.25 MG TABLET [8139]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3718-9","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"TRIAZOLAM 0.25 MG TABLET [8139]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-0017-55","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":53.0,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"TRIAZOLAM 0.125 MG TABLET [8138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3717-9","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET [8134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0460-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121-1049-1","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRAZODONE 50 MG TABLET [8085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-560-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE 50 MG TABLET [8085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-443-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE 50 MG TABLET [8085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-443-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE 50 MG TABLET [8085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6868-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE 150 MG TABLET [8084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-432-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE 150 MG TABLET [8084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-432-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION [193570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9347","type":"HCPCS"},{"code":"0310-4535-30","type":"NDC"}],"standard_charges":[{"gross_charge":20815.5,"discounted_cash":17485.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"0003-0293-20","type":"NDC"}],"standard_charges":[{"gross_charge":77.25,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":154.25,"discounted_cash":129.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"0003-0293-05","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":151.75,"discounted_cash":127.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION [11584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"0003-0494-20","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM [8114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-065-35","type":"NDC"}],"standard_charges":[{"gross_charge":68.25,"discounted_cash":57.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-055-05","type":"NDC"}],"standard_charges":[{"gross_charge":224.75,"discounted_cash":188.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 454 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-055-36","type":"NDC"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-055-35","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0006-80","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0006-15","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM - WOUND CARE [181301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-064-05","type":"NDC"}],"standard_charges":[{"gross_charge":156.5,"discounted_cash":131.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 454 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM - WOUND CARE [181301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-064-35","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM - WOUND CARE [181301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0004-80","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM - WOUND CARE [181301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0004-15","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52565-056-15","type":"NDC"}],"standard_charges":[{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE [8121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0655-40","type":"NDC"}],"standard_charges":[{"gross_charge":341.5,"discounted_cash":286.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE [8121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1267-5","type":"NDC"}],"standard_charges":[{"gross_charge":331.25,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0003-80","type":"NDC"}],"standard_charges":[{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 G"}]},{"description":"TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION [193570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-4535-30","type":"NDC"}],"standard_charges":[{"gross_charge":83261.25,"discounted_cash":69939.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION [193570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-4505-25","type":"NDC"}],"standard_charges":[{"gross_charge":120266.25,"discounted_cash":101023.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION [186401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-9305-25","type":"NDC"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":147.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION [186401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-9305-01","type":"NDC"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":147.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7682","type":"HCPCS"},{"code":"70756-604-44","type":"NDC"}],"standard_charges":[{"gross_charge":529.25,"discounted_cash":444.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7682","type":"HCPCS"},{"code":"0093-4085-63","type":"NDC"}],"standard_charges":[{"gross_charge":529.25,"discounted_cash":444.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7682","type":"HCPCS"},{"code":"0078-0494-71","type":"NDC"}],"standard_charges":[{"gross_charge":646.5,"discounted_cash":543.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323-303-51","type":"NDC"}],"standard_charges":[{"gross_charge":419.5,"discounted_cash":352.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"39822-0412-6","type":"NDC"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":330.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"39822-0412-1","type":"NDC"}],"standard_charges":[{"gross_charge":418.75,"discounted_cash":351.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0953-25","type":"NDC"}],"standard_charges":[{"gross_charge":786.5,"discounted_cash":660.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-647-05","type":"NDC"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":502.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0647-05","type":"NDC"}],"standard_charges":[{"gross_charge":821.5,"discounted_cash":690.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN 0.3 % EYE OINTMENT [125508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0644-35","type":"NDC"}],"standard_charges":[{"gross_charge":921.0,"discounted_cash":773.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"TOBRAMYCIN 0.3 % EYE DROPS [124422]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-643-05","type":"NDC"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN 0.3 % EYE DROPS [124422]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-290-05","type":"NDC"}],"standard_charges":[{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-645-65","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-760-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-760-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6418-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-645-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-645-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7682","type":"HCPCS"},{"code":"70756-604-56","type":"NDC"}],"standard_charges":[{"gross_charge":529.25,"discounted_cash":444.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [39918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323-306-02","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [39918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"0409-3578-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TOLTERODINE 2 MG TABLET [22783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-098-09","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TOLTERODINE 2 MG TABLET [22783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0800-2","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TOLTERODINE 2 MG TABLET [22783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-235-20","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TOLTERODINE 1 MG TABLET [22782]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-097-09","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TOLTERODINE 1 MG TABLET [22782]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0010-06","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TOLTERODINE 1 MG TABLET [22782]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0170-6","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TOLNAFTATE 1 % TOPICAL POWDER [8021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0904-0726-45","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"TOLNAFTATE 1 % TOPICAL CREAM [8020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2020-1","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TOLNAFTATE 1 % TOPICAL CREAM [8020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-0722-36","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.18 G"}]},{"description":"TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q0249","type":"HCPCS"},{"code":"50242-135-01","type":"NDC"}],"standard_charges":[{"gross_charge":1937.75,"discounted_cash":1627.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":7872.0,"discounted_cash":6612.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION [108062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-136-01","type":"NDC"}],"standard_charges":[{"gross_charge":4844.25,"discounted_cash":4069.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":9688.5,"discounted_cash":8138.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT [11566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0648-35","type":"NDC"}],"standard_charges":[{"gross_charge":980.5,"discounted_cash":823.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [39918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323-306-30","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"},{"gross_charge":151.25,"discounted_cash":127.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [39918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323-306-26","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [39918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"36000-242-01","type":"NDC"}],"standard_charges":[{"gross_charge":147.75,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [39918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457-473-22","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [39918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457-473-00","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-998-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [189998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9273","type":"HCPCS"},{"code":"51144-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":25356.0,"discounted_cash":21299.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG/KG"},{"gross_charge":14616.5,"discounted_cash":12277.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TIRZEPATIDE (WEIGHT LOSS) 5 MG/0.5 ML SUBCUTANEOUS SOLUTION [199478]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-0243-04","type":"NDC"}],"standard_charges":[{"gross_charge":1128.25,"discounted_cash":947.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1692.5,"discounted_cash":1421.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":282.25,"discounted_cash":237.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":564.25,"discounted_cash":473.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TIRZEPATIDE (WEIGHT LOSS) 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION [199481]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-0152-04","type":"NDC"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1377.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2460.0,"discounted_cash":2066.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":820.0,"discounted_cash":688.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TIROFIBAN 5 MG/100 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [23050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3246","type":"HCPCS"},{"code":"55150-429-01","type":"NDC"}],"standard_charges":[{"gross_charge":485.25,"discounted_cash":407.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"TIROFIBAN 5 MG/100 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [23050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3246","type":"HCPCS"},{"code":"25208-002-03","type":"NDC"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":426.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"TIROFIBAN 5 MG/100 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [23050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3246","type":"HCPCS"},{"code":"25208-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":426.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"TIROFIBAN 250 MCG/ML CONCENTRATE,INTRAVENOUS [23049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3246","type":"HCPCS"},{"code":"25208-001-04","type":"NDC"}],"standard_charges":[{"gross_charge":148.75,"discounted_cash":124.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG/KG"}]},{"description":"TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS [131664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25208-002-02","type":"NDC"}],"standard_charges":[{"gross_charge":1080.75,"discounted_cash":907.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [165137]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0597-0100-51","type":"NDC"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [38315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0597-0075-75","type":"NDC"}],"standard_charges":[{"gross_charge":300.25,"discounted_cash":252.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 EACH"}]},{"description":"TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [38315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0597-0075-41","type":"NDC"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":1201.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 EACH"}]},{"description":"TINIDAZOLE 500 MG TABLET [38907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-427-12","type":"NDC"}],"standard_charges":[{"gross_charge":228.75,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"TIMOLOL MALEATE 0.5 % ONCE DAILY EYE DROPS [70283]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-045-50","type":"NDC"}],"standard_charges":[{"gross_charge":1256.5,"discounted_cash":1055.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % EYE DROPS [11562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-514-05","type":"NDC"}],"standard_charges":[{"gross_charge":114.75,"discounted_cash":96.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % EYE DROPS [11562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-227-05","type":"NDC"}],"standard_charges":[{"gross_charge":114.75,"discounted_cash":96.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % EYE DROPS [11562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-801-05","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % EYE DROPS [11562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-288-10","type":"NDC"}],"standard_charges":[{"gross_charge":114.75,"discounted_cash":96.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.25 % EYE DROPS [11561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-513-05","type":"NDC"}],"standard_charges":[{"gross_charge":101.25,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.25 % EYE DROPS [11561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-226-05","type":"NDC"}],"standard_charges":[{"gross_charge":101.25,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.25 % EYE DROPS [11561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-802-05","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL 0.5 % EYE DROPS [15115]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76478-002-05","type":"NDC"}],"standard_charges":[{"gross_charge":751.5,"discounted_cash":631.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-180-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0252-3","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-503-89","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-998-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 4 MG TABLET [14793]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-4400-51","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-5190-01","type":"NDC"}],"standard_charges":[{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":212.25,"discounted_cash":178.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TIZANIDINE 2 MG TABLET [14792]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-775-95","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 2 MG TABLET [14792]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-775-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 2 MG TABLET [14792]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-179-15","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 2 MG TABLET [14792]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0251-3","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TIZANIDINE 2 MG TABLET [14792]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0034-51","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-197-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.75,"discounted_cash":68.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TORIPALIMAB-TPZI 240 MG/6 ML (40 MG/ML) INTRAVENOUS SOLUTION [197146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70114-340-01","type":"NDC"}],"standard_charges":[{"gross_charge":19070.25,"discounted_cash":16019.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":19070.25,"discounted_cash":16019.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION [108590]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"25021-236-04","type":"NDC"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION [108590]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"0703-4714-71","type":"NDC"}],"standard_charges":[{"gross_charge":527.25,"discounted_cash":442.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION [108590]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"0703-4714-01","type":"NDC"}],"standard_charges":[{"gross_charge":527.25,"discounted_cash":442.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION [108590]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"0409-0302-01","type":"NDC"}],"standard_charges":[{"gross_charge":341.75,"discounted_cash":287.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"TOPOTECAN 4 MG INTRAVENOUS SOLUTION [17285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"16729-151-31","type":"NDC"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":1074.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOPOTECAN 4 MG INTRAVENOUS SOLUTION [17285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"63323-762-10","type":"NDC"}],"standard_charges":[{"gross_charge":1006.75,"discounted_cash":845.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOPIRAMATE 25 MG TABLET [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6928-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOPIRAMATE 25 MG TABLET [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-816-03","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOPIRAMATE 25 MG TABLET [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-122-03","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOPIRAMATE 25 MG TABLET [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-707-86","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOPIRAMATE 25 MG TABLET [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-342-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":113.5,"discounted_cash":95.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOPIRAMATE 25 MG TABLET [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-639-65","type":"NDC"}],"standard_charges":[{"gross_charge":216.75,"discounted_cash":182.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":433.5,"discounted_cash":364.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":108.5,"discounted_cash":91.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TORSEMIDE 20 MG TABLET [18293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-917-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TRACE ELEMENTS ZINC 1,000 MCG-CU 60 MCG-MANG 3 MCG-SE 6 MCG/ML IV SOLN [189903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-9302-25","type":"NDC"}],"standard_charges":[{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRACE ELEMENTS ZINC 1,000 MCG-CU 60 MCG-MANG 3 MCG-SE 6 MCG/ML IV SOLN [189903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-9302-01","type":"NDC"}],"standard_charges":[{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRABECTEDIN 1 MG INTRAVENOUS SOLUTION [167953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9352","type":"HCPCS"},{"code":"59676-610-01","type":"NDC"}],"standard_charges":[{"gross_charge":10935.25,"discounted_cash":9185.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TORSEMIDE 5 MG TABLET [18295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-754-15","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":84.75,"discounted_cash":71.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 5 MG TABLET [18295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-754-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":84.75,"discounted_cash":71.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 5 MG TABLET [18295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-529-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 5 MG TABLET [18295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-915-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 20 MG TABLET [18293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-756-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 20 MG TABLET [18293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-756-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 20 MG TABLET [18293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-539-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 20 MG TABLET [18293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-539-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 20 MG TABLET [18293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0077-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TOPIRAMATE 25 MG TABLET [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-031-60","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR [29435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-192-30","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":89.0,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR [29435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7164-56","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR [29435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7164-05","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR [29435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0048-2","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR [29435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0048-1","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR [29435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-5191-04","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":99.75,"discounted_cash":83.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR [29435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-5191-02","type":"NDC"}],"standard_charges":[{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR [29435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-5191-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436-160-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":134.25,"discounted_cash":112.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6592-04","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7163-98","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":108.75,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7163-56","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":108.75,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0047-2","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0047-1","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-189-30","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLVAPTAN 15 MG TABLET [97893]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148-020-50","type":"NDC"}],"standard_charges":[{"gross_charge":1902.75,"discounted_cash":1598.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":3800.5,"discounted_cash":3192.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"TOLVAPTAN 15 MG TABLET [97893]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4704-0","type":"NDC"}],"standard_charges":[{"gross_charge":1722.0,"discounted_cash":1446.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":3439.0,"discounted_cash":2888.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"TOPIRAMATE 100 MG TABLET [18922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-711-86","type":"NDC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOPIRAMATE 100 MG TABLET [18922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-344-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOPIRAMATE 100 MG TABLET [18922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-344-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOPIRAMATE 100 MG TABLET [18922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-641-65","type":"NDC"}],"standard_charges":[{"gross_charge":147.75,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":295.5,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOPIRAMATE 100 MG TABLET [18922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-033-60","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":91.5,"discounted_cash":76.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOLVAPTAN 15 MG TABLET [97893]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-868-31","type":"NDC"}],"standard_charges":[{"gross_charge":1712.75,"discounted_cash":1438.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":3420.5,"discounted_cash":2873.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"TOLVAPTAN 15 MG TABLET [97893]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-868-03","type":"NDC"}],"standard_charges":[{"gross_charge":1712.75,"discounted_cash":1438.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":3420.5,"discounted_cash":2873.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"TOLVAPTAN 15 MG TABLET [97893]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4704-2","type":"NDC"}],"standard_charges":[{"gross_charge":1722.0,"discounted_cash":1446.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":3439.0,"discounted_cash":2888.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"PROPRANOLOL 10 MG TABLET [6656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-587-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION [174343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-150-01","type":"NDC"}],"standard_charges":[{"gross_charge":42355.25,"discounted_cash":35578.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":84710.5,"discounted_cash":71156.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [124767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":17673.5,"discounted_cash":14845.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":17673.5,"discounted_cash":14845.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [124767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9301","type":"HCPCS"},{"code":"50242-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":1767.5,"discounted_cash":1484.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15906.0,"discounted_cash":13361.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT [5755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"21922-031-04","type":"NDC"}],"standard_charges":[{"gross_charge":460.25,"discounted_cash":386.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT [5755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-244-94","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT [5755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-799-65","type":"NDC"}],"standard_charges":[{"gross_charge":813.75,"discounted_cash":683.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT [5755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1272-1","type":"NDC"}],"standard_charges":[{"gross_charge":460.25,"discounted_cash":386.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT [5755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0089-15","type":"NDC"}],"standard_charges":[{"gross_charge":460.25,"discounted_cash":386.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-880-14","type":"NDC"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-314-17","type":"NDC"}],"standard_charges":[{"gross_charge":460.25,"discounted_cash":386.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1263-1","type":"NDC"}],"standard_charges":[{"gross_charge":460.25,"discounted_cash":386.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0081-15","type":"NDC"}],"standard_charges":[{"gross_charge":460.25,"discounted_cash":386.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN MAGIC MOUTHWASH ORAL MIXTURE (NYSTATIN/MAALOX/LIDOCAINE) [176051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0000-0003-57","type":"NDC"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 ML"}]},{"description":"NYSTATIN 500,000 UNIT TABLET [5752]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-051-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000000 UNITS"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 500,000 UNIT TABLET [5752]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-400-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000000 UNITS"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 500,000 UNIT TABLET [5752]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0983-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000000 UNITS"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1045-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-379-05","type":"NDC"}],"standard_charges":[{"gross_charge":2444.75,"discounted_cash":2053.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6178-01","type":"NDC"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":992.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OCTREOTIDE ACETATE 200 MCG/ML INJECTION SOLUTION [91280]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323-378-05","type":"NDC"}],"standard_charges":[{"gross_charge":805.75,"discounted_cash":676.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"68462-896-10","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"68462-896-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323-376-00","type":"NDC"}],"standard_charges":[{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"23155-688-41","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"23155-688-31","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0641-6175-10","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0641-6175-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0703-3311-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323-376-04","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"25021-452-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0078-0181-61","type":"NDC"}],"standard_charges":[{"gross_charge":178.75,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":134.25,"discounted_cash":112.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323-376-01","type":"NDC"}],"standard_charges":[{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0703-3311-04","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0078-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":178.75,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":134.25,"discounted_cash":112.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62756-352-40","type":"NDC"}],"standard_charges":[{"gross_charge":3880.5,"discounted_cash":3259.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7276-41","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER - WOUND CARE [181293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-2008-15","type":"NDC"}],"standard_charges":[{"gross_charge":149.5,"discounted_cash":125.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907-060-44","type":"NDC"}],"standard_charges":[{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-370-01","type":"NDC"}],"standard_charges":[{"gross_charge":152.5,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-769-03","type":"NDC"}],"standard_charges":[{"gross_charge":343.25,"discounted_cash":288.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-769-02","type":"NDC"}],"standard_charges":[{"gross_charge":267.5,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-769-01","type":"NDC"}],"standard_charges":[{"gross_charge":165.5,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-306-15","type":"NDC"}],"standard_charges":[{"gross_charge":157.25,"discounted_cash":132.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68308-152-15","type":"NDC"}],"standard_charges":[{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39822-3015-1","type":"NDC"}],"standard_charges":[{"gross_charge":126.75,"discounted_cash":106.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0465-15","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT [5750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72578-089-01","type":"NDC"}],"standard_charges":[{"gross_charge":113.5,"discounted_cash":95.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT [5750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0686-15","type":"NDC"}],"standard_charges":[{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT [5750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0166-15","type":"NDC"}],"standard_charges":[{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT [5750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0007-15","type":"NDC"}],"standard_charges":[{"gross_charge":113.5,"discounted_cash":95.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM [5749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1289-2","type":"NDC"}],"standard_charges":[{"gross_charge":143.5,"discounted_cash":120.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM [5749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1289-1","type":"NDC"}],"standard_charges":[{"gross_charge":118.5,"discounted_cash":99.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM [5749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-059-35","type":"NDC"}],"standard_charges":[{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM [5749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-059-11","type":"NDC"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM [5749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0054-15","type":"NDC"}],"standard_charges":[{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NORTRIPTYLINE 25 MG CAPSULE [5675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-293-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 25 MG CAPSULE [5675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-293-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-537-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0868-50","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0868-40","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0868-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0868-00","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1125-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0703-3301-04","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-008-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-037-50","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-037-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-599-59","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 UNITS"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200000 UNITS"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"25021-451-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"OLANZAPINE 2.5 MG TABLET [21057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-3110-0","type":"NDC"}],"standard_charges":[{"gross_charge":302.75,"discounted_cash":254.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":454.0,"discounted_cash":381.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":151.5,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":227.0,"discounted_cash":190.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 2.5 MG TABLET [21057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-163-30","type":"NDC"}],"standard_charges":[{"gross_charge":302.75,"discounted_cash":254.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":454.0,"discounted_cash":381.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":151.5,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":227.0,"discounted_cash":190.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 2.5 MG TABLET [21057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6283-61","type":"NDC"}],"standard_charges":[{"gross_charge":302.75,"discounted_cash":254.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":454.0,"discounted_cash":381.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":151.5,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":227.0,"discounted_cash":190.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG TABLET [17937]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-383-90","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":182.25,"discounted_cash":153.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":243.0,"discounted_cash":204.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG TABLET [17937]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-070-07","type":"NDC"}],"standard_charges":[{"gross_charge":125.25,"discounted_cash":105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":187.75,"discounted_cash":157.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":250.5,"discounted_cash":210.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG TABLET [17937]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-740-11","type":"NDC"}],"standard_charges":[{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":274.5,"discounted_cash":230.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":68.75,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":103.0,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG TABLET [17937]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-740-01","type":"NDC"}],"standard_charges":[{"gross_charge":137.25,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":274.5,"discounted_cash":230.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":68.75,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":103.0,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 2.5 MG TABLET [21057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-380-30","type":"NDC"}],"standard_charges":[{"gross_charge":281.5,"discounted_cash":236.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":422.25,"discounted_cash":354.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":140.75,"discounted_cash":118.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":211.25,"discounted_cash":177.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 5 MG TABLET [17936]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-3111-0","type":"NDC"}],"standard_charges":[{"gross_charge":178.75,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":268.0,"discounted_cash":225.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":357.25,"discounted_cash":300.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-083-07","type":"NDC"}],"standard_charges":[{"gross_charge":189.25,"discounted_cash":158.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":283.75,"discounted_cash":238.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":378.5,"discounted_cash":317.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-262-79","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-262-81","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-086-30","type":"NDC"}],"standard_charges":[{"gross_charge":189.25,"discounted_cash":158.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":283.75,"discounted_cash":238.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":378.5,"discounted_cash":317.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 2.5 MG TABLET [21057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-380-90","type":"NDC"}],"standard_charges":[{"gross_charge":273.25,"discounted_cash":229.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":409.75,"discounted_cash":344.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":205.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG TABLET [17937]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6376-61","type":"NDC"}],"standard_charges":[{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":178.75,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION [100265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9302","type":"HCPCS"},{"code":"0078-0669-61","type":"NDC"}],"standard_charges":[{"gross_charge":3037.0,"discounted_cash":2551.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION [100265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9302","type":"HCPCS"},{"code":"0078-0669-13","type":"NDC"}],"standard_charges":[{"gross_charge":8974.0,"discounted_cash":7538.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":3037.0,"discounted_cash":2551.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OFATUMUMAB 1,000 MG/50 ML INTRAVENOUS SOLUTION [116016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0078-0690-61","type":"NDC"}],"standard_charges":[{"gross_charge":12450.0,"discounted_cash":10458.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [165063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"0078-0804-61","type":"NDC"}],"standard_charges":[{"gross_charge":14184.75,"discounted_cash":11915.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [165063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"0078-0825-81","type":"NDC"}],"standard_charges":[{"gross_charge":14184.75,"discounted_cash":11915.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [165062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"0078-0818-81","type":"NDC"}],"standard_charges":[{"gross_charge":9472.75,"discounted_cash":7957.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18945.5,"discounted_cash":15914.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [165064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"0078-0811-81","type":"NDC"}],"standard_charges":[{"gross_charge":10443.5,"discounted_cash":8772.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323-377-01","type":"NDC"}],"standard_charges":[{"gross_charge":245.25,"discounted_cash":206.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":490.25,"discounted_cash":411.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"68462-897-10","type":"NDC"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":199.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"68462-897-01","type":"NDC"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":199.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323-377-00","type":"NDC"}],"standard_charges":[{"gross_charge":245.25,"discounted_cash":206.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323-377-41","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0641-6176-10","type":"NDC"}],"standard_charges":[{"gross_charge":228.5,"discounted_cash":191.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0641-6176-01","type":"NDC"}],"standard_charges":[{"gross_charge":228.5,"discounted_cash":191.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323-377-04","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0641-6174-10","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"0641-6174-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323-365-04","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"OFLOXACIN 0.3 % EAR DROPS [22257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0363-1","type":"NDC"}],"standard_charges":[{"gross_charge":634.25,"discounted_cash":532.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OFLOXACIN 0.3 % EAR DROPS [22257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-410-05","type":"NDC"}],"standard_charges":[{"gross_charge":634.25,"discounted_cash":532.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OLANZAPINE 10 MG TABLET [17937]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-4117-30","type":"NDC"}],"standard_charges":[{"gross_charge":154.75,"discounted_cash":129.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":232.0,"discounted_cash":194.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":309.25,"discounted_cash":259.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":77.5,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2358","type":"HCPCS"},{"code":"72603-181-01","type":"NDC"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":192.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":114.5,"discounted_cash":96.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2358","type":"HCPCS"},{"code":"55150-308-01","type":"NDC"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":194.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":173.25,"discounted_cash":145.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2358","type":"HCPCS"},{"code":"0517-0955-01","type":"NDC"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":128.75,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":193.0,"discounted_cash":162.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2358","type":"HCPCS"},{"code":"0781-3159-72","type":"NDC"}],"standard_charges":[{"gross_charge":225.5,"discounted_cash":189.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":112.75,"discounted_cash":94.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":169.25,"discounted_cash":142.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2358","type":"HCPCS"},{"code":"0002-7597-01","type":"NDC"}],"standard_charges":[{"gross_charge":247.5,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":123.75,"discounted_cash":103.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":185.5,"discounted_cash":155.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OFLOXACIN 0.3 % EAR DROPS [22257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72603-186-01","type":"NDC"}],"standard_charges":[{"gross_charge":646.75,"discounted_cash":543.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NORTRIPTYLINE 25 MG CAPSULE [5675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-604-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-639-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-436-35","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-436-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3304-3","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0418-13","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH [27473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-515-01","type":"NDC"}],"standard_charges":[{"gross_charge":260.75,"discounted_cash":219.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH [27473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-515-30","type":"NDC"}],"standard_charges":[{"gross_charge":260.75,"discounted_cash":219.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"NITROGLYCERIN 0.3 MG SUBLINGUAL TABLET [5603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-638-01","type":"NDC"}],"standard_charges":[{"gross_charge":318.25,"discounted_cash":267.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 EACH"}]},{"description":"NITROGLYCERIN 0.3 MG SUBLINGUAL TABLET [5603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0417-24","type":"NDC"}],"standard_charges":[{"gross_charge":600.75,"discounted_cash":504.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 EACH"}]},{"description":"NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH [27472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-297-03","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH [27472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9104-93","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9102-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-296-03","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":103.75,"discounted_cash":87.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH [27471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9102-93","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-639-45","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-174-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [165564]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0003-3772-11","type":"NDC"}],"standard_charges":[{"gross_charge":27378.5,"discounted_cash":22997.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"}]},{"description":"NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [178092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0003-3734-13","type":"NDC"}],"standard_charges":[{"gross_charge":15979.75,"discounted_cash":13422.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 ML"},{"gross_charge":15400.5,"discounted_cash":12936.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"}]},{"description":"NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [191265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9298","type":"HCPCS"},{"code":"0003-7125-11","type":"NDC"}],"standard_charges":[{"gross_charge":31025.5,"discounted_cash":26061.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [165565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0003-3774-12","type":"NDC"}],"standard_charges":[{"gross_charge":22245.0,"discounted_cash":18685.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"}]},{"description":"NITROPRUSSIDE 100 MCG/ML INJECTION FOR CATH LAB ONLY [408674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55555-0000-05","type":"NDC"}],"standard_charges":[{"gross_charge":1289.0,"discounted_cash":1082.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NITROGLYCERIN ER 2.5 MG CAPSULE,EXTENDED RELEASE [5600]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483-221-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.5 MG"}]},{"description":"NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"0517-4810-25","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":105.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL [27096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"28595-120-49","type":"NDC"}],"standard_charges":[{"gross_charge":803.75,"discounted_cash":675.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.9 G"}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL [27096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70003-300-20","type":"NDC"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 G"}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL [27096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-210-02","type":"NDC"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 G"}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL [27096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-210-01","type":"NDC"}],"standard_charges":[{"gross_charge":803.75,"discounted_cash":675.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.9 G"}]},{"description":"NITROGLYCERIN 25 MG/250 ML (100 MCG/ML) IN 5 % DEXTROSE  INTRAVENOUS [15858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"7700-6209-20","type":"NDC"}],"standard_charges":[{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"NITROGLYCERIN 25 MG/250 ML (100 MCG/ML) IN 5 % DEXTROSE  INTRAVENOUS [15858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"0338-1047-02","type":"NDC"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":184.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NITROGLYCERIN 2 % TRANSDERMAL OINTMENT [5606]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0281-0326-30","type":"NDC"}],"standard_charges":[{"gross_charge":254.75,"discounted_cash":213.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"NITROGLYCERIN 2 % TRANSDERMAL OINTMENT [5606]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0281-0326-08","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 INCH"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INCH"}]},{"description":"NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH [27475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9116-93","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.6 MG SUBLINGUAL TABLET [5605]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-640-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.6 MG SUBLINGUAL TABLET [5605]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-437-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.6 MG SUBLINGUAL TABLET [5605]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0419-24","type":"NDC"}],"standard_charges":[{"gross_charge":600.75,"discounted_cash":504.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 EACH"}]},{"description":"NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH [27474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-298-03","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH [27474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9112-93","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [190601]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-1085-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [191700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5317-20","type":"NDC"}],"standard_charges":[{"gross_charge":741.25,"discounted_cash":622.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [191700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5317-02","type":"NDC"}],"standard_charges":[{"gross_charge":741.25,"discounted_cash":622.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [191700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-1101-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"NIRMATRELVIR 150 MG (10)-RITONAVIR 100 MG (10) TABLETS IN A DOSE PACK [191700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-1101-04","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [185277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-230-12","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":415.25,"discounted_cash":348.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIMODIPINE 30 MG/5 ML ORAL SYRINGE (FOR ORAL USE ONLY) [185277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-230-05","type":"NDC"}],"standard_charges":[{"gross_charge":207.75,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":415.25,"discounted_cash":348.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIMODIPINE 30 MG CAPSULE [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-512-30","type":"NDC"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":260.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIMODIPINE 30 MG CAPSULE [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-512-11","type":"NDC"}],"standard_charges":[{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":248.75,"discounted_cash":208.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIMODIPINE 30 MG CAPSULE [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-512-00","type":"NDC"}],"standard_charges":[{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":248.75,"discounted_cash":208.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIMODIPINE 30 MG CAPSULE [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-209-13","type":"NDC"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":260.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIMODIPINE 30 MG CAPSULE [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-209-07","type":"NDC"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":260.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIMODIPINE 30 MG CAPSULE [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-797-33","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":46.75,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIMODIPINE 30 MG CAPSULE [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-135-65","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":123.75,"discounted_cash":103.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIMODIPINE 30 MG CAPSULE [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-135-64","type":"NDC"}],"standard_charges":[{"gross_charge":64.75,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":129.5,"discounted_cash":108.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NILUTAMIDE 150 MG TABLET [25420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59212-111-14","type":"NDC"}],"standard_charges":[{"gross_charge":508.5,"discounted_cash":427.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":1017.0,"discounted_cash":854.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7082-06","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-262-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [190601]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-1085-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [190601]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-0345-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [190601]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-0345-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [190601]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5321-03","type":"NDC"}],"standard_charges":[{"gross_charge":741.25,"discounted_cash":622.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63629-2464-1","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-439-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52427-285-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-303-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-446-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-446-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-348-20","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-348-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0122-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3422-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756-411-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-307-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NIVOLUMAB 600 MG-HYALURONIDASE-NVHY 10,000 UNIT/5 ML SUBCUT SOLUTION [200872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"0003-6120-01","type":"NDC"}],"standard_charges":[{"gross_charge":31959.25,"discounted_cash":26845.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":15979.75,"discounted_cash":13422.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":23969.5,"discounted_cash":20134.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72603-176-01","type":"NDC"}],"standard_charges":[{"gross_charge":8299.5,"discounted_cash":6971.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 230 ML"}]},{"description":"NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-496-10","type":"NDC"}],"standard_charges":[{"gross_charge":8299.5,"discounted_cash":6971.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 230 ML"}]},{"description":"NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1991-05","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-1992-08","type":"NDC"}],"standard_charges":[{"gross_charge":2220.75,"discounted_cash":1865.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 230 ML"}]},{"description":"NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70408-239-32","type":"NDC"}],"standard_charges":[{"gross_charge":8299.25,"discounted_cash":6971.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [10723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-689-88","type":"NDC"}],"standard_charges":[{"gross_charge":2220.75,"discounted_cash":1865.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 230 ML"}]},{"description":"NITAZOXANIDE 500 MG TABLET [39254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-405-03","type":"NDC"}],"standard_charges":[{"gross_charge":634.5,"discounted_cash":532.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NITAZOXANIDE 500 MG TABLET [39254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67546-111-14","type":"NDC"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":603.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NITAZOXANIDE 500 MG TABLET [39254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67546-111-12","type":"NDC"}],"standard_charges":[{"gross_charge":667.5,"discounted_cash":560.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [196404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90380","type":"HCPCS"},{"code":"49281-575-15","type":"NDC"}],"standard_charges":[{"gross_charge":2029.0,"discounted_cash":1704.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [196404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90380","type":"HCPCS"},{"code":"49281-575-00","type":"NDC"}],"standard_charges":[{"gross_charge":2029.0,"discounted_cash":1704.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [196405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90381","type":"HCPCS"},{"code":"49281-574-88","type":"NDC"}],"standard_charges":[{"gross_charge":2029.0,"discounted_cash":1704.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [196405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90381","type":"HCPCS"},{"code":"49281-574-15","type":"NDC"}],"standard_charges":[{"gross_charge":2029.0,"discounted_cash":1704.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [190601]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5321-30","type":"NDC"}],"standard_charges":[{"gross_charge":741.25,"discounted_cash":622.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"NORTRIPTYLINE 10 MG CAPSULE [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-281-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 10 MG CAPSULE [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-603-15","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 10 MG CAPSULE [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-603-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 10 MG CAPSULE [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4001-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 10 MG CAPSULE [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4001-5","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 10 MG CAPSULE [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0810-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY [39802]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"386000803","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 116 ML"}]},{"description":"NORTRIPTYLINE 10 MG CAPSULE [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-281-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 25 MG CAPSULE [5675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-604-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 25 MG CAPSULE [5675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-016-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 25 MG CAPSULE [5675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4002-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 25 MG CAPSULE [5675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0811-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE 10 MG CAPSULE [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907-069-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY [39802]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"386000802","type":"NDC"}],"standard_charges":[{"gross_charge":189.5,"discounted_cash":159.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 116 ML"}]},{"description":"NORETHINDRONE ACETATE 5 MG TABLET [10747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-475-05","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3755-75","type":"NDC"}],"standard_charges":[{"gross_charge":153.75,"discounted_cash":129.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-852-04","type":"NDC"}],"standard_charges":[{"gross_charge":147.5,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-852-00","type":"NDC"}],"standard_charges":[{"gross_charge":147.5,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-1153-03","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-1153-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MCG"},{"gross_charge":292.0,"discounted_cash":245.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MCG/ML"},{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"36000-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"36000-162-10","type":"NDC"}],"standard_charges":[{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3375-04","type":"NDC"}],"standard_charges":[{"gross_charge":146.75,"discounted_cash":123.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NM TC99M DTPA PER VIAL [408076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9539","type":"HCPCS"},{"code":"45567-0010-01","type":"NDC"}],"standard_charges":[{"gross_charge":339.5,"discounted_cash":285.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MILLICURIE"}]},{"description":"NM TC99M DTPA AEROSOL [408088]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9567","type":"HCPCS"},{"code":"45567-0010-02","type":"NDC"}],"standard_charges":[{"gross_charge":509.25,"discounted_cash":427.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MILLICURIE"}]},{"description":"NM SODIUM IODIDE I-131 5 MCI [408080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0019-9450-01","type":"NDC"}],"standard_charges":[{"gross_charge":10100.0,"discounted_cash":8484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MILLI-UNITS"}]},{"description":"NM SODIUM IODIDE I-131 5 MCI [408080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9528","type":"HCPCS"},{"code":"0019-9450-01","type":"NDC"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":1696.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLI-UNITS"},{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLI-UNITS"}]},{"description":"NM SODIUM IODIDE I-131 20 MCI [408081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0019-9450-02","type":"NDC"}],"standard_charges":[{"gross_charge":10100.0,"discounted_cash":8484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MILLI-UNITS"}]},{"description":"NM SODIUM IODIDE I-131 20 MCI [408081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9517","type":"HCPCS"},{"code":"0019-9450-02","type":"NDC"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":1696.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLI-UNITS"},{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLI-UNITS"}]},{"description":"NM SODIUM IODIDE I-131 100 MCI [408082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0019-9450-03","type":"NDC"}],"standard_charges":[{"gross_charge":10100.0,"discounted_cash":8484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MILLI-UNITS"}]},{"description":"NM SODIUM IODIDE I-131 100 MCI [408082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9517","type":"HCPCS"},{"code":"0019-9450-03","type":"NDC"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":1696.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MILLI-UNITS"},{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLI-UNITS"}]},{"description":"NM SODIUM FLUORIDE F18  [408087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9580","type":"HCPCS"},{"code":"60055-0018-10","type":"NDC"}],"standard_charges":[{"gross_charge":1624.75,"discounted_cash":1364.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MILLICURIE"}]},{"description":"INDIUM IN-111 OXYQUINOLINE 1 MCI/ML (37 MBQ/ML)(1 ML) INTRAVENOUS SOLN [98452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9570","type":"HCPCS"},{"code":"17156-021-01","type":"NDC"}],"standard_charges":[{"gross_charge":2105.0,"discounted_cash":1768.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MILLICURIE"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3755-95","type":"NDC"}],"standard_charges":[{"gross_charge":153.75,"discounted_cash":129.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3375-14","type":"NDC"}],"standard_charges":[{"gross_charge":146.75,"discounted_cash":123.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-940-04","type":"NDC"}],"standard_charges":[{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-940-21","type":"NDC"}],"standard_charges":[{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NORETHINDRONE ACETATE 5 MG TABLET [10747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-304-50","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NORETHINDRONE ACETATE 5 MG TABLET [10747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51285-424-10","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NORETHINDRONE ACETATE 5 MG TABLET [10747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0211-10","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION WRAPPER [184631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-641-10","type":"NDC"}],"standard_charges":[{"gross_charge":295.75,"discounted_cash":248.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION WRAPPER [184631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0108-20","type":"NDC"}],"standard_charges":[{"gross_charge":271.75,"discounted_cash":228.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION WRAPPER [184631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-504-25","type":"NDC"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION WRAPPER [184631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-9036-17","type":"NDC"}],"standard_charges":[{"gross_charge":165.75,"discounted_cash":139.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION WRAPPER [184631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7023-25","type":"NDC"}],"standard_charges":[{"gross_charge":294.75,"discounted_cash":247.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN DEXTROSE 5 % IV [132471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1493-17","type":"NDC"}],"standard_charges":[{"gross_charge":209.25,"discounted_cash":175.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN DEXTROSE 5 % IV [132471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71019-222-11","type":"NDC"}],"standard_charges":[{"gross_charge":266.25,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN DEXTROSE 5 % IV [132471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1036-17","type":"NDC"}],"standard_charges":[{"gross_charge":228.25,"discounted_cash":191.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN 0.9 % NACL IV [132450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-316-25","type":"NDC"}],"standard_charges":[{"gross_charge":179.25,"discounted_cash":150.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72603-180-10","type":"NDC"}],"standard_charges":[{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72603-180-01","type":"NDC"}],"standard_charges":[{"gross_charge":109.75,"discounted_cash":92.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION WRAPPER [184631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-641-01","type":"NDC"}],"standard_charges":[{"gross_charge":295.75,"discounted_cash":248.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"OLANZAPINE 5 MG TABLET [17936]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-723-11","type":"NDC"}],"standard_charges":[{"gross_charge":147.25,"discounted_cash":123.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":220.75,"discounted_cash":185.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":294.5,"discounted_cash":247.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":110.5,"discounted_cash":92.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OXCARBAZEPINE 300 MG TABLET [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7263-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 300 MG TABLET [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-853-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 300 MG TABLET [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-853-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 300 MG TABLET [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-138-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 300 MG TABLET [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-184-88","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 300 MG TABLET [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-293-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 300 MG TABLET [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0337-05","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":86.25,"discounted_cash":72.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":172.5,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 150 MG TABLET [27049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-845-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 150 MG TABLET [27049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-845-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 150 MG TABLET [27049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 150 MG TABLET [27049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-183-88","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION [30479]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-123-62","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-270-37","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-722-20","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-722-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6605-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-400-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-400-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63629-1354-2","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-456-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-2821-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0038-00","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-4975-21","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION [30479]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-125-50","type":"NDC"}],"standard_charges":[{"gross_charge":1019.5,"discounted_cash":856.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION [30479]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-649-12","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION [30479]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-649-11","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION [30479]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-123-59","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXCARBAZEPINE 150 MG TABLET [27049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0456-05","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":189.0,"discounted_cash":158.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43066-018-01","type":"NDC"}],"standard_charges":[{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-201-20","type":"NDC"}],"standard_charges":[{"gross_charge":493.25,"discounted_cash":414.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-6132-7","type":"NDC"}],"standard_charges":[{"gross_charge":493.25,"discounted_cash":414.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0955-1733-20","type":"NDC"}],"standard_charges":[{"gross_charge":493.25,"discounted_cash":414.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3317-80","type":"NDC"}],"standard_charges":[{"gross_charge":1519.5,"discounted_cash":1276.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-442-20","type":"NDC"}],"standard_charges":[{"gross_charge":859.25,"discounted_cash":721.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-212-20","type":"NDC"}],"standard_charges":[{"gross_charge":1638.0,"discounted_cash":1375.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-233-20","type":"NDC"}],"standard_charges":[{"gross_charge":246.75,"discounted_cash":207.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0955-1727-20","type":"NDC"}],"standard_charges":[{"gross_charge":493.25,"discounted_cash":414.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61703-363-22","type":"NDC"}],"standard_charges":[{"gross_charge":473.5,"discounted_cash":397.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-3986-01","type":"NDC"}],"standard_charges":[{"gross_charge":493.25,"discounted_cash":414.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OSELTAMIVIR 75 MG CAPSULE [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-044-11","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 75 MG CAPSULE [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-799-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 75 MG CAPSULE [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-819-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 75 MG CAPSULE [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-632-31","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 75 MG CAPSULE [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-677-11","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 75 MG CAPSULE [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-258-66","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 75 MG CAPSULE [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-664-10","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 75 MG CAPSULE [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1010-2","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 75 MG CAPSULE [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-470-13","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16729-332-05","type":"NDC"}],"standard_charges":[{"gross_charge":1519.5,"discounted_cash":1276.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-3985-01","type":"NDC"}],"standard_charges":[{"gross_charge":246.75,"discounted_cash":207.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61703-363-18","type":"NDC"}],"standard_charges":[{"gross_charge":236.75,"discounted_cash":198.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0955-1725-10","type":"NDC"}],"standard_charges":[{"gross_charge":246.75,"discounted_cash":207.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXAZEPAM 30 MG CAPSULE [5932]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-814-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXAZEPAM 15 MG CAPSULE [5931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-813-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXAZEPAM 15 MG CAPSULE [5931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-813-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXAZEPAM 15 MG CAPSULE [5931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2069-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXAZEPAM 10 MG CAPSULE [5930]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-812-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXAZEPAM 10 MG CAPSULE [5930]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-812-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXANDROLONE 2.5 MG TABLET [10803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0271-11","type":"NDC"}],"standard_charges":[{"gross_charge":185.75,"discounted_cash":156.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"OXANDROLONE 10 MG TABLET [33826]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0272-06","type":"NDC"}],"standard_charges":[{"gross_charge":165.75,"discounted_cash":139.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16729-332-03","type":"NDC"}],"standard_charges":[{"gross_charge":759.75,"discounted_cash":638.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43066-014-01","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":119.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288-101-10","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0955-1731-10","type":"NDC"}],"standard_charges":[{"gross_charge":246.75,"discounted_cash":207.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-750-10","type":"NDC"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3315-70","type":"NDC"}],"standard_charges":[{"gross_charge":759.75,"discounted_cash":638.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-469-10","type":"NDC"}],"standard_charges":[{"gross_charge":493.25,"discounted_cash":414.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OSELTAMIVIR 75 MG CAPSULE [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0004-0800-85","type":"NDC"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":123.25,"discounted_cash":103.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-270-41","type":"NDC"}],"standard_charges":[{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-975-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-975-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6743-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-917-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8515-62","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8515-23","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 20 MG TABLET [87822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-057-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-354-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-018-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-223-88","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0552-62","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0552-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 20 MG/ML ORAL CONCENTRATE [10812]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8557-30","type":"NDC"}],"standard_charges":[{"gross_charge":2248.75,"discounted_cash":1888.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYCODONE 20 MG/ML ORAL CONCENTRATE [10812]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5014-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-187-88","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8515-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCHLOROSENE SODIUM TOPICAL POWDER FOR SOLUTION [10811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0327-0001-10","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OXYCHLOROSENE (CLORPACTIN) IN WATER FOR IRRIGATION 1000 ML [189316]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-9910-00","type":"NDC"}],"standard_charges":[{"gross_charge":7140.75,"discounted_cash":5998.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-255-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6570-61","type":"NDC"}],"standard_charges":[{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-209-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-317-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-371-10","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":126.5,"discounted_cash":106.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-627-15","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-008-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-056-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23635-581-10","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":84.25,"discounted_cash":70.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2878-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-184-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 15 MG TABLET [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-184-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1273-6","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":140.5,"discounted_cash":118.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"57237-077-10","type":"NDC"}],"standard_charges":[{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":301.25,"discounted_cash":253.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"62756-240-60","type":"NDC"}],"standard_charges":[{"gross_charge":150.5,"discounted_cash":126.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":300.75,"discounted_cash":252.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"65862-390-10","type":"NDC"}],"standard_charges":[{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":301.25,"discounted_cash":253.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"0781-5238-06","type":"NDC"}],"standard_charges":[{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":301.25,"discounted_cash":253.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"0781-5238-64","type":"NDC"}],"standard_charges":[{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":301.25,"discounted_cash":253.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"62756-240-64","type":"NDC"}],"standard_charges":[{"gross_charge":150.5,"discounted_cash":126.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":300.75,"discounted_cash":252.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"68462-157-13","type":"NDC"}],"standard_charges":[{"gross_charge":156.25,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":312.25,"discounted_cash":262.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"0378-7732-93","type":"NDC"}],"standard_charges":[{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":301.25,"discounted_cash":253.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION [32700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0023-1145-01","type":"NDC"}],"standard_charges":[{"gross_charge":2356.75,"discounted_cash":1979.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE [27694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-722-90","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE [27694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0065-2","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24658-350-12","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6706-06","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-761-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-660-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"57237-077-30","type":"NDC"}],"standard_charges":[{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":301.25,"discounted_cash":253.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"68462-158-11","type":"NDC"}],"standard_charges":[{"gross_charge":418.25,"discounted_cash":351.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":627.25,"discounted_cash":526.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":104.75,"discounted_cash":87.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":209.25,"discounted_cash":175.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155-547-42","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155-547-41","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"0409-4755-18","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"67457-440-22","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"67457-440-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"55150-125-02","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"0641-6078-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"0641-6078-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"36000-012-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"0409-4755-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"0781-5239-80","type":"NDC"}],"standard_charges":[{"gross_charge":403.25,"discounted_cash":338.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":605.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":201.75,"discounted_cash":169.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"0781-5239-64","type":"NDC"}],"standard_charges":[{"gross_charge":403.5,"discounted_cash":338.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":605.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":201.75,"discounted_cash":169.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"62756-356-66","type":"NDC"}],"standard_charges":[{"gross_charge":401.75,"discounted_cash":337.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":602.75,"discounted_cash":506.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":100.5,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":201.0,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 8 MG DISINTEGRATING TABLET [27698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"62756-356-64","type":"NDC"}],"standard_charges":[{"gross_charge":398.25,"discounted_cash":334.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":597.25,"discounted_cash":501.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":99.75,"discounted_cash":83.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":199.25,"discounted_cash":167.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-127-65","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-127-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OLOPATADINE 0.2 % EYE DROPS [76979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-0122-1","type":"NDC"}],"standard_charges":[{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"OLOPATADINE 0.2 % EYE DROPS [76979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-671-27","type":"NDC"}],"standard_charges":[{"gross_charge":61.75,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"OLOPATADINE 0.2 % EYE DROPS [76979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58602-007-39","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"OLOPATADINE 0.2 % EYE DROPS [76979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-8150-01","type":"NDC"}],"standard_charges":[{"gross_charge":120.5,"discounted_cash":101.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"OLOPATADINE 0.2 % EYE DROPS [76979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0586-4","type":"NDC"}],"standard_charges":[{"gross_charge":735.75,"discounted_cash":618.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"OLOPATADINE 0.2 % EYE DROPS [76979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-305-12","type":"NDC"}],"standard_charges":[{"gross_charge":735.75,"discounted_cash":618.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"OLOPATADINE 0.2 % EYE DROPS [76979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7684-32","type":"NDC"}],"standard_charges":[{"gross_charge":776.5,"discounted_cash":652.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"OLOPATADINE 0.2 % EYE DROPS [76979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-272-25","type":"NDC"}],"standard_charges":[{"gross_charge":729.75,"discounted_cash":612.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"OLOPATADINE 0.2 % EYE DROPS [76979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0272-25","type":"NDC"}],"standard_charges":[{"gross_charge":918.5,"discounted_cash":771.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"OLOPATADINE 0.1 % EYE DROPS [19452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-271-05","type":"NDC"}],"standard_charges":[{"gross_charge":956.75,"discounted_cash":803.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OLOPATADINE 0.1 % EYE DROPS [19452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0271-05","type":"NDC"}],"standard_charges":[{"gross_charge":1248.5,"discounted_cash":1048.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OLMESARTAN 20 MG TABLET [32762]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65597-103-30","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":135.5,"discounted_cash":113.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLAPARIB 150 MG TABLET [176909]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-0679-60","type":"NDC"}],"standard_charges":[{"gross_charge":712.0,"discounted_cash":598.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"OLAPARIB 100 MG TABLET [176910]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-0668-60","type":"NDC"}],"standard_charges":[{"gross_charge":712.0,"discounted_cash":598.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"OLANZAPINE 5 MG TABLET [17936]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-381-90","type":"NDC"}],"standard_charges":[{"gross_charge":161.25,"discounted_cash":135.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":322.25,"discounted_cash":270.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 5 MG TABLET [17936]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-068-07","type":"NDC"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":249.0,"discounted_cash":209.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":332.0,"discounted_cash":278.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OMADACYCLINE 100 MG INTRAVENOUS SOLUTION [180750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71715-001-02","type":"NDC"}],"standard_charges":[{"gross_charge":1691.5,"discounted_cash":1420.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1691.5,"discounted_cash":1420.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"OMADACYCLINE 100 MG INTRAVENOUS SOLUTION [180750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71715-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":1691.5,"discounted_cash":1420.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0884-08","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-034-16","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-3170-7","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-657-12","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5401-89","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE [180722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242-214-03","type":"NDC"}],"standard_charges":[{"gross_charge":5166.0,"discounted_cash":4339.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":7749.0,"discounted_cash":6509.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":10332.0,"discounted_cash":8678.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12915.0,"discounted_cash":10848.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":2583.0,"discounted_cash":2169.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155-548-41","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE [180722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242-214-01","type":"NDC"}],"standard_charges":[{"gross_charge":5168.0,"discounted_cash":4341.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":7752.0,"discounted_cash":6511.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":10336.0,"discounted_cash":8682.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12920.0,"discounted_cash":10852.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":2584.0,"discounted_cash":2170.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OMALIZUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE [197735]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242-227-01","type":"NDC"}],"standard_charges":[{"gross_charge":8395.0,"discounted_cash":7051.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [180724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242-215-03","type":"NDC"}],"standard_charges":[{"gross_charge":5075.0,"discounted_cash":4263.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":7612.25,"discounted_cash":6394.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":10149.75,"discounted_cash":8525.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12687.0,"discounted_cash":10657.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"}]},{"description":"OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [180724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242-215-01","type":"NDC"}],"standard_charges":[{"gross_charge":5166.0,"discounted_cash":4339.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":7749.0,"discounted_cash":6509.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":10332.0,"discounted_cash":8678.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12915.0,"discounted_cash":10848.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155-548-42","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155-547-31","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"60505-6130-0","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0004-0822-05","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":93.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":156.25,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 30 MG CAPSULE [88704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-4591-13","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 30 MG CAPSULE [88704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-042-11","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 30 MG CAPSULE [88704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-817-01","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":238.5,"discounted_cash":200.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 30 MG CAPSULE [88704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-630-31","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 30 MG CAPSULE [88704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-675-11","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 30 MG CAPSULE [88704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1264-1","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 30 MG CAPSULE [88704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-468-13","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4714-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-217-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5547-12","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":124.0,"discounted_cash":104.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":165.5,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":206.75,"discounted_cash":173.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-678-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":46.75,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":84.25,"discounted_cash":70.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":112.25,"discounted_cash":94.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1165-6","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":140.5,"discounted_cash":118.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-384-26","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":84.25,"discounted_cash":70.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":112.25,"discounted_cash":94.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":140.5,"discounted_cash":118.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5570-05","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":85.5,"discounted_cash":71.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":102.75,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":205.25,"discounted_cash":172.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":256.5,"discounted_cash":215.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-603-21","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"ONDANSETRON HCL 8 MG TABLET [10779]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"0781-1681-31","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":213.75,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG TABLET [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"65862-187-30","type":"NDC"}],"standard_charges":[{"gross_charge":81.75,"discounted_cash":68.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":327.0,"discounted_cash":274.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG TABLET [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"68462-105-30","type":"NDC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":165.75,"discounted_cash":139.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":331.25,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG TABLET [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"62756-130-01","type":"NDC"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":159.75,"discounted_cash":134.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":319.25,"discounted_cash":268.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG TABLET [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"55111-153-30","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":167.5,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":334.75,"discounted_cash":281.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION [106349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"16729-298-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION [106349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155-549-31","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION [106349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"67457-441-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION [106349]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"0409-4759-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"70860-776-41","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"70860-776-02","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155-548-31","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155-548-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"60505-6130-5","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG TABLET [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"68084-220-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG TABLET [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"68084-220-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 8 MG TABLET [10779]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"65862-188-30","type":"NDC"}],"standard_charges":[{"gross_charge":109.5,"discounted_cash":91.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":219.0,"discounted_cash":183.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 8 MG TABLET [10779]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"63304-459-30","type":"NDC"}],"standard_charges":[{"gross_charge":112.25,"discounted_cash":94.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":224.25,"discounted_cash":188.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 8 MG TABLET [10779]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"62756-131-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":213.75,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 8 MG TABLET [10779]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"55111-154-30","type":"NDC"}],"standard_charges":[{"gross_charge":112.25,"discounted_cash":94.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":224.25,"discounted_cash":188.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"50268-647-14","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"50268-647-11","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"7700-5327-05","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"68094-763-62","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"68094-763-59","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"16714-671-02","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":171.5,"discounted_cash":144.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"65162-691-79","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"51672-4091-3","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION [18877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"0054-0064-47","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG TABLET [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"0904-6551-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-354-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR [27660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-262-37","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE [37662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-622-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"MORPHINE ER 10 MG CAPSULE,EXTENDED RELEASE PELLETS [87824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0225-00","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":324.5,"discounted_cash":272.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":164.75,"discounted_cash":138.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":196.75,"discounted_cash":165.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-965-30","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5013-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"00054-0352-44","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-082-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0404-44","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8003-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"MORPHINE 8 MG/ML INJECTION SOLUTION [127046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323-458-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE 50 MG/ML INTRAVENOUS SOLUTION [127361]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1896-20","type":"NDC"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MORPHINE 50 MG/ML INTRAVENOUS SOLUTION [127361]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1134-05","type":"NDC"}],"standard_charges":[{"gross_charge":215.75,"discounted_cash":181.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MORPHINE 50 MG/ML INTRAVENOUS SOLUTION [127361]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1134-03","type":"NDC"}],"standard_charges":[{"gross_charge":114.75,"discounted_cash":96.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MORPHINE 5 MG/ML INJECTION WRAPPER [177085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045-006-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MORPHINE 5 MG/ML INJECTION SOLUTION [5173]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323-455-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MORPHINE ER 100 MG CAPSULE,EXTENDED RELEASE PELLETS [27874]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0233-00","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":77.25,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE 5 MG/ML INJECTION SOLUTION [5173]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323-455-00","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8315-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 120 MG CAPSULE,EXTENDED RELEASE 24 HR MULTIPHASE [32712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3093-11","type":"NDC"}],"standard_charges":[{"gross_charge":138.25,"discounted_cash":116.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":71.75,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-452-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-804-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8390-62","type":"NDC"}],"standard_charges":[{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8390-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 100 MG CAPSULE,EXTENDED RELEASE PELLETS [27874]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3507-06","type":"NDC"}],"standard_charges":[{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE 4 MG/ML INTRAVENOUS SOLUTION WRAPPER [168582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323-454-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE 4 MG/ML INTRAVENOUS SOLUTION WRAPPER [168582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323-454-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE 2 MG/ML INJECTION WRAPPER [179290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0409-1890-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"MORPHINE 2 MG/ML INJECTION SYRINGE [5170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045-004-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"MORPHINE 2 MG/ML INJECTION SYRINGE [5170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045-004-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"MORPHINE 2 MG/ML INJECTION SYRINGE [5170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"76045-004-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE 2 MG/ML INJECTION SOLUTION [30594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323-452-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"MORPHINE 15 MG IMMEDIATE RELEASE TABLET [5178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0273-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE 15 MG IMMEDIATE RELEASE TABLET [5178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0235-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE 15 MG IMMEDIATE RELEASE TABLET [5178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0235-24","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE 10 MG/ML INJECTION SOLUTION WRAPPER [178565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323-451-00","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":247.25,"discounted_cash":207.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"MORPHINE 10 MG/ML INTRAVENOUS SOLUTION [27390]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0641-6127-25","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"MORPHINE 10 MG/ML INTRAVENOUS SOLUTION [27390]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0641-6127-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"MORPHINE 10 MG/ML INJECTION SOLUTION WRAPPER [178565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323-451-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"MORPHINE 10 MG/ML INJECTION SOLUTION WRAPPER [178565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0409-1893-03","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"MORPHINE 10 MG/ML INJECTION SOLUTION WRAPPER [178565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"76045-008-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"MORPHINE 10 MG/ML INJECTION SOLUTION WRAPPER [178565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0409-1893-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"MORPHINE 2 MG/ML INJECTION WRAPPER [179290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0409-1890-03","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"MORPHINE 2 MG/ML INJECTION WRAPPER [179290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323-452-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"MORPHINE 4 MG/ML INTRAVENOUS SOLUTION WRAPPER [168582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0409-1891-03","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE 4 MG/ML INTRAVENOUS SOLUTION WRAPPER [168582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0641-6125-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE 4 MG/ML INTRAVENOUS SOLUTION WRAPPER [168582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0641-6125-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE 4 MG/ML INTRAVENOUS SOLUTION WRAPPER [168582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045-005-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE 4 MG/ML INTRAVENOUS SOLUTION WRAPPER [168582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0409-1891-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8315-62","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE 30 MG/30 ML (1 MG/ML) INTRAVENOUS PCA SYRINGE [77005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"76329-1911-1","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MORPHINE 30 MG IMMEDIATE RELEASE TABLET [5179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0236-24","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE 2 MG/ML INTRAVENOUS SYRINGE [135118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0409-1890-23","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE 2 MG/ML INTRAVENOUS SYRINGE [135118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0409-1890-13","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4858-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-801-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET [10663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904053961","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"MULTIVITAMIN TABLET WRAPPER [7857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068105000","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"MULTIVITAMIN TABLET WRAPPER [7857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"2055502700","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"MULTIVITAMIN TABLET WRAPPER [7857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5789650101","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"MULTIVITAMIN TABLET WRAPPER [7857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536354710","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"MULTIVITAMIN TABLET WRAPPER [7857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536354701","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"MULTIVITAMIN TABLET WRAPPER [7857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"178055001","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"MULTIVITAMIN ORAL LIQUID [10865]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4459-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID [132337]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"573051330","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID [132337]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6961800858","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID [132337]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-6173-15","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID [132337]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5434462","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MOXIFLOXACIN 400 MG TABLET [26854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-201-30","type":"NDC"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":128.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS [35699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7135-93","type":"NDC"}],"standard_charges":[{"gross_charge":716.5,"discounted_cash":601.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS [35699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-422-01","type":"NDC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":577.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS [35699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0582-4","type":"NDC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":577.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS [35699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-4013-03","type":"NDC"}],"standard_charges":[{"gross_charge":748.25,"discounted_cash":628.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION [193826]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9350","type":"HCPCS"},{"code":"50242-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":2277.5,"discounted_cash":1913.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION [193826]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9350","type":"HCPCS"},{"code":"50242-142-01","type":"NDC"}],"standard_charges":[{"gross_charge":37119.0,"discounted_cash":31179.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MORPHINE ER 90 MG CAPSULE,EXTENDED RELEASE 24 HR MULTIPHASE [32711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3092-11","type":"NDC"}],"standard_charges":[{"gross_charge":155.75,"discounted_cash":130.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"MORPHINE ER 80 MG CAPSULE,EXTENDED RELEASE PELLETS [77728]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3506-06","type":"NDC"}],"standard_charges":[{"gross_charge":132.75,"discounted_cash":111.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"MORPHINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR MULTIPHASE [97028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3117-11","type":"NDC"}],"standard_charges":[{"gross_charge":100.75,"discounted_cash":84.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MUPIROCIN 2 % TOPICAL OINTMENT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-112-22","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 G"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"0054-0163-25","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"0004-0259-01","type":"NDC"}],"standard_charges":[{"gross_charge":291.75,"discounted_cash":245.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION [25005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"66689-307-08","type":"NDC"}],"standard_charges":[{"gross_charge":137.75,"discounted_cash":115.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION [25005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"67877-230-22","type":"NDC"}],"standard_charges":[{"gross_charge":137.75,"discounted_cash":115.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION [25005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"0004-0261-29","type":"NDC"}],"standard_charges":[{"gross_charge":157.5,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":78.75,"discounted_cash":66.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MVI,PEDI NO.1,COMPONENT(VIAL 1 OF 2) 400 UNIT-200 MCG/4 ML IV SOLUTION [176905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-7886-8","type":"NDC"}],"standard_charges":[{"gross_charge":180.25,"discounted_cash":151.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"MVI,PEDI NO.1,COMPONENT (VIAL 2 OF 2) 140 MCG-20 MCG-1 MCG/ML IV SOLN [176922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-9023-9","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MVI,PEDI NO.1,COMPONENT (VIAL 2 OF 2) 140 MCG-20 MCG-1 MCG/ML IV SOLN [176922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-7886-9","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MVI,ADULT NO.4,VIT K,COMP(VIAL 1 OF 2) 3,300 UNIT-150 MCG/5 ML IV SOLN [176947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-7862-8","type":"NDC"}],"standard_charges":[{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION [133523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-7862-1","type":"NDC"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":120.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION [133523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-5650-2","type":"NDC"}],"standard_charges":[{"gross_charge":461.25,"discounted_cash":387.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN [129551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-7886-1","type":"NDC"}],"standard_charges":[{"gross_charge":225.25,"discounted_cash":189.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN [129551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-5647-0","type":"NDC"}],"standard_charges":[{"gross_charge":757.5,"discounted_cash":636.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN [129551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-5646-1","type":"NDC"}],"standard_charges":[{"gross_charge":139.75,"discounted_cash":117.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MVI, ADULT NO.4, VIT K (VIAL 2 OF 2) 600 MCG-60 MCG-5 MCG/5 ML IV SOLN [176948]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-7862-9","type":"NDC"}],"standard_charges":[{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MUPIROCIN 2 % TOPICAL OINTMENT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-112-14","type":"NDC"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"MUPIROCIN 2 % TOPICAL OINTMENT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1312-1","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"MUPIROCIN 2 % TOPICAL OINTMENT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-180-22","type":"NDC"}],"standard_charges":[{"gross_charge":232.75,"discounted_cash":195.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 G"}]},{"description":"MUPIROCIN 2 % TOPICAL OINTMENT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1010-42","type":"NDC"}],"standard_charges":[{"gross_charge":351.5,"discounted_cash":295.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 G"}]},{"description":"MORPHINE ER 60 MG CAPSULE,EXTENDED RELEASE PELLETS [27873]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3505-06","type":"NDC"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":81.75,"discounted_cash":68.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 30 MG CAPSULE,EXTENDED RELEASE PELLETS [27871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1278-01","type":"NDC"}],"standard_charges":[{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 30 MG CAPSULE,EXTENDED RELEASE PELLETS [27871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3503-06","type":"NDC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 30 MG CAPSULE,EXTENDED RELEASE PELLETS [27871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0227-00","type":"NDC"}],"standard_charges":[{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 30 MG CAPSULE,EXTENDED RELEASE 24 HR MULTIPHASE [32709]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3090-11","type":"NDC"}],"standard_charges":[{"gross_charge":159.75,"discounted_cash":134.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":121.25,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6557-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-4270-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8315-23","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8330-01","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 60 MG CAPSULE,EXTENDED RELEASE 24 HR MULTIPHASE [32710]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3091-11","type":"NDC"}],"standard_charges":[{"gross_charge":155.25,"discounted_cash":130.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":117.75,"discounted_cash":98.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"MORPHINE ER 50 MG CAPSULE,EXTENDED RELEASE PELLETS [27872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55700-552-60","type":"NDC"}],"standard_charges":[{"gross_charge":188.5,"discounted_cash":158.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 45 MG CAPSULE,EXTENDED RELEASE 24 HR MULTIPHASE [97027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3116-11","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MORPHINE ER 40 MG CAPSULE,EXTENDED RELEASE PELLETS [117343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1479-01","type":"NDC"}],"standard_charges":[{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6558-61","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8330-23","type":"NDC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-802-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8330-62","type":"NDC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"0093-7334-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-001-62","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0237-63","type":"NDC"}],"standard_charges":[{"gross_charge":231.25,"discounted_cash":194.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"MIRVETUXIMAB SORAVTANSINE-GYNX 5 MG/ML INTRAVENOUS SOLUTION [193628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72903-853-01","type":"NDC"}],"standard_charges":[{"gross_charge":13611.25,"discounted_cash":11433.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":62965.25,"discounted_cash":52890.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"}]},{"description":"MIRTAZAPINE 30 MG TABLET [17465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-708-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 30 MG TABLET [17465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-120-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 30 MG TABLET [17465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-356-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 30 MG TABLET [17465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-087-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 30 MG TABLET [17465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-120-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 30 MG TABLET [17465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-087-20","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 15 MG TABLET [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-707-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MISOPROSTOL 100 MCG TABLET [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-1451-34","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 100 MCG TABLET [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-4430-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-161-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5008-2","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5008-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-4431-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-1461-34","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-1461-31","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 100 MCG TABLET [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-735-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 100 MCG TABLET [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-735-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 100 MCG TABLET [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-040-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 100 MCG TABLET [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-040-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 100 MCG TABLET [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-160-12","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 100 MCG TABLET [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-160-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 100 MCG TABLET [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5007-2","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 100 MCG TABLET [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5007-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MIRTAZAPINE 15 MG TABLET [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6519-61","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRIKIZUMAB-MRKZ 100 MG/ML SUBCUTANEOUS PEN INJECTOR [197134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8011-01","type":"NDC"}],"standard_charges":[{"gross_charge":22323.25,"discounted_cash":18751.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":33484.75,"discounted_cash":28127.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR [116842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-151-06","type":"NDC"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":224.0,"discounted_cash":188.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR [116842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0469-2601-90","type":"NDC"}],"standard_charges":[{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":248.75,"discounted_cash":208.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR [116842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0469-2601-30","type":"NDC"}],"standard_charges":[{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":248.75,"discounted_cash":208.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MINOXIDIL 2.5 MG TABLET [5115]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-204-01","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MINOXIDIL 2.5 MG TABLET [5115]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-386-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MINOXIDIL 2.5 MG TABLET [5115]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-256-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MINOXIDIL 2.5 MG TABLET [5115]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5642-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MINOXIDIL 10 MG TABLET [5114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-257-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MINOXIDIL 10 MG TABLET [5114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5643-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MINOCYCLINE 50 MG CAPSULE [5111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-316-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MINOCYCLINE 50 MG CAPSULE [5111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-482-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MIRIKIZUMAB-MRKZ 100 MG/ML SUBCUTANEOUS PEN INJECTOR [197134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-8011-27","type":"NDC"}],"standard_charges":[{"gross_charge":22323.25,"discounted_cash":18751.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":33484.75,"discounted_cash":28127.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"MIRTAZAPINE 15 MG DISINTEGRATING TABLET [29531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0052-0106-30","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"MIRTAZAPINE 15 MG TABLET [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-031-34","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 15 MG TABLET [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0247-1","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 15 MG TABLET [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-355-10","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 15 MG TABLET [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-086-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-161-06","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MIRTAZAPINE 15 MG TABLET [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-086-20","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 15 MG TABLET [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7206-56","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 15 MG DISINTEGRATING TABLET [29531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-021-06","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-001-59","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-041-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MORPHINE (PF) 1 MG/2 ML INTRAVENOUS SYRINGE [169201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092-1132-43","type":"NDC"}],"standard_charges":[{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":84.25,"discounted_cash":70.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":126.5,"discounted_cash":106.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":168.5,"discounted_cash":141.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION [29464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"0409-3814-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":81.75,"discounted_cash":68.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION [29464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"0641-6020-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":189.25,"discounted_cash":158.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION [29464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"0641-6020-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":189.25,"discounted_cash":158.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION [29464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"0409-3814-12","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":81.75,"discounted_cash":68.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MORPHINE (PF) 0.01 MG/ML IV SYRING (NICU) [177078]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7054-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MORPHINE (BULK) 100 % POWDER [5184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-1521-53","type":"NDC"}],"standard_charges":[{"gross_charge":415.5,"discounted_cash":349.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"MONTELUKAST 5 MG CHEWABLE TABLET [22510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-213-90","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 5 MG CHEWABLE TABLET [22510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-728-90","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 5 MG CHEWABLE TABLET [22510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-574-15","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 5 MG CHEWABLE TABLET [22510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-574-11","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 5 MG CHEWABLE TABLET [22510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-623-30","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 5 MG CHEWABLE TABLET [22510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-594-90","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"0641-6019-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0237-49","type":"NDC"}],"standard_charges":[{"gross_charge":83.25,"discounted_cash":69.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MORPHINE 0.4 MG/ML ORAL SYRINGE FOR NICU [167662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-6159-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 MG/KG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG/KG"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.07 MG/KG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.09 MG/KG"}]},{"description":"MORPHINE 0.4 MG/ML ORAL SYRINGE FOR NICU [167662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0000-0004-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 MG/KG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG/KG"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.07 MG/KG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.09 MG/KG"}]},{"description":"MORPHINE 0.4 MG/ML ORAL SYRINGE FOR NICU [167662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-0011-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 MG/KG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG/KG"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.07 MG/KG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.09 MG/KG"}]},{"description":"MORPHINE (PF) 4 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE [133541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092-1537-43","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE (PF) 30 MG/30 ML(1 MG/ML) IN 0.9% SOD.CHLORIDE IV PCA SYRINGE [133663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-979-30","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MORPHINE (PF) 30 MG/30 ML (1 MG/ML) PCA INTRAVENOUS SOLUTION [131392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"0409-2029-02","type":"NDC"}],"standard_charges":[{"gross_charge":64.75,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MORPHINE (PF) 25 MG/ML INJECTION SOLUTION [27392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"66794-162-02","type":"NDC"}],"standard_charges":[{"gross_charge":1657.5,"discounted_cash":1392.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MORPHINE (PF) 25 MG/ML INJECTION SOLUTION [27392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"0641-6040-01","type":"NDC"}],"standard_charges":[{"gross_charge":1519.5,"discounted_cash":1276.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MORPHINE (PF) 2 MG/2 ML(1 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [133428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73177-105-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MORPHINE (PF) 2 MG/2 ML(1 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [133428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1133-43","type":"NDC"}],"standard_charges":[{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MORPHINE (PF) 10 MG/ML INJECTION SOLUTION [77009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"0641-6039-01","type":"NDC"}],"standard_charges":[{"gross_charge":893.75,"discounted_cash":750.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"0641-6019-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MONTELUKAST 5 MG CHEWABLE TABLET [22510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-594-30","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MODAFINIL 200 MG TABLET [24703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-605-03","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":186.5,"discounted_cash":156.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MODAFINIL 200 MG TABLET [24703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-602-30","type":"NDC"}],"standard_charges":[{"gross_charge":113.75,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":222.5,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MODAFINIL 200 MG TABLET [24703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3500-30","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":186.5,"discounted_cash":156.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MODAFINIL 200 MG TABLET [24703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55253-802-30","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":186.5,"discounted_cash":156.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MODAFINIL 100 MG TABLET [24702]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-385-30","type":"NDC"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":303.0,"discounted_cash":254.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MODAFINIL 100 MG TABLET [24702]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2526-3","type":"NDC"}],"standard_charges":[{"gross_charge":148.5,"discounted_cash":124.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":292.0,"discounted_cash":245.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MODAFINIL 100 MG TABLET [24702]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55253-801-30","type":"NDC"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":303.0,"discounted_cash":254.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MITOMYCIN 40 MG FOR CUSTOM VOLUME SOLUTION [173366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"16729-116-38","type":"NDC"}],"standard_charges":[{"gross_charge":4303.75,"discounted_cash":3615.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":4303.75,"discounted_cash":3615.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MITOMYCIN 5 MG INTRAVENOUS SOLUTION [10632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"71288-137-20","type":"NDC"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":619.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MITOMYCIN 5 MG INTRAVENOUS SOLUTION [10632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"65219-564-20","type":"NDC"}],"standard_charges":[{"gross_charge":1042.25,"discounted_cash":875.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MITOMYCIN 40 MG INTRAVENOUS SOLUTION [10631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"55390-253-01","type":"NDC"}],"standard_charges":[{"gross_charge":892.5,"discounted_cash":749.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MISOPROSTOL 25 MCG SPLIT TABS [400620]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7167-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-746-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-746-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 200 MCG TABLET [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-041-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MOGAMULIZUMAB-KPKC 4 MG/ML INTRAVENOUS SOLUTION [179634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9204","type":"HCPCS"},{"code":"42747-761-01","type":"NDC"}],"standard_charges":[{"gross_charge":37089.25,"discounted_cash":31154.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":9621.25,"discounted_cash":8081.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MONTELUKAST 5 MG CHEWABLE TABLET [22510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5555-92","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 5 MG CHEWABLE TABLET [22510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5555-31","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 4 MG CHEWABLE TABLET [27234]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-212-90","type":"NDC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":42.5,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 4 MG CHEWABLE TABLET [27234]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-573-15","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 4 MG CHEWABLE TABLET [27234]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-573-11","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 4 MG CHEWABLE TABLET [27234]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-622-90","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST 4 MG CHEWABLE TABLET [27234]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5554-92","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER [105699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0085-4610-05","type":"NDC"}],"standard_charges":[{"gross_charge":905.5,"discounted_cash":760.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 G"}]},{"description":"MOMETASONE-FORMOTEROL HFA 100 MCG-5 MCG/ACTUATION AEROSOL INHALER [105698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0085-7206-07","type":"NDC"}],"standard_charges":[{"gross_charge":905.5,"discounted_cash":760.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 G"}]},{"description":"MOMETASONE 50 MCG/ACTUATION NASAL SPRAY [21905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-891-29","type":"NDC"}],"standard_charges":[{"gross_charge":955.75,"discounted_cash":802.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 G"}]},{"description":"MOMETASONE 50 MCG/ACTUATION NASAL SPRAY [21905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0085-1288-01","type":"NDC"}],"standard_charges":[{"gross_charge":1080.25,"discounted_cash":907.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 G"}]},{"description":"MOMETASONE 220 MCG/ACTUATION(60 DOSES) BREATH ACTIVATED POWDER INHALER [129828]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78206-114-02","type":"NDC"}],"standard_charges":[{"gross_charge":580.25,"discounted_cash":487.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MOMETASONE 220 MCG/ACTUATION(14 DOSES) BREATH ACTIVATED POWDER INHALER [41828]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78206-114-03","type":"NDC"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":212.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MOMETASONE 220 MCG/ACTUATION(14 DOSES) BREATH ACTIVATED POWDER INHALER [41828]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0085-1341-06","type":"NDC"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":305.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MOMETASONE 0.1 % TOPICAL CREAM [10646]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0634-15","type":"NDC"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":165.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"0781-2067-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"43598-528-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":110.25,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"0517-1133-05","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":87.25,"discounted_cash":73.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":130.75,"discounted_cash":109.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":174.25,"discounted_cash":146.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"0517-1133-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":87.25,"discounted_cash":73.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":130.75,"discounted_cash":109.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":174.25,"discounted_cash":146.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"0548-9601-00","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":110.25,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"63323-413-36","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":130.75,"discounted_cash":109.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"0641-6150-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"0641-6150-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"43598-528-36","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":110.25,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"76014-003-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"25021-610-10","type":"NDC"}],"standard_charges":[{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":158.0,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":236.75,"discounted_cash":198.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":315.75,"discounted_cash":265.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70594-069-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70594-069-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70069-805-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70069-805-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOMYCIN 500 MG TABLET [5472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39822-0310-5","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NEOMYCIN 500 MG TABLET [5472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1177-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-631-36","type":"NDC"}],"standard_charges":[{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-795-35","type":"NDC"}],"standard_charges":[{"gross_charge":134.25,"discounted_cash":112.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-790-62","type":"NDC"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":211.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NELFINAVIR 250 MG TABLET [20032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63010-010-30","type":"NDC"}],"standard_charges":[{"gross_charge":98.5,"discounted_cash":82.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NEFAZODONE 150 MG TABLET [13445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7113-06","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NEFAZODONE 100 MG TABLET [13444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1024-06","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NEBIVOLOL 10 MG TABLET [89286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1410-30","type":"NDC"}],"standard_charges":[{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NAPROXEN 500 MG TABLET [5393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-491-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAPROXEN 500 MG TABLET [5393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-491-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAPROXEN 500 MG TABLET [5393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-268-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT [38701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-780-55","type":"NDC"}],"standard_charges":[{"gross_charge":234.25,"discounted_cash":196.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT [38701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-4250-35","type":"NDC"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0268-31","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"63323-413-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":141.25,"discounted_cash":118.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"76014-002-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INTRAVENOUS SOLUTION [122266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"76014-002-33","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-631-10","type":"NDC"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":347.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-645-11","type":"NDC"}],"standard_charges":[{"gross_charge":431.25,"discounted_cash":362.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-635-62","type":"NDC"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":347.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-630-06","type":"NDC"}],"standard_charges":[{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [130270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-143-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [130270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-143-14","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [130270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-143-00","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [130270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-8805-67","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [130270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6680-67","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [130270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-143-70","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-0013-1","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093983744","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-143-03","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-143-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 G"}]},{"description":"NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-646-10","type":"NDC"}],"standard_charges":[{"gross_charge":431.25,"discounted_cash":362.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"63323-415-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"01500-0586-29","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4898500155","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-5894-88","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7090-0","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7063-0","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"01500-0586-31","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1108-88","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4898500154","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-448-74","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-448-70","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-5896-88","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0135-0194-02","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"}]},{"description":"NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7089-0","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"}]},{"description":"NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7062-0","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"}]},{"description":"NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-447-71","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"}]},{"description":"NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"00015-0586-30","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"}]},{"description":"NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1107-88","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"}]},{"description":"NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4898500150","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"}]},{"description":"NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-447-74","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"}]},{"description":"NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-5895-88","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"}]},{"description":"NICOTINE (POLACRILEX) 2 MG GUM [10717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1362-23","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NICOTINE (POLACRILEX) 2 MG GUM [10717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-573-08","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN [94576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43066-016-10","type":"NDC"}],"standard_charges":[{"gross_charge":448.75,"discounted_cash":376.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN [94576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9633-10","type":"NDC"}],"standard_charges":[{"gross_charge":856.5,"discounted_cash":719.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-446-71","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [28643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60429-047-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [28643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71205-963-00","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [28643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-597-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [28643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [28643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-597-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [28643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-597-15","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [28643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-260-37","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIFEDIPINE 10 MG CAPSULE [5558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-211-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"NIFEDIPINE 10 MG CAPSULE [5558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-022-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"NIFEDIPINE 10 MG CAPSULE [5558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-022-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"NIFEDIPINE 10 MG CAPSULE [5558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-194-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"NIFEDIPINE 10 MG CAPSULE [5558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-1004-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"NIFEDIPINE 10 MG CAPSULE [5558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-440-24","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"NIFEDIPINE 10 MG CAPSULE [5558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2497-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7088-0","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7061-0","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN [94576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9633-01","type":"NDC"}],"standard_charges":[{"gross_charge":856.5,"discounted_cash":719.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN [94576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10122-325-10","type":"NDC"}],"standard_charges":[{"gross_charge":927.75,"discounted_cash":779.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN [94576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10122-325-01","type":"NDC"}],"standard_charges":[{"gross_charge":927.75,"discounted_cash":779.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"},{"gross_charge":873.75,"discounted_cash":733.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"NIACIN ER 1,000 MG TABLET,EXTENDED RELEASE 24 HR [27183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-586-11","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NIACIN ER 1,000 MG TABLET,EXTENDED RELEASE 24 HR [27183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-020-90","type":"NDC"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NIACIN ER 1,000 MG TABLET,EXTENDED RELEASE 24 HR [27183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-323-09","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":46.75,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NIACIN ER 1,000 MG TABLET,EXTENDED RELEASE [5543]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536703801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NIACIN 500 MG TABLET [5542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904227260","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NIACIN 100 MG TABLET [5539]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068105700","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NIACIN 100 MG TABLET [5539]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026858215","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NIACIN 100 MG TABLET [5539]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026858211","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION [24119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-6186-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION [24119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-057-24","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION [24119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0047-24","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"NEVIRAPINE 200 MG TABLET [17403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-331-06","type":"NDC"}],"standard_charges":[{"gross_charge":73.25,"discounted_cash":61.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"NIACIN ER 1,000 MG TABLET,EXTENDED RELEASE 24 HR [27183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-586-13","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NICARDIPINE 30 MG CAPSULE [10713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-121-90","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":200.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"NICARDIPINE 30 MG CAPSULE [10713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1430-77","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION [12370]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9542-10","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION [12370]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9689-10","type":"NDC"}],"standard_charges":[{"gross_charge":166.75,"discounted_cash":140.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-018-90","type":"NDC"}],"standard_charges":[{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-321-09","type":"NDC"}],"standard_charges":[{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":53.0,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [27181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-539-81","type":"NDC"}],"standard_charges":[{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NIACIN ER 250 MG CAPSULE,EXTENDED RELEASE [5536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1000670020","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NIACIN ER 250 MG CAPSULE,EXTENDED RELEASE [5536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7431205800","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NAPROXEN 500 MG TABLET [5393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-403-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NADOLOL 20 MG TABLET [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-812-20","type":"NDC"}],"standard_charges":[{"gross_charge":255.75,"discounted_cash":214.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":339.5,"discounted_cash":285.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":172.25,"discounted_cash":144.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NADOLOL 20 MG TABLET [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-812-01","type":"NDC"}],"standard_charges":[{"gross_charge":255.75,"discounted_cash":214.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":339.5,"discounted_cash":285.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":172.25,"discounted_cash":144.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NADOLOL 20 MG TABLET [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0028-01","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":188.5,"discounted_cash":158.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NABUMETONE 750 MG TABLET [10677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-359-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NABUMETONE 750 MG TABLET [10677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0146-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NABUMETONE 500 MG TABLET [10676]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1657-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NABUMETONE 500 MG TABLET [10676]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3670-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NABUMETONE 500 MG TABLET [10676]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-358-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NABUMETONE 500 MG TABLET [10676]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0145-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [166697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90621","type":"HCPCS"},{"code":"0005-0100-10","type":"NDC"}],"standard_charges":[{"gross_charge":890.25,"discounted_cash":747.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-123-15","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-140-10","type":"NDC"}],"standard_charges":[{"gross_charge":146.75,"discounted_cash":123.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-328-20","type":"NDC"}],"standard_charges":[{"gross_charge":188.25,"discounted_cash":158.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3125-95","type":"NDC"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-222-10","type":"NDC"}],"standard_charges":[{"gross_charge":143.5,"discounted_cash":120.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":143.5,"discounted_cash":120.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2290","type":"HCPCS"},{"code":"55150-122-15","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":176.5,"discounted_cash":148.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1800 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":189.0,"discounted_cash":158.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG/KG"}]},{"description":"NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2290","type":"HCPCS"},{"code":"25021-139-10","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2290","type":"HCPCS"},{"code":"63323-327-10","type":"NDC"}],"standard_charges":[{"gross_charge":120.75,"discounted_cash":101.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2290","type":"HCPCS"},{"code":"0781-3124-95","type":"NDC"}],"standard_charges":[{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NADOLOL 20 MG TABLET [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-347-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NADOLOL 20 MG TABLET [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-686-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NADOLOL 20 MG TABLET [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-133-01","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":188.25,"discounted_cash":158.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [166697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90621","type":"HCPCS"},{"code":"0005-0100-01","type":"NDC"}],"standard_charges":[{"gross_charge":890.25,"discounted_cash":747.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE [38063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7518","type":"HCPCS"},{"code":"70377-040-11","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":61.75,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":123.5,"discounted_cash":103.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"16729-019-01","type":"NDC"}],"standard_charges":[{"gross_charge":106.25,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"0781-5175-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"0054-0166-25","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"0004-0260-01","type":"NDC"}],"standard_charges":[{"gross_charge":291.75,"discounted_cash":245.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"60687-494-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"60687-494-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"67877-266-01","type":"NDC"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"51079-721-20","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"16729-094-01","type":"NDC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.0,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"51079-379-20","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"67877-225-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.5,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE [38063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7518","type":"HCPCS"},{"code":"68084-918-25","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7518","type":"HCPCS"},{"code":"67877-426-12","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7518","type":"HCPCS"},{"code":"68084-907-21","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7518","type":"HCPCS"},{"code":"68084-907-11","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7518","type":"HCPCS"},{"code":"51079-508-20","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7518","type":"HCPCS"},{"code":"51079-508-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7518","type":"HCPCS"},{"code":"0378-4201-78","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7518","type":"HCPCS"},{"code":"0078-0385-66","type":"NDC"}],"standard_charges":[{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":126.0,"discounted_cash":105.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":246.75,"discounted_cash":207.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"64380-725-06","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-328-22","type":"NDC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-117-26","type":"NDC"}],"standard_charges":[{"gross_charge":141.5,"discounted_cash":118.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-328-21","type":"NDC"}],"standard_charges":[{"gross_charge":188.25,"discounted_cash":158.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE [5374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"55150-345-10","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":103.0,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":205.75,"discounted_cash":172.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE [5374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"55150-345-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":103.0,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":205.75,"discounted_cash":172.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE [5374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"43598-750-58","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":204.75,"discounted_cash":171.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE [5374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"43598-750-11","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":204.75,"discounted_cash":171.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE [5374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"76329-3469-1","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE [5374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"76329-1469-1","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE [5374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"76329-3369-1","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":215.5,"discounted_cash":181.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"0409-1219-41","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":146.5,"discounted_cash":123.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":293.0,"discounted_cash":246.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"0409-1215-21","type":"NDC"}],"standard_charges":[{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":320.75,"discounted_cash":269.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":641.25,"discounted_cash":538.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"55150-327-10","type":"NDC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":504.75,"discounted_cash":423.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":504.75,"discounted_cash":423.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MCG/ML"}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE [5374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"42023-224-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 4 MG/ACTUATION NASAL SPRAY [168959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69547-353-02","type":"NDC"}],"standard_charges":[{"gross_charge":307.5,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"NAPROXEN 500 MG TABLET [5393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-190-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAPROXEN 500 MG TABLET [5393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-190-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAPROXEN 375 MG TABLET [5392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-189-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAPROXEN 250 MG TABLET [5391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-853-07","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAPROXEN 250 MG TABLET [5391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-594-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAPROXEN 250 MG TABLET [5391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-594-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAPROXEN 250 MG TABLET [5391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-188-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAPHAZOLINE 0.025 %-PHENIRAMINE 0.3 % EYE DROPS [5384]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0085-15","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NALTREXONE 50 MG TABLET [10685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-1170-03","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NALTREXONE 50 MG TABLET [10685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-1170-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NALOXONE 4 MG/ACTUATION NASAL SPRAY [168959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69547-627-02","type":"NDC"}],"standard_charges":[{"gross_charge":146.75,"discounted_cash":123.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"55150-327-01","type":"NDC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":504.75,"discounted_cash":423.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"0409-1219-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":146.5,"discounted_cash":123.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":293.0,"discounted_cash":246.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"0409-1215-01","type":"NDC"}],"standard_charges":[{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":320.75,"discounted_cash":269.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":641.25,"discounted_cash":538.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXEGOL 25 MG TABLET [165681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57841-1301-3","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"NALDEMEDINE 0.2 MG TABLET [177100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59385-041-30","type":"NDC"}],"standard_charges":[{"gross_charge":131.5,"discounted_cash":110.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"0409-1467-61","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"0409-1465-71","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"7700-6048-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"0409-1467-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"0409-1465-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"0409-1464-61","type":"NDC"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":267.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"0409-1463-71","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"0409-1464-01","type":"NDC"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":267.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"0409-1463-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-117-41","type":"NDC"}],"standard_charges":[{"gross_charge":141.5,"discounted_cash":118.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"67457-292-00","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":400.5,"discounted_cash":336.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":800.75,"discounted_cash":672.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"70069-071-10","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":422.0,"discounted_cash":354.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"70069-071-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":422.0,"discounted_cash":354.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"17478-041-01","type":"NDC"}],"standard_charges":[{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":320.75,"discounted_cash":269.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":641.25,"discounted_cash":538.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"67457-299-10","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":146.5,"discounted_cash":123.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":293.0,"discounted_cash":246.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"67457-299-00","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":146.5,"discounted_cash":123.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":293.0,"discounted_cash":246.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"0641-6132-25","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":243.0,"discounted_cash":204.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"0641-6132-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":243.0,"discounted_cash":204.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"67457-599-02","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":400.5,"discounted_cash":336.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":800.75,"discounted_cash":672.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"67457-599-00","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":400.5,"discounted_cash":336.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":800.75,"discounted_cash":672.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"67457-292-02","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":400.5,"discounted_cash":336.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":800.75,"discounted_cash":672.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"PRASUGREL HCL 10 MG TABLET [98373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-5123-30","type":"NDC"}],"standard_charges":[{"gross_charge":124.25,"discounted_cash":104.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRASUGREL HCL 10 MG TABLET [98373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-5123-01","type":"NDC"}],"standard_charges":[{"gross_charge":124.25,"discounted_cash":104.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAMIPEXOLE 1.5 MG TABLET [21289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-185-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 1.5 MG TABLET [21289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-035-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 1.5 MG TABLET [21289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-334-90","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 1.5 MG TABLET [21289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0191-90","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 1.5 MG TABLET [21289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0191-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 1 MG TABLET [21288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-034-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRASUGREL HCL 10 MG TABLET [98373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-5123-77","type":"NDC"}],"standard_charges":[{"gross_charge":124.25,"discounted_cash":104.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRASUGREL HCL 10 MG TABLET [98373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4643-3","type":"NDC"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAVASTATIN 20 MG TABLET [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7201-98","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 10 MG TABLET [11110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5891-61","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":78.25,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":156.5,"discounted_cash":131.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 10 MG TABLET [11110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-195-90","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":173.75,"discounted_cash":145.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 10 MG TABLET [11110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0168-9","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":173.75,"discounted_cash":145.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 10 MG TABLET [11110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0168-5","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":173.75,"discounted_cash":145.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 10 MG TABLET [11110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0771-98","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":173.75,"discounted_cash":145.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRASUGREL HCL 10 MG TABLET [98373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-273-10","type":"NDC"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRASUGREL HCL 10 MG TABLET [98373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-830-30","type":"NDC"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET [21290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-032-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET [21290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-331-90","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":135.5,"discounted_cash":113.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET [21290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-092-90","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":119.25,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET [21290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0184-90","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":227.75,"discounted_cash":191.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":341.5,"discounted_cash":286.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET [21290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0184-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":49.25,"discounted_cash":41.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":98.5,"discounted_cash":82.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":197.0,"discounted_cash":165.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":295.5,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 0.125 MG TABLET [21287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-180-90","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":159.5,"discounted_cash":133.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 0.125 MG TABLET [21287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-031-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":166.75,"discounted_cash":140.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 1 MG TABLET [21288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-333-90","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 1 MG TABLET [21288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-094-90","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 1 MG TABLET [21288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0190-90","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":85.5,"discounted_cash":71.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAVASTATIN 20 MG TABLET [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-458-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAMIPEXOLE 1 MG TABLET [21288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0190-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET [21290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6704-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET [21290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-605-90","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":135.5,"discounted_cash":113.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAZOSIN 2 MG CAPSULE [6469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4068-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 2 MG CAPSULE [6469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-631-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 2 MG CAPSULE [6469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-631-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 2 MG CAPSULE [6469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-2302-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 1 MG CAPSULE [6468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5310-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 1 MG CAPSULE [6468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4067-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 1 MG CAPSULE [6468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-630-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 1 MG CAPSULE [6468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-630-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 2 MG CAPSULE [6469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5320-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11980-180-05","type":"NDC"}],"standard_charges":[{"gross_charge":791.25,"discounted_cash":664.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11980-174-10","type":"NDC"}],"standard_charges":[{"gross_charge":1378.25,"discounted_cash":1157.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION [27038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11980-174-05","type":"NDC"}],"standard_charges":[{"gross_charge":791.25,"discounted_cash":664.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PRAZOSIN 5 MG CAPSULE [6470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-021-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 5 MG CAPSULE [6470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5350-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 5 MG CAPSULE [6470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4069-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 5 MG CAPSULE [6470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-632-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 5 MG CAPSULE [6470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-632-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 2 MG CAPSULE [6469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-667-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN 1 MG CAPSULE [6468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1101-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAVASTATIN 40 MG TABLET [11112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7202-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 20 MG TABLET [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-649-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 20 MG TABLET [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-178-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 20 MG TABLET [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-178-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 20 MG TABLET [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-009-15","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 20 MG TABLET [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5892-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 20 MG TABLET [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-196-90","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 20 MG TABLET [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-458-20","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":88.5,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 40 MG TABLET [11112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0170-9","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAZIQUANTEL 600 MG TABLET [11113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-231-83","type":"NDC"}],"standard_charges":[{"gross_charge":472.5,"discounted_cash":396.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":945.0,"discounted_cash":793.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG/KG"},{"gross_charge":1181.25,"discounted_cash":992.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG/KG"}]},{"description":"PRAZIQUANTEL 600 MG TABLET [11113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50419-747-01","type":"NDC"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":1050.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG/KG"},{"gross_charge":1312.5,"discounted_cash":1102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG/KG"}]},{"description":"PRAVASTATIN 80 MG TABLET [32128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-570-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 40 MG TABLET [11112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-190-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 40 MG TABLET [11112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-190-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 40 MG TABLET [11112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5893-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN 40 MG TABLET [11112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-782-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-119-05","type":"NDC"}],"standard_charges":[{"gross_charge":217.25,"discounted_cash":182.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PRAMIPEXOLE 0.125 MG TABLET [21287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-091-90","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":159.5,"discounted_cash":133.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ CAP OR TAB (ALL FORMULATIONS) [172649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ CAP OR TAB (ALL FORMULATIONS) [172649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-148-10","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-148-08","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7904-09","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0675-04","type":"NDC"}],"standard_charges":[{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-119-10","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7109-09","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0807-04","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-688-10","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-688-01","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7116-09","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7116-09","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0695-04","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 30 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9804]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7903-09","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L-LACTATED RINGERS-5 % DEXTROSE INTRAVENOUS [16014]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0338-0811-04","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-144-10","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-144-04","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7902-09","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7902-09","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0671-04","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE IV [9800]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7901-09","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE IV [9800]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7901-09","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE IV [9800]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0663-04","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-118-10","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7107-09","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ CAP OR TAB (ALL FORMULATIONS) [172649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-160-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE [12184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-5316-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE [12184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0275-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ CAP OR TAB (ALL FORMULATIONS) [172649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-5317-89","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ CAP OR TAB (ALL FORMULATIONS) [172649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-5317-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ CAP OR TAB (ALL FORMULATIONS) [172649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-5316-89","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ CAP OR TAB (ALL FORMULATIONS) [172649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-170-06","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ CAP OR TAB (ALL FORMULATIONS) [172649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-160-06","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ CAP OR TAB (ALL FORMULATIONS) [172649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-170-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ CAP OR TAB (ALL FORMULATIONS) [172649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-160-13","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0803-04","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [9795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7652-00","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 5 % DEXTROSE INTRAVENOUS SOLUTION [9791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7905-09","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ ORAL PACKET [6434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0360-89","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ ORAL PACKET [6434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0360-01","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ ORAL PACKET [6434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-1554-10","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ ORAL PACKET [6434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-1554-04","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-965-03","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-965-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-965-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0409-6653-18","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0409-6651-19","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":61.75,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0409-6651-06","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":61.75,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-965-20","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-965-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-965-05","type":"NDC"}],"standard_charges":[{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0338-0705-48","type":"NDC"}],"standard_charges":[{"gross_charge":87.25,"discounted_cash":73.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"7700-2278-10","type":"NDC"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0990-7075-26","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 5 % DEXTROSE INTRAVENOUS SOLUTION [9791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7905-09","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 5 % DEXTROSE INTRAVENOUS SOLUTION [9791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0683-04","type":"NDC"}],"standard_charges":[{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-686-10","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-686-01","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7115-09","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7115-09","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0691-04","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [11081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7865-00","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLN [36046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-9257-39","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLN [36046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0704-34","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81033-412-51","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81033-412-15","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-628-58","type":"NDC"}],"standard_charges":[{"gross_charge":141.25,"discounted_cash":118.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-891-52","type":"NDC"}],"standard_charges":[{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-891-16","type":"NDC"}],"standard_charges":[{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1680-50","type":"NDC"}],"standard_charges":[{"gross_charge":100.25,"discounted_cash":84.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1680-40","type":"NDC"}],"standard_charges":[{"gross_charge":102.75,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1680-15","type":"NDC"}],"standard_charges":[{"gross_charge":114.25,"discounted_cash":95.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1680-00","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":82.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-341-07","type":"NDC"}],"standard_charges":[{"gross_charge":141.25,"discounted_cash":118.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-341-71","type":"NDC"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":94.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-341-50","type":"NDC"}],"standard_charges":[{"gross_charge":141.25,"discounted_cash":118.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-341-44","type":"NDC"}],"standard_charges":[{"gross_charge":141.25,"discounted_cash":118.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-047-80","type":"NDC"}],"standard_charges":[{"gross_charge":154.25,"discounted_cash":129.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-047-30","type":"NDC"}],"standard_charges":[{"gross_charge":154.25,"discounted_cash":129.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1255-15","type":"NDC"}],"standard_charges":[{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-047-50","type":"NDC"}],"standard_charges":[{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-047-01","type":"NDC"}],"standard_charges":[{"gross_charge":154.25,"discounted_cash":129.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-1542-58","type":"NDC"}],"standard_charges":[{"gross_charge":1375.0,"discounted_cash":1155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-628-44","type":"NDC"}],"standard_charges":[{"gross_charge":141.25,"discounted_cash":118.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE [12184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-466-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35942]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-632-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [6451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-086-05","type":"NDC"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET [11087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0486-1111-05","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET [11087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0486-1111-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [6451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-056-29","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MMOL"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MMOL"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MMOL"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MMOL"},{"gross_charge":585.5,"discounted_cash":491.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM CHLORIDE IV SOLN [132764]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"15082-922-25","type":"NDC"}],"standard_charges":[{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MMOL"}]},{"description":"POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM CHLORIDE IV SOLN [132764]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-6207-25","type":"NDC"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":156.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MMOL"},{"gross_charge":317.75,"discounted_cash":266.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MMOL"}]},{"description":"POTASSIUM PHOSPHATE 10 MMOL/100 ML IN 0.9 % SODIUM CHLORIDE  FOR 20 [177067]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-5719-10","type":"NDC"}],"standard_charges":[{"gross_charge":142.75,"discounted_cash":119.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MMOL"},{"gross_charge":231.25,"discounted_cash":194.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MMOL"}]},{"description":"POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION [6445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-280-30","type":"NDC"}],"standard_charges":[{"gross_charge":1438.0,"discounted_cash":1207.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION [6445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71740-112-30","type":"NDC"}],"standard_charges":[{"gross_charge":1736.5,"discounted_cash":1458.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1948-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6025800316","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION [22646]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"121067616","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-756-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-756-09","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-973-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [6451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7295-01","type":"NDC"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [6451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"99999-0001-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.33 ML"}]},{"description":"POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [6451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7295-11","type":"NDC"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PRAMIPEXOLE 0.125 MG TABLET [21287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0183-90","type":"NDC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":227.75,"discounted_cash":191.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":455.5,"discounted_cash":382.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":683.0,"discounted_cash":573.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRALSETINIB 100 MG CAPSULE [186481]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72064-210-90","type":"NDC"}],"standard_charges":[{"gross_charge":657.5,"discounted_cash":552.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1315.0,"discounted_cash":1104.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1972.5,"discounted_cash":1656.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":2630.0,"discounted_cash":2209.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"PRALSETINIB 100 MG CAPSULE [186481]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72064-210-60","type":"NDC"}],"standard_charges":[{"gross_charge":657.5,"discounted_cash":552.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1315.0,"discounted_cash":1104.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1972.5,"discounted_cash":1656.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":2630.0,"discounted_cash":2209.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION [6462]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2730","type":"HCPCS"},{"code":"60977-141-27","type":"NDC"}],"standard_charges":[{"gross_charge":426.75,"discounted_cash":358.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION [6462]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2730","type":"HCPCS"},{"code":"60977-141-01","type":"NDC"}],"standard_charges":[{"gross_charge":426.75,"discounted_cash":358.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POVIDONE-IODINE 5 % EYE SOLUTION [19791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0411-30","type":"NDC"}],"standard_charges":[{"gross_charge":104.25,"discounted_cash":87.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"POVIDONE-IODINE 10 % TOPICAL SOLUTION [6458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52380-1905-4","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"POVIDONE-IODINE 10 % TOPICAL OINTMENT [6455]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-1102-31","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.35 G"}]},{"description":"POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET [70284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6025800615","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET [70284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6025800601","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [6451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-056-09","type":"NDC"}],"standard_charges":[{"gross_charge":585.5,"discounted_cash":491.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [6451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-052-29","type":"NDC"}],"standard_charges":[{"gross_charge":156.75,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [6451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-052-09","type":"NDC"}],"standard_charges":[{"gross_charge":156.75,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [6451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"99999-0001-15","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1069-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5720-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE [124449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-3023-13","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35942]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-5317-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35942]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-170-92","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35942]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-170-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35942]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-632-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5720-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-5325-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-5319-89","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-5319-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-472-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-360-09","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE [12184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-466-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-190-06","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-190-13","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-190-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-360-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-447-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-119-10","type":"NDC"}],"standard_charges":[{"gross_charge":434.25,"discounted_cash":364.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [6487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-637-05","type":"NDC"}],"standard_charges":[{"gross_charge":227.5,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-212-08","type":"NDC"}],"standard_charges":[{"gross_charge":502.75,"discounted_cash":422.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0526-12","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE 12.5 MG TABLET [6621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"65162-745-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 12.5 MG TABLET [6621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"57664-107-88","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 12.5 MG TABLET [6621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"10702-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 12.5 MG TABLET [6621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"68084-154-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 12.5 MG TABLET [6621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"68084-154-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 12.5 MG TABLET [6621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"68382-040-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-040-31","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"}]},{"description":"PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-5296-5","type":"NDC"}],"standard_charges":[{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"}]},{"description":"PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0536-06","type":"NDC"}],"standard_charges":[{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"}]},{"description":"PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2985-39","type":"NDC"}],"standard_charges":[{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"}]},{"description":"PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-5296-1","type":"NDC"}],"standard_charges":[{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"}]},{"description":"PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0536-12","type":"NDC"}],"standard_charges":[{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"}]},{"description":"PROGESTERONE MICRONIZED 100 MG VAGINAL INSERT [82391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55566-6500-3","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"PROGESTERONE MICRONIZED 100 MG VAGINAL INSERT [82391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55566-6500-2","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"PROGESTERONE 50 MG/ML INTRAMUSCULAR OIL [6597]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2675","type":"HCPCS"},{"code":"70700-286-22","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-759-30","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE 25 MG/ML INJECTION SOLUTION [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"0641-6208-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 25 MG/ML INJECTION SOLUTION [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"39822-5525-3","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 25 MG/ML INJECTION SOLUTION [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"39822-5525-2","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 25 MG/ML INJECTION SOLUTION [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"0641-6084-25","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 25 MG/ML INJECTION SOLUTION [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"0641-6084-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 25 MG/ML INJECTION SOLUTION [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"0641-0928-21","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 25 MG/ML INJECTION SOLUTION [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"0641-0928-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-5297-4","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0526-06","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2992-39","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-5297-1","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-759-00","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROGESTERONE 50 MG/ML INTRAMUSCULAR OIL [6597]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2675","type":"HCPCS"},{"code":"0143-9725-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0164","type":"HCPCS"},{"code":"50268-684-15","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCAINAMIDE 100 MG/ML INJECTION SOLUTION [6562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"14789-901-07","type":"NDC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":183.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"PROCAINAMIDE 100 MG/ML INJECTION SOLUTION [6562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"0409-1902-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"PROBENECID 500 MG TABLET [6561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1367-10","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PROBENECID 500 MG TABLET [6561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5347-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PRIMIDONE 50 MG TABLET [11129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-544-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMIDONE 50 MG TABLET [11129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-686-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMIDONE 50 MG TABLET [11129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-686-15","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMIDONE 50 MG TABLET [11129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-544-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMIDONE 50 MG TABLET [11129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-202-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMIDONE 50 MG TABLET [11129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1301-05","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMIDONE 50 MG TABLET [11129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1301-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMIDONE 250 MG TABLET [6544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-545-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROCAINAMIDE 100 MG/ML INJECTION SOLUTION [6562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"14789-901-10","type":"NDC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":183.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"PROCAINAMIDE 100 MG/ML INJECTION SOLUTION [6562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"0409-1902-11","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7226-12","type":"NDC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0135-12","type":"NDC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0164","type":"HCPCS"},{"code":"50268-684-11","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0164","type":"HCPCS"},{"code":"59746-113-06","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0164","type":"HCPCS"},{"code":"59746-115-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0164","type":"HCPCS"},{"code":"51079-542-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0164","type":"HCPCS"},{"code":"51079-542-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0164","type":"HCPCS"},{"code":"0378-5110-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"43066-090-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROMETHAZINE 25 MG/ML INJECTION SOLUTION [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"0641-6208-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"67457-640-02","type":"NDC"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"67457-640-00","type":"NDC"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"70860-778-41","type":"NDC"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"70860-778-02","type":"NDC"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"0641-6135-25","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"0641-6135-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155-294-41","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155-523-41","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155-523-31","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155-294-31","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155-294-42","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"55390-077-10","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0135-06","type":"NDC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [6580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"43066-090-25","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROMETHAZINE 6.25 MG-CODEINE 10 MG/5 ML SYRUP [6627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-804-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"80830-2365-1","type":"NDC"}],"standard_charges":[{"gross_charge":129.75,"discounted_cash":108.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-269-22","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"16714-977-20","type":"NDC"}],"standard_charges":[{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"16714-977-01","type":"NDC"}],"standard_charges":[{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155-345-44","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-345-43","type":"NDC"}],"standard_charges":[{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-345-33","type":"NDC"}],"standard_charges":[{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155-345-31","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-0248-10","type":"NDC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-0248-01","type":"NDC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0069-0234-20","type":"NDC"}],"standard_charges":[{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0069-0234-01","type":"NDC"}],"standard_charges":[{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0069-0209-10","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0069-0209-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0641-6194-10","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0641-6194-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6196-01","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6196-10","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4699-54","type":"NDC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0409-4699-53","type":"NDC"}],"standard_charges":[{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0591-2136-68","type":"NDC"}],"standard_charges":[{"gross_charge":186.25,"discounted_cash":156.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0591-2136-57","type":"NDC"}],"standard_charges":[{"gross_charge":186.25,"discounted_cash":156.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0591-2136-55","type":"NDC"}],"standard_charges":[{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0591-2136-51","type":"NDC"}],"standard_charges":[{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-608-51","type":"NDC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":160.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"25021-608-50","type":"NDC"}],"standard_charges":[{"gross_charge":118.5,"discounted_cash":99.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"25021-608-20","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-269-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-269-69","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"80830-2365-7","type":"NDC"}],"standard_charges":[{"gross_charge":129.75,"discounted_cash":108.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-269-59","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION [29335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1800","type":"HCPCS"},{"code":"63323-604-01","type":"NDC"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION [29335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1800","type":"HCPCS"},{"code":"63323-604-00","type":"NDC"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROPRANOLOL 10 MG TABLET [6656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69292-530-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 10 MG TABLET [6656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6550-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 10 MG TABLET [6656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5482-21","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 10 MG TABLET [6656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5554-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 10 MG TABLET [6656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0182-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION [29335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1800","type":"HCPCS"},{"code":"0143-9872-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-269-94","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-269-29","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-270-50","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPAFENONE 150 MG TABLET [11146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-361-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE 150 MG TABLET [11146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-361-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE 150 MG TABLET [11146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5448-25","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE 150 MG TABLET [11146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5448-21","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE 150 MG TABLET [11146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-551-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE 150 MG TABLET [11146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0582-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROMETHAZINE-DM 6.25 MG-15 MG/5 ML ORAL SYRUP [11145]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64679-604-16","type":"NDC"}],"standard_charges":[{"gross_charge":236.75,"discounted_cash":198.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PROMETHAZINE-DM 6.25 MG-15 MG/5 ML ORAL SYRUP [11145]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4455-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROMETHAZINE-DM 6.25 MG-15 MG/5 ML ORAL SYRUP [11145]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-604-16","type":"NDC"}],"standard_charges":[{"gross_charge":236.75,"discounted_cash":198.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP [6620]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"64679-608-16","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":209.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP [6620]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"7700-5352-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP [6620]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"50383-801-16","type":"NDC"}],"standard_charges":[{"gross_charge":150.25,"discounted_cash":126.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP [6620]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"60432-608-16","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":209.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PROMETHAZINE 6.25 MG-CODEINE 10 MG/5 ML SYRUP [6627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-065-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROMETHAZINE 6.25 MG-CODEINE 10 MG/5 ML SYRUP [6627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70408-185-34","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROMETHAZINE 6.25 MG-CODEINE 10 MG/5 ML SYRUP [6627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2064-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROPAFENONE 150 MG TABLET [11146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-230-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-269-67","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-269-65","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-269-50","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0409-4699-33","type":"NDC"}],"standard_charges":[{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [11150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4699-24","type":"NDC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPARACAINE 0.5 % EYE DROPS [6644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-016-01","type":"NDC"}],"standard_charges":[{"gross_charge":238.75,"discounted_cash":200.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PROPARACAINE 0.5 % EYE DROPS [6644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-730-06","type":"NDC"}],"standard_charges":[{"gross_charge":229.25,"discounted_cash":192.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PROPARACAINE 0.5 % EYE DROPS [6644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-263-12","type":"NDC"}],"standard_charges":[{"gross_charge":238.75,"discounted_cash":200.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PROPAFENONE 225 MG TABLET [11147]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-164-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE 225 MG TABLET [11147]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-231-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE 225 MG TABLET [11147]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5449-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE 225 MG TABLET [11147]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5449-21","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE 225 MG TABLET [11147]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-552-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE 225 MG TABLET [11147]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0583-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PRIMIDONE 250 MG TABLET [6544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-687-15","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PREDNISONE 20 MG TABLET [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687-145-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 20 MG TABLET [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746-175-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 20 MG TABLET [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-0018-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 20 MG TABLET [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-0018-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 20 MG TABLET [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0603-5339-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 20 MG TABLET [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0591-5443-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG TABLET [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687-134-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 20 MG TABLET [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687-145-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 5 MG TABLET [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687-122-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 5 MG TABLET [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"63739-518-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 5 MG TABLET [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746-172-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 5 MG TABLET [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0603-5337-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 5 MG TABLET [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-8724-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 20 MG TABLET [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0904-7127-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG TABLET [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0603-5338-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG TABLET [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"64380-782-06","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG TABLET [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746-171-06","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG TABLET [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0603-5335-21","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG TABLET [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-8739-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG TABLET [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-4741-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4452-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0759-08","type":"NDC"}],"standard_charges":[{"gross_charge":499.5,"discounted_cash":419.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"PREDNISONE 10 MG TABLET [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-0017-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG TABLET [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687-134-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG TABLET [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"63739-519-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG TABLET [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746-173-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG TABLET [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-0017-29","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG TABLET [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-0017-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 5 MG/5 ML ORAL SOLUTION [6492]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0054-3722-50","type":"NDC"}],"standard_charges":[{"gross_charge":394.75,"discounted_cash":331.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"PREGABALIN 75 MG CAPSULE [42164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-013-90","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 75 MG CAPSULE [42164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-352-90","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 75 MG CAPSULE [42164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-1014-41","type":"NDC"}],"standard_charges":[{"gross_charge":120.5,"discounted_cash":101.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":90.25,"discounted_cash":75.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 75 MG CAPSULE [42164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-1014-68","type":"NDC"}],"standard_charges":[{"gross_charge":109.5,"discounted_cash":91.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 50 MG CAPSULE [42163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6992-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 50 MG CAPSULE [42163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-569-90","type":"NDC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 50 MG CAPSULE [42163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-012-90","type":"NDC"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":85.5,"discounted_cash":71.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 50 MG CAPSULE [42163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-411-09","type":"NDC"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":85.5,"discounted_cash":71.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 75 MG CAPSULE [42164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-570-90","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PRIMIDONE 250 MG TABLET [6544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-545-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMIDONE 250 MG TABLET [6544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66490-691-10","type":"NDC"}],"standard_charges":[{"gross_charge":134.75,"discounted_cash":113.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":337.0,"discounted_cash":283.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMIDONE 250 MG TABLET [6544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5321-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMAQUINE 26.3 MG (15 MG BASE) TABLET [6541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60429-035-14","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PRIMAQUINE 26.3 MG (15 MG BASE) TABLET [6541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PRIMAQUINE 26.3 MG (15 MG BASE) TABLET [6541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-1596-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PRENATAL VITS NO.126-FERROUS FUM 28 MG IRON-FOLIC ACID 800 MCG TABLET [168783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536406301","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PRENATAL VITAMIN WRAPPER [171574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4229168601","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PRENATAL VITAMIN WRAPPER [171574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5199115501","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PRENATAL VITAMIN WITH CALCIUM NO.72-IRON 27 MG-FOLIC ACID 1 MG TABLET [132451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4494610451","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PREGABALIN 75 MG CAPSULE [42164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7000-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 75 MG CAPSULE [42164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-495-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 75 MG CAPSULE [42164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-495-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PRENATAL VITAMIN WRAPPER [171574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904531360","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9799]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-142-10","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"PREGABALIN 50 MG CAPSULE [42163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-351-90","type":"NDC"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":85.5,"discounted_cash":71.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 25 MG CAPSULE [42162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-350-90","type":"NDC"}],"standard_charges":[{"gross_charge":227.75,"discounted_cash":191.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":455.5,"discounted_cash":382.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 25 MG CAPSULE [42162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-1012-68","type":"NDC"}],"standard_charges":[{"gross_charge":328.25,"discounted_cash":275.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":656.25,"discounted_cash":551.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":246.25,"discounted_cash":206.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 225 MG CAPSULE [42168]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-1019-68","type":"NDC"}],"standard_charges":[{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":78.0,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":114.5,"discounted_cash":96.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PREGABALIN 200 MG CAPSULE [42167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-1017-68","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PREGABALIN 150 MG CAPSULE [42166]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-1016-68","type":"NDC"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":114.5,"discounted_cash":96.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PREGABALIN 100 MG CAPSULE [42165]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-1015-68","type":"NDC"}],"standard_charges":[{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":123.25,"discounted_cash":103.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":184.75,"discounted_cash":155.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":246.25,"discounted_cash":206.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PREDNISONE 5 MG/5 ML ORAL SOLUTION [6492]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"7700-2063-05","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PREDNISONE 5 MG/5 ML ORAL SOLUTION [6492]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0054-3722-63","type":"NDC"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":1118.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"PREGABALIN 25 MG CAPSULE [42162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-119-90","type":"NDC"}],"standard_charges":[{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":316.25,"discounted_cash":265.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":79.25,"discounted_cash":66.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":118.75,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 50 MG CAPSULE [42163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-1013-41","type":"NDC"}],"standard_charges":[{"gross_charge":180.5,"discounted_cash":151.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":90.25,"discounted_cash":75.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":135.5,"discounted_cash":113.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 50 MG CAPSULE [42163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-1013-68","type":"NDC"}],"standard_charges":[{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":123.25,"discounted_cash":103.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 300 MG CAPSULE [42169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-1018-68","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PREGABALIN 25 MG CAPSULE [42162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-568-90","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 25 MG CAPSULE [42162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-011-90","type":"NDC"}],"standard_charges":[{"gross_charge":227.75,"discounted_cash":191.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":455.5,"discounted_cash":382.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [9799]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-142-02","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/50 ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11075]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0409-7075-14","type":"NDC"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789-109-16","type":"NDC"}],"standard_charges":[{"gross_charge":315.25,"discounted_cash":264.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"PAROXETINE 10 MG TABLET [16632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5676-61","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":76.25,"discounted_cash":64.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PARICALCITOL 5 MCG/ML SOLUTION WRAPPER [22960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2501","type":"HCPCS"},{"code":"67457-380-25","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 MCG/KG"},{"gross_charge":131.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MCG/KG"}]},{"description":"PARICALCITOL 5 MCG/ML SOLUTION WRAPPER [22960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2501","type":"HCPCS"},{"code":"67457-380-12","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 MCG/KG"},{"gross_charge":131.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MCG/KG"}]},{"description":"PARICALCITOL 5 MCG/ML SOLUTION WRAPPER [22960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2501","type":"HCPCS"},{"code":"0143-9624-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 MCG/KG"},{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MCG/KG"},{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PARICALCITOL 5 MCG/ML SOLUTION WRAPPER [22960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2501","type":"HCPCS"},{"code":"16729-311-63","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 MCG/KG"},{"gross_charge":131.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MCG/KG"},{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PARICALCITOL 5 MCG/ML SOLUTION WRAPPER [22960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2501","type":"HCPCS"},{"code":"16729-311-08","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 MCG/KG"},{"gross_charge":131.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MCG/KG"},{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PARICALCITOL 5 MCG/ML SOLUTION WRAPPER [22960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2501","type":"HCPCS"},{"code":"0074-1658-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 MCG/KG"},{"gross_charge":189.5,"discounted_cash":159.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MCG/KG"}]},{"description":"PARENTERAL AMINO ACID 15 % COMBINATION NO.6 INTRAVENOUS SOLUTION [182074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-4500-00","type":"NDC"}],"standard_charges":[{"gross_charge":403.75,"discounted_cash":339.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION [180021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0502-06","type":"NDC"}],"standard_charges":[{"gross_charge":791.75,"discounted_cash":665.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"PARENTERAL AMINO ACID 15 % COMBINATION NO.1 INTRAVENOUS WRAPPER [189751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-3200-55","type":"NDC"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":311.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"PARENTERAL AMINO ACID 15 % COMBINATION NO.1 INTRAVENOUS WRAPPER [189751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0502-03","type":"NDC"}],"standard_charges":[{"gross_charge":404.5,"discounted_cash":339.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 G"},{"gross_charge":633.5,"discounted_cash":532.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"},{"gross_charge":535.25,"discounted_cash":449.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"PARENTERAL AMINO ACID 10 % COMBINATION NO.1 INTRAVENOUS SOLUTION [131178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-4164-05","type":"NDC"}],"standard_charges":[{"gross_charge":304.75,"discounted_cash":255.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"PARABEN-CETYL ALCOHOL-STEARYL ALCOHOL-PROPY GLYCOL-SLS TOPICAL CLEANER [128904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"299392108","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"0517-4002-01","type":"NDC"}],"standard_charges":[{"gross_charge":270.5,"discounted_cash":227.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"14789-121-07","type":"NDC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"14789-121-05","type":"NDC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"0517-4002-25","type":"NDC"}],"standard_charges":[{"gross_charge":270.5,"discounted_cash":227.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PAROXETINE 10 MG TABLET [16632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-044-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4587-05","type":"NDC"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":109.25,"discounted_cash":91.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":163.75,"discounted_cash":137.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"PAROXETINE 10 MG/5 ML ORAL SUSPENSION [22959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0402-5","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":64.75,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"PAROXETINE 10 MG TABLET [16632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-347-09","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 10 MG TABLET [16632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-154-30","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 10 MG TABLET [16632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-7001-93","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 10 MG TABLET [16632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-154-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 10 MG TABLET [16632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-097-16","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.0,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 10 MG TABLET [16632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-044-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":72.25,"discounted_cash":60.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3232-95","type":"NDC"}],"standard_charges":[{"gross_charge":6619.75,"discounted_cash":5560.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG/ML"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION *FOR MIXTURES* [178576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0008-4001-25","type":"NDC"}],"standard_charges":[{"gross_charge":6583.0,"discounted_cash":5529.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG/ML"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0012-98","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0008-0841-81","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":117.5,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION *FOR MIXTURES* [178576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"0008-4001-25","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION *FOR MIXTURES* [178576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"0008-4001-10","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION *FOR MIXTURES* [178576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"0008-4001-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION *FOR MIXTURES* [178576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"0008-0923-60","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION *FOR MIXTURES* [178576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"0008-0923-55","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION *FOR MIXTURES* [178576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"0008-0923-51","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"71288-600-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"71288-600-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"72603-128-10","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"72603-128-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"67850-150-25","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"67850-150-00","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"65219-433-15","type":"NDC"}],"standard_charges":[{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":79.25,"discounted_cash":66.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-051-20","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-333-90","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-071-64","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-071-60","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0008-0844-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0008-0844-02","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 80 MG IN 100 ML 0.9 % SODIUM CHLORIDE INFUSION (PREMIX) [178574]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"7700-3536-10","type":"NDC"}],"standard_charges":[{"gross_charge":262.75,"discounted_cash":220.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"35573-428-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"35573-428-51","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-637-09","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6474-61","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-813-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-813-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-068-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-068-51","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-713-90","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-560-90","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-564-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-181-46","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 20 MG TABLET [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5677-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PENICILLIN G POTASSIUM 2.5 MILLION UNITS IN 105 ML 0.9% SODIUM CHLORIDE (PREMIX) [178017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"7700-0699-10","type":"NDC"}],"standard_charges":[{"gross_charge":107.5,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MILLION UNITS"}]},{"description":"PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION [6085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"44567-312-01","type":"NDC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MILLION UNITS"}]},{"description":"PENICILLIN G POTASSIUM 10,000 UNITS/ML SYRINGE (DESENSITIZATION) [172731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"5555-0000-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"0049-0520-83","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MILLION UNITS"},{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.8 MILLION UNITS"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MILLION UNITS"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25000 UNITS/KG"},{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MILLION UNITS"}]},{"description":"PENICILLIN G BENZATHINE,PROCAIN 900,000 UNIT-300K UNIT/2 ML IM SYRINGE [105029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"60793-602-10","type":"NDC"}],"standard_charges":[{"gross_charge":1044.5,"discounted_cash":877.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML IM SYRINGE [108051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"60793-600-02","type":"NDC"}],"standard_charges":[{"gross_charge":1196.25,"discounted_cash":1004.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MILLION UNITS"},{"gross_charge":2392.5,"discounted_cash":2009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MILLION UNITS"}]},{"description":"PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML IM SYRINGE [108051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"60793-600-10","type":"NDC"}],"standard_charges":[{"gross_charge":1196.25,"discounted_cash":1004.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MILLION UNITS"},{"gross_charge":2392.5,"discounted_cash":2009.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MILLION UNITS"}]},{"description":"PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE [10897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793-700-01","type":"NDC"}],"standard_charges":[{"gross_charge":832.25,"discounted_cash":699.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MILLION UNITS"},{"gross_charge":1664.5,"discounted_cash":1398.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MILLION UNITS"},{"gross_charge":3328.75,"discounted_cash":2796.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MILLION UNITS"}]},{"description":"PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE [10897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793-700-10","type":"NDC"}],"standard_charges":[{"gross_charge":832.25,"discounted_cash":699.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MILLION UNITS"},{"gross_charge":1664.5,"discounted_cash":1398.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MILLION UNITS"},{"gross_charge":3328.75,"discounted_cash":2796.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MILLION UNITS"}]},{"description":"PENICILLIN G BENZATHINE 2,400,000 UNIT/4 ML INTRAMUSCULAR SYRINGE [108050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793-702-04","type":"NDC"}],"standard_charges":[{"gross_charge":2758.75,"discounted_cash":2317.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MILLION UNITS"}]},{"description":"PENICILLIN G BENZATHINE 2,400,000 UNIT/4 ML INTRAMUSCULAR SYRINGE [108050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793-702-10","type":"NDC"}],"standard_charges":[{"gross_charge":2508.0,"discounted_cash":2106.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MILLION UNITS"}]},{"description":"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE [108049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793-701-02","type":"NDC"}],"standard_charges":[{"gross_charge":1441.5,"discounted_cash":1210.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MILLION UNITS"},{"gross_charge":2882.75,"discounted_cash":2421.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MILLION UNITS"}]},{"description":"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE [108049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793-701-10","type":"NDC"}],"standard_charges":[{"gross_charge":1441.5,"discounted_cash":1210.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MILLION UNITS"},{"gross_charge":2882.75,"discounted_cash":2421.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MILLION UNITS"}]},{"description":"PENICILLAMINE 250 MG CAPSULE [10894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25010-705-15","type":"NDC"}],"standard_charges":[{"gross_charge":1122.0,"discounted_cash":942.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":2244.0,"discounted_cash":1884.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PEN NEEDLE, DIABETIC 29 GAUGE X 1/2\" [38000]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8290328203","type":"NDC"}],"standard_charges":[{"gross_charge":306.75,"discounted_cash":257.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 EACH"}]},{"description":"PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [165691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-3026-02","type":"NDC"}],"standard_charges":[{"gross_charge":18661.5,"discounted_cash":15675.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":24204.25,"discounted_cash":20331.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2545","type":"HCPCS"},{"code":"13925-522-01","type":"NDC"}],"standard_charges":[{"gross_charge":740.25,"discounted_cash":621.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PENTAMIDINE 300 MG SOLUTION FOR INHALATION [28235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2545","type":"HCPCS"},{"code":"63323-877-15","type":"NDC"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":600.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PENICILLIN V POTASSIUM 500 MG TABLET [6093]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-041-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PENICILLIN V POTASSIUM 500 MG TABLET [6093]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-235-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PENICILLIN V POTASSIUM 500 MG TABLET [6093]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1655-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION [6091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4127-73","type":"NDC"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PENICILLIN V POTASSIUM 250 MG TABLET [6092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-040-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PENICILLIN V POTASSIUM 250 MG TABLET [6092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-234-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PENICILLIN V POTASSIUM 250 MG TABLET [6092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1172-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"70860-126-41","type":"NDC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"70860-126-20","type":"NDC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"0049-0420-10","type":"NDC"}],"standard_charges":[{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"0049-0420-05","type":"NDC"}],"standard_charges":[{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"0049-0520-84","type":"NDC"}],"standard_charges":[{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"44567-311-10","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [6086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"0781-6135-95","type":"NDC"}],"standard_charges":[{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION [6085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"72603-345-01","type":"NDC"}],"standard_charges":[{"gross_charge":256.25,"discounted_cash":215.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION [6085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"0049-0430-20","type":"NDC"}],"standard_charges":[{"gross_charge":250.5,"discounted_cash":210.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION [6085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"0049-0530-28","type":"NDC"}],"standard_charges":[{"gross_charge":250.5,"discounted_cash":210.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [165691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-3026-04","type":"NDC"}],"standard_charges":[{"gross_charge":18661.5,"discounted_cash":15675.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"}]},{"description":"PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [165691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-3026-01","type":"NDC"}],"standard_charges":[{"gross_charge":18661.5,"discounted_cash":15675.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"}]},{"description":"PAROXETINE 20 MG TABLET [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-098-16","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 20 MG TABLET [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-098-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 20 MG TABLET [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-045-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 20 MG TABLET [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-774-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 20 MG TABLET [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-774-20","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 20 MG TABLET [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-045-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 20 MG TABLET [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0083-2","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PAROXETINE 20 MG TABLET [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-155-99","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [179436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"83257-005-41","type":"NDC"}],"standard_charges":[{"gross_charge":6187.5,"discounted_cash":5197.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [179436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"67457-833-06","type":"NDC"}],"standard_charges":[{"gross_charge":8567.25,"discounted_cash":7196.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [180794]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"70114-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":8567.25,"discounted_cash":7196.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [183746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5120","type":"HCPCS"},{"code":"61314-866-01","type":"NDC"}],"standard_charges":[{"gross_charge":11635.5,"discounted_cash":9773.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEGFILGRASTIM-APGF 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [186862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5122","type":"HCPCS"},{"code":"0069-0324-01","type":"NDC"}],"standard_charges":[{"gross_charge":11633.75,"discounted_cash":9772.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [32267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513-190-01","type":"NDC"}],"standard_charges":[{"gross_charge":13169.75,"discounted_cash":11062.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR [165657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513-192-01","type":"NDC"}],"standard_charges":[{"gross_charge":13169.75,"discounted_cash":11062.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEG3350 100 GRAM-SOD SULF 7.5 GRAM-NACL-KCL-ASCORBATE-C ORAL PWDR PACK [77400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-201-75","type":"NDC"}],"standard_charges":[{"gross_charge":495.75,"discounted_cash":416.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 KIT"}]},{"description":"PEG3350 100 GRAM-SOD SULF 7.5 GRAM-NACL-KCL-ASCORBATE-C ORAL PWDR PACK [77400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649-201-75","type":"NDC"}],"standard_charges":[{"gross_charge":619.5,"discounted_cash":520.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 KIT"}]},{"description":"PEG 400-PROPYLENE GLYCOL 0.4 %-0.3 % EYE DROPS [35891]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0429-15","type":"NDC"}],"standard_charges":[{"gross_charge":78.25,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-766-21","type":"NDC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-090-19","type":"NDC"}],"standard_charges":[{"gross_charge":174.25,"discounted_cash":146.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10572-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52268-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52268-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":152.5,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"PEDIATRIC MULTIVITAMIN ORAL DROPS WRAPPER [408185872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87040203","type":"NDC"}],"standard_charges":[{"gross_charge":485.5,"discounted_cash":407.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PEDIATRIC MULTIVITAMIN NO.42 CHEWABLE TABLET [133916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068111600","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PEDIATRIC MULTIVITAMIN NO.42 CHEWABLE TABLET [133916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068104900","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PEDIATRIC MULTIVITAMIN NO.189-FERROUS SULFATE 11 MG/ML ORAL DROPS [185500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87040501","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PEDIATRIC MULTIVITAMIN NO.17 CHEWABLE TABLET [178201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904262170","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PEDIATRIC MULTIVITAMIN CHEWABLE TABLET WRAPPER [185039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1650008619","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PEDIATRIC MULTIVITAMIN CHEWABLE TABLET WRAPPER [185039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1650007814","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [168797]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53436-084-30","type":"NDC"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":199.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [168797]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53436-084-01","type":"NDC"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":199.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"65219-433-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":79.25,"discounted_cash":66.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"0781-3232-94","type":"NDC"}],"standard_charges":[{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE-ACETAMINOPHEN 2.5 MG-325 MG TABLET [10815]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68308-840-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 2.5 MG-325 MG TABLET [10815]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60951-701-70","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 2.5 MG-325 MG TABLET [10815]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-4978-21","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 2.5 MG-325 MG TABLET [10815]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63481-627-70","type":"NDC"}],"standard_charges":[{"gross_charge":141.25,"discounted_cash":118.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":277.5,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7095-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-104-50","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68308-480-47","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0523-23","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-204-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0523-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-480-20","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":53.0,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":105.75,"discounted_cash":88.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":211.25,"discounted_cash":177.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE ER 60 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-460-10","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":222.75,"discounted_cash":187.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-440-20","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":150.5,"discounted_cash":126.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":301.0,"discounted_cash":252.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-440-10","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":146.75,"discounted_cash":123.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":293.5,"discounted_cash":246.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0512-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0512-62","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYMORPHONE ER 20 MG TABLET,EXTENDED RELEASE,12 HR [76679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64896-699-01","type":"NDC"}],"standard_charges":[{"gross_charge":78.25,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":151.5,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":297.75,"discounted_cash":250.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYMORPHONE 10 MG TABLET [76676]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-071-06","type":"NDC"}],"standard_charges":[{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-1037-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6761-30","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4110081123","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11523-1167-6","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093941433","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-410-59","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYMETAZOLINE 0.05 % NASAL MIST [128638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4110001511","type":"NDC"}],"standard_charges":[{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET [31863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-645-15","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET [31863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-645-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET [31863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET [31863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-045-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET [31863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0522-23","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET [31863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0522-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-949-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0512-23","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-355-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-355-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE ER 30 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165109]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-430-10","type":"NDC"}],"standard_charges":[{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":159.0,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":317.75,"discounted_cash":266.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64950-354-05","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-401-50","type":"NDC"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-401-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6966-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-001-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68308-505-47","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 5 MG TABLET [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0552-23","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64950-354-45","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-151-16","type":"NDC"}],"standard_charges":[{"gross_charge":554.25,"discounted_cash":465.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6828-94","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4827-05","type":"NDC"}],"standard_charges":[{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165108]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-420-20","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":175.75,"discounted_cash":147.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":351.5,"discounted_cash":295.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165108]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-420-10","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":171.5,"discounted_cash":144.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":342.75,"discounted_cash":287.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165107]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-415-20","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":92.5,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":185.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYMORPHONE ER 20 MG TABLET,EXTENDED RELEASE,12 HR [76679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64896-699-13","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":150.5,"discounted_cash":126.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165107]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-415-10","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":90.25,"discounted_cash":75.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":180.5,"discounted_cash":151.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":360.75,"discounted_cash":303.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-410-20","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":188.75,"discounted_cash":158.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":377.25,"discounted_cash":316.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [165106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-410-10","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":183.75,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":367.5,"discounted_cash":308.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4827-50","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4227-05","type":"NDC"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6828-05","type":"NDC"}],"standard_charges":[{"gross_charge":46.75,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4827-40","type":"NDC"}],"standard_charges":[{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-559-90","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-180-46","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-332-90","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":55.5,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-096-90","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0011-98","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":55.5,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0008-0843-81","type":"NDC"}],"standard_charges":[{"gross_charge":117.5,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":234.75,"discounted_cash":197.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513-956-01","type":"NDC"}],"standard_charges":[{"gross_charge":14870.25,"discounted_cash":12491.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":17197.25,"discounted_cash":14445.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"}]},{"description":"PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513-954-01","type":"NDC"}],"standard_charges":[{"gross_charge":5369.75,"discounted_cash":4510.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"61703-326-18","type":"NDC"}],"standard_charges":[{"gross_charge":244.75,"discounted_cash":205.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"61703-324-18","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":351.0,"discounted_cash":294.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"67457-430-10","type":"NDC"}],"standard_charges":[{"gross_charge":176.5,"discounted_cash":148.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"71288-409-05","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"63323-673-05","type":"NDC"}],"standard_charges":[{"gross_charge":261.25,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"69097-439-35","type":"NDC"}],"standard_charges":[{"gross_charge":641.25,"discounted_cash":538.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"69639-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":246.75,"discounted_cash":207.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"0409-2504-10","type":"NDC"}],"standard_charges":[{"gross_charge":863.5,"discounted_cash":725.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"69543-371-10","type":"NDC"}],"standard_charges":[{"gross_charge":358.25,"discounted_cash":300.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"69543-371-01","type":"NDC"}],"standard_charges":[{"gross_charge":358.25,"discounted_cash":300.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-067-85","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-585-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"0781-3232-95","type":"NDC"}],"standard_charges":[{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"62756-129-40","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"62756-129-44","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"0143-9284-10","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":105.5,"discounted_cash":88.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"0143-9284-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":105.5,"discounted_cash":88.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"55150-202-10","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"55150-202-00","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"67457-317-25","type":"NDC"}],"standard_charges":[{"gross_charge":1285.5,"discounted_cash":1079.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-585-15","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PENTAMIDINE 300 MG SOLUTION FOR INJECTION [27430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-113-10","type":"NDC"}],"standard_charges":[{"gross_charge":367.5,"discounted_cash":308.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/KG"},{"gross_charge":735.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"60505-6193-1","type":"NDC"}],"standard_charges":[{"gross_charge":690.5,"discounted_cash":580.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"16714-834-01","type":"NDC"}],"standard_charges":[{"gross_charge":1337.0,"discounted_cash":1123.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61703-342-50","type":"NDC"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":485.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61703-342-22","type":"NDC"}],"standard_charges":[{"gross_charge":228.75,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.7 ML"}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"42023-116-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UNITS"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 UNITS"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"OXYTOCIN IN NORMAL SALINE 20 UNIT/1,000 ML INTRAVENOUS SOLUTION [178030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7069-10","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"OXYTOCIN IN NORMAL SALINE 20 UNIT/1,000 ML INTRAVENOUS SOLUTION [178030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1067-08","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [129645]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1552-07","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [129645]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71019-253-01","type":"NDC"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":110.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [129645]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1068-07","type":"NDC"}],"standard_charges":[{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"63323-012-07","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UNITS"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"63323-012-03","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UNITS"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"42023-116-25","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UNITS"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"63323-012-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UNITS"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"OXYMORPHONE ER 40 MG TABLET,EXTENDED RELEASE,12 HR [76680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64896-701-13","type":"NDC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":115.25,"discounted_cash":96.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":225.5,"discounted_cash":189.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-763-52","type":"NDC"}],"standard_charges":[{"gross_charge":1048.25,"discounted_cash":880.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"67457-471-52","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"70860-200-05","type":"NDC"}],"standard_charges":[{"gross_charge":109.5,"discounted_cash":91.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-200-17","type":"NDC"}],"standard_charges":[{"gross_charge":320.25,"discounted_cash":269.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.7 ML"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"0703-4094-01","type":"NDC"}],"standard_charges":[{"gross_charge":228.5,"discounted_cash":191.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"63323-942-41","type":"NDC"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":636.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"63323-942-05","type":"NDC"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":636.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"55111-694-07","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"62856-797-01","type":"NDC"}],"standard_charges":[{"gross_charge":859.25,"discounted_cash":721.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALIVIZUMAB 50 MG/0.5 ML INTRAMUSCULAR SOLUTION [108060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90378","type":"HCPCS"},{"code":"60574-4114-1","type":"NDC"}],"standard_charges":[{"gross_charge":132745.5,"discounted_cash":111506.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"}]},{"description":"PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90378","type":"HCPCS"},{"code":"66658-231-01","type":"NDC"}],"standard_charges":[{"gross_charge":117847.25,"discounted_cash":98991.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"}]},{"description":"PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90378","type":"HCPCS"},{"code":"60574-4113-1","type":"NDC"}],"standard_charges":[{"gross_charge":105652.0,"discounted_cash":88747.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"}]},{"description":"PALIPERIDONE ER 9 MG TABLET,EXTENDED RELEASE 24 HR [78066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43975-352-03","type":"NDC"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":99.25,"discounted_cash":83.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":148.75,"discounted_cash":124.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR [78065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-282-03","type":"NDC"}],"standard_charges":[{"gross_charge":83.25,"discounted_cash":69.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":166.25,"discounted_cash":139.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":249.25,"discounted_cash":209.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"25021-783-05","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"PALIPERIDONE ER 6 MG TABLET,EXTENDED RELEASE 24 HR [78065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-868-01","type":"NDC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":248.75,"discounted_cash":208.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR [78064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-524-06","type":"NDC"}],"standard_charges":[{"gross_charge":99.25,"discounted_cash":83.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":198.25,"discounted_cash":166.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":297.5,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR [78064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-223-01","type":"NDC"}],"standard_charges":[{"gross_charge":166.25,"discounted_cash":139.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":332.5,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":498.5,"discounted_cash":418.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"25021-255-05","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62332-621-17","type":"NDC"}],"standard_charges":[{"gross_charge":503.25,"discounted_cash":422.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.7 ML"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16714-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":741.25,"discounted_cash":622.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"0703-3213-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-3218-01","type":"NDC"}],"standard_charges":[{"gross_charge":810.75,"discounted_cash":681.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-3216-01","type":"NDC"}],"standard_charges":[{"gross_charge":270.25,"discounted_cash":227.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.7 ML"}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-200-50","type":"NDC"}],"standard_charges":[{"gross_charge":956.5,"discounted_cash":803.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323-130-11","type":"NDC"}],"standard_charges":[{"gross_charge":171.75,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PINDOLOL 5 MG TABLET [6297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0052-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PILOCARPINE 4 % EYE DROPS [6282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":408.75,"discounted_cash":343.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE 4 % EYE DROPS [6282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-206-15","type":"NDC"}],"standard_charges":[{"gross_charge":434.5,"discounted_cash":364.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE 2 % EYE DROPS [6280]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-191-01","type":"NDC"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE 2 % EYE DROPS [6280]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-204-15","type":"NDC"}],"standard_charges":[{"gross_charge":414.5,"discounted_cash":348.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE 2 % EYE DROPS [6280]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0998-0204-15","type":"NDC"}],"standard_charges":[{"gross_charge":469.5,"discounted_cash":394.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE 1 % EYE DROPS [6279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-223-12","type":"NDC"}],"standard_charges":[{"gross_charge":389.75,"discounted_cash":327.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE 1 % EYE DROPS [6279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-203-15","type":"NDC"}],"standard_charges":[{"gross_charge":405.25,"discounted_cash":340.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE 1 % EYE DROPS [6279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0998-0203-15","type":"NDC"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":385.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PIFLUFOLASTAT F 18 37 MBQ/ML TO 2,960 MBQ/ML (1-80 MCI/ML) IV SOLUTION [189012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9595","type":"HCPCS"},{"code":"71258-022-01","type":"NDC"}],"standard_charges":[{"gross_charge":4927.75,"discounted_cash":4139.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"43598-405-16","type":"NDC"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":105.5,"discounted_cash":88.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-740-30","type":"NDC"}],"standard_charges":[{"gross_charge":116.25,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-999-02","type":"NDC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":461.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":274.75,"discounted_cash":230.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-973-02","type":"NDC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":461.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":274.75,"discounted_cash":230.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1014-1","type":"NDC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":461.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":274.75,"discounted_cash":230.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1051-3","type":"NDC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":461.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":274.75,"discounted_cash":230.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-170-30","type":"NDC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":461.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":274.75,"discounted_cash":230.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PIOGLITAZONE 15 MG TABLET [25528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-151-04","type":"NDC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":210.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":315.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE 30 MG TABLET [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7272-98","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":108.75,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE 30 MG TABLET [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-055-10","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":108.5,"discounted_cash":91.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE 30 MG TABLET [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-055-07","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":108.5,"discounted_cash":91.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE 30 MG TABLET [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5421-92","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":108.5,"discounted_cash":91.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE 30 MG TABLET [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5421-31","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":108.5,"discounted_cash":91.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE 30 MG TABLET [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-301-14","type":"NDC"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":240.75,"discounted_cash":202.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE 15 MG TABLET [25528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7271-56","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":142.25,"discounted_cash":119.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE 15 MG TABLET [25528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-054-10","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE 15 MG TABLET [25528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-054-07","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE 15 MG TABLET [25528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5420-92","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-381-94","type":"NDC"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":556.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":165.75,"discounted_cash":139.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":331.5,"discounted_cash":278.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE [11019]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58151-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":121.25,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE [11019]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-3740-66","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":78.5,"discounted_cash":65.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":117.75,"discounted_cash":98.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6187-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0369-40","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0369-24","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4111-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-905-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"0641-2555-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"42192-614-30","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION [6270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-510-02","type":"NDC"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":125.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.01 MG/KG"},{"gross_charge":297.75,"discounted_cash":250.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.02 MG/KG"},{"gross_charge":446.75,"discounted_cash":375.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.03 MG/KG"},{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":193.25,"discounted_cash":162.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-381-11","type":"NDC"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":556.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":165.75,"discounted_cash":139.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":331.5,"discounted_cash":278.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0187-1704-05","type":"NDC"}],"standard_charges":[{"gross_charge":578.25,"discounted_cash":485.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":144.75,"discounted_cash":121.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":289.25,"discounted_cash":242.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"0409-9158-50","type":"NDC"}],"standard_charges":[{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"0409-9158-31","type":"NDC"}],"standard_charges":[{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"43598-405-11","type":"NDC"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":105.5,"discounted_cash":88.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"0409-9158-25","type":"NDC"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":199.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"0409-9158-01","type":"NDC"}],"standard_charges":[{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE [117592]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"76329-1240-1","type":"NDC"}],"standard_charges":[{"gross_charge":161.5,"discounted_cash":135.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [127088]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"0409-9157-50","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [127088]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"0409-9157-31","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [127088]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"0409-9157-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"42192-614-10","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PIOGLITAZONE 30 MG TABLET [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-220-90","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":108.75,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-157-17","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-157-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6931-86","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6931-76","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11523-7268-8","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69784-180-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69784-180-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69784-180-14","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69784-180-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11523-7234-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-430-99","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-430-98","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-306-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4110080676","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11523-7268-3","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90713","type":"HCPCS"},{"code":"49281-860-78","type":"NDC"}],"standard_charges":[{"gross_charge":219.5,"discounted_cash":184.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [108127]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90713","type":"HCPCS"},{"code":"49281-860-10","type":"NDC"}],"standard_charges":[{"gross_charge":219.5,"discounted_cash":184.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ 30 MG INTRAVENOUS SOLUTION [186537]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":54738.0,"discounted_cash":45979.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.8 MG/KG"},{"gross_charge":54683.75,"discounted_cash":45934.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.8 MG/KG"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION [182469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-105-01","type":"NDC"}],"standard_charges":[{"gross_charge":38190.75,"discounted_cash":32080.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"}]},{"description":"PODOFILOX 0.5 % TOPICAL GEL [20635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-6118-03","type":"NDC"}],"standard_charges":[{"gross_charge":2310.5,"discounted_cash":1940.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [128310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90732","type":"HCPCS"},{"code":"0006-4837-03","type":"NDC"}],"standard_charges":[{"gross_charge":577.5,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [128310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90732","type":"HCPCS"},{"code":"0006-4837-01","type":"NDC"}],"standard_charges":[{"gross_charge":577.5,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION [11037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90732","type":"HCPCS"},{"code":"0006-4943-01","type":"NDC"}],"standard_charges":[{"gross_charge":577.5,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION [11037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90732","type":"HCPCS"},{"code":"0006-4943-00","type":"NDC"}],"standard_charges":[{"gross_charge":577.5,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PNEUMOCOCCAL 21-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [199117]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90684","type":"HCPCS"},{"code":"0006-4347-99","type":"NDC"}],"standard_charges":[{"gross_charge":1235.75,"discounted_cash":1038.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PNEUMOCOCCAL 21-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [199117]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90684","type":"HCPCS"},{"code":"0006-4347-02","type":"NDC"}],"standard_charges":[{"gross_charge":1235.75,"discounted_cash":1038.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [189404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"0005-2000-10","type":"NDC"}],"standard_charges":[{"gross_charge":1179.25,"discounted_cash":990.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1152372688","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [189404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"0005-2000-01","type":"NDC"}],"standard_charges":[{"gross_charge":1216.25,"discounted_cash":1021.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [11596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-7824-10","type":"NDC"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":330.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [11596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-315-10","type":"NDC"}],"standard_charges":[{"gross_charge":90.75,"discounted_cash":76.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789-109-10","type":"NDC"}],"standard_charges":[{"gross_charge":315.25,"discounted_cash":264.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0990-7074-26","type":"NDC"}],"standard_charges":[{"gross_charge":93.5,"discounted_cash":78.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"7700-2277-10","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [11074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0338-0709-48","type":"NDC"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM ALUM (BULK) POWDER [346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"2435730030","type":"NDC"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":488.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-8183-11","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-2001-4","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-8183-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN [11057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1946-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN [11057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6025800216","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"POLYVINYL ALCOHOL-POVIDONE (PF) 1.4 %-0.6 % EYE DROPS IN A DROPPERETTE [128459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-0506-50","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DROP"}]},{"description":"POLYVINYL ALCOHOL-POVIDONE (PF) 1.4 %-0.6 % EYE DROPS IN A DROPPERETTE [128459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-0506-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DROP"}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE [11050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5199120399","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE [11050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6025818501","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE [11050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5199120311","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE [11050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904539561","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION [6393]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-234-10","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS/KG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS/KG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [11596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-628-10","type":"NDC"}],"standard_charges":[{"gross_charge":117.75,"discounted_cash":98.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [11596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-908-10","type":"NDC"}],"standard_charges":[{"gross_charge":88.25,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [11596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-703-11","type":"NDC"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90670","type":"HCPCS"},{"code":"0005-1971-02","type":"NDC"}],"standard_charges":[{"gross_charge":972.25,"discounted_cash":816.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [103895]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90670","type":"HCPCS"},{"code":"0005-1971-01","type":"NDC"}],"standard_charges":[{"gross_charge":972.25,"discounted_cash":816.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505-6157-0","type":"NDC"}],"standard_charges":[{"gross_charge":116.25,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":116.25,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.375 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"44567-802-10","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150-120-30","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"25021-165-30","type":"NDC"}],"standard_charges":[{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0409-3385-13","type":"NDC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"63323-981-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 G"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.25 G"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2025 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG OF PIPERACILLIN"}]},{"description":"PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0338-9632-24","type":"NDC"}],"standard_charges":[{"gross_charge":157.25,"discounted_cash":132.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.25 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0338-9632-01","type":"NDC"}],"standard_charges":[{"gross_charge":157.25,"discounted_cash":132.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.25 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0206-8860-01","type":"NDC"}],"standard_charges":[{"gross_charge":177.5,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.25 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0206-8860-02","type":"NDC"}],"standard_charges":[{"gross_charge":177.5,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.25 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"63323-981-23","type":"NDC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150-119-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"25021-164-30","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIOGLITAZONE 45 MG TABLET [25530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-451-24","type":"NDC"}],"standard_charges":[{"gross_charge":46.75,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":93.5,"discounted_cash":78.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"67457-522-00","type":"NDC"}],"standard_charges":[{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"67457-522-37","type":"NDC"}],"standard_charges":[{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"64679-056-01","type":"NDC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"64679-056-02","type":"NDC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION [12587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"63323-304-94","type":"NDC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0338-9638-12","type":"NDC"}],"standard_charges":[{"gross_charge":192.5,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0338-9638-01","type":"NDC"}],"standard_charges":[{"gross_charge":192.5,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0206-8862-01","type":"NDC"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0206-8862-02","type":"NDC"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505-6159-4","type":"NDC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505-6159-0","type":"NDC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0409-3390-11","type":"NDC"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":95.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"64679-012-02","type":"NDC"}],"standard_charges":[{"gross_charge":149.75,"discounted_cash":125.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"64679-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"67457-523-45","type":"NDC"}],"standard_charges":[{"gross_charge":149.75,"discounted_cash":125.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"67457-523-00","type":"NDC"}],"standard_charges":[{"gross_charge":149.75,"discounted_cash":125.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0409-3390-04","type":"NDC"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":95.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0338-9636-24","type":"NDC"}],"standard_charges":[{"gross_charge":191.25,"discounted_cash":160.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.375 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0338-9636-01","type":"NDC"}],"standard_charges":[{"gross_charge":191.25,"discounted_cash":160.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.375 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0206-8861-01","type":"NDC"}],"standard_charges":[{"gross_charge":218.75,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.375 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0206-8861-02","type":"NDC"}],"standard_charges":[{"gross_charge":218.75,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.375 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"0409-3385-11","type":"NDC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"63323-983-23","type":"NDC"}],"standard_charges":[{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"63323-983-21","type":"NDC"}],"standard_charges":[{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505-6157-4","type":"NDC"}],"standard_charges":[{"gross_charge":116.25,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150-121-50","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"42192-614-05","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"42192-614-02","type":"NDC"}],"standard_charges":[{"gross_charge":422.25,"discounted_cash":354.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":140.75,"discounted_cash":118.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"0641-2555-41","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENOBARBITAL 16.2 MG TABLET WRAPPER [178567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-192-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48.6 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"}]},{"description":"PHENOBARBITAL 16.2 MG TABLET WRAPPER [178567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13517-110-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48.6 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"}]},{"description":"PHENOBARBITAL 16.2 MG TABLET WRAPPER [178567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51293-625-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48.6 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"}]},{"description":"PHENOBARBITAL 16.2 MG TABLET WRAPPER [178567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1445-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48.6 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"}]},{"description":"PHENOBARBITAL 16.2 MG TABLET WRAPPER [178567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5165-21","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48.6 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"}]},{"description":"PHENOBARB-HYOSCYAMN-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG TABLET [126233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59212-425-10","type":"NDC"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":94.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"PHENOBARB-HYOSCY-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG/5 ML ELIXIR [6225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75826-127-04","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENOBARB-HYOSCY-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG/5 ML ELIXIR [6225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71914-162-16","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENOBARB-HYOSCY-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG/5 ML ELIXIR [6225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2345-05","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENOBARB-HYOSCY-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG/5 ML ELIXIR [6225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59212-423-16","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENELZINE 15 MG TABLET [10933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-360-21","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"PHENAZOPYRIDINE 100 MG TABLET [6193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-681-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR [6212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-1508-58","type":"NDC"}],"standard_charges":[{"gross_charge":377.25,"discounted_cash":316.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PHENAZOPYRIDINE 100 MG TABLET [6193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-620-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR [6212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2062-07","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR [6212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-3189-05","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION [6221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494-416-01","type":"NDC"}],"standard_charges":[{"gross_charge":279.5,"discounted_cash":234.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION [6221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494-416-25","type":"NDC"}],"standard_charges":[{"gross_charge":279.5,"discounted_cash":234.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":828.25,"discounted_cash":695.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION [6221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"0641-0477-21","type":"NDC"}],"standard_charges":[{"gross_charge":337.5,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION [6221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"0641-0477-25","type":"NDC"}],"standard_charges":[{"gross_charge":337.5,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL 60 MG TABLET [6218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1455-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PHENOBARBITAL 32.4 MG TABLET [6217]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6575-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL 32.4 MG TABLET [6217]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5166-21","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL 30 MG TABLET [6216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1450-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR [6212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-675-16","type":"NDC"}],"standard_charges":[{"gross_charge":396.75,"discounted_cash":333.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR [6212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13517-107-16","type":"NDC"}],"standard_charges":[{"gross_charge":377.25,"discounted_cash":316.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PHENAZOPYRIDINE 100 MG TABLET [6193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75826-114-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PERMETHRIN 5 % TOPICAL CREAM [10917]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"21922-021-07","type":"NDC"}],"standard_charges":[{"gross_charge":485.25,"discounted_cash":407.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"PERMETHRIN 5 % TOPICAL CREAM [10917]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-897-01","type":"NDC"}],"standard_charges":[{"gross_charge":498.25,"discounted_cash":418.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"PERMETHRIN 5 % TOPICAL CREAM [10917]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0242-60","type":"NDC"}],"standard_charges":[{"gross_charge":508.75,"discounted_cash":427.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"PERMETHRIN 5 % TOPICAL CREAM [10917]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-269-37","type":"NDC"}],"standard_charges":[{"gross_charge":488.5,"discounted_cash":410.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"PERMETHRIN 1 % TOPICAL LIQUID [10918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-150-78","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 ML"}]},{"description":"PERMETHRIN 1 % TOPICAL LIQUID [10918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093973944","type":"NDC"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 ML"}]},{"description":"PERMETHRIN 1 % TOPICAL LIQUID [10918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6373612003","type":"NDC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 ML"}]},{"description":"PERMETHRIN 1 % TOPICAL LIQUID [10918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6373612002","type":"NDC"}],"standard_charges":[{"gross_charge":68.25,"discounted_cash":57.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 ML"}]},{"description":"PERFLUTREN LIPID MICROSPHERES 2.2 MG/10ML INTRAVENOUS *INITIAL* [178012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":494.25,"discounted_cash":415.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":988.25,"discounted_cash":830.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":988.25,"discounted_cash":830.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PERFLUTREN LIPID MICROSPHERES 2.2 MG/10ML INTRAVENOUS *INITIAL* [178012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994-011-16","type":"NDC"}],"standard_charges":[{"gross_charge":494.25,"discounted_cash":415.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":988.25,"discounted_cash":830.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":988.25,"discounted_cash":830.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PERFLUTREN LIPID MICROSPHERES 2.2 MG/10ML INTRAVENOUS *INITIAL* [178012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994-011-04","type":"NDC"}],"standard_charges":[{"gross_charge":494.25,"discounted_cash":415.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":988.25,"discounted_cash":830.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":988.25,"discounted_cash":830.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION [165194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61364-181-03","type":"NDC"}],"standard_charges":[{"gross_charge":1360.5,"discounted_cash":1142.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION [165194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61364-181-01","type":"NDC"}],"standard_charges":[{"gross_charge":1360.5,"discounted_cash":1142.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PEPPERMINT OIL [6116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"395201591","type":"NDC"}],"standard_charges":[{"gross_charge":139.25,"discounted_cash":116.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE [21300]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5448-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE [12912]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-098-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION [6097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2515","type":"HCPCS"},{"code":"76478-501-50","type":"NDC"}],"standard_charges":[{"gross_charge":10525.25,"discounted_cash":8841.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION [6097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2515","type":"HCPCS"},{"code":"76478-501-20","type":"NDC"}],"standard_charges":[{"gross_charge":5643.75,"discounted_cash":4740.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PENTETATE INDIUM DISODIUM IN-111 1.5 MCI/1.5 ML INTRATHECAL SOLUTION [113146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9548","type":"HCPCS"},{"code":"51808-0125-01","type":"NDC"}],"standard_charges":[{"gross_charge":2877.0,"discounted_cash":2416.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MILLICURIE"}]},{"description":"PENTETATE INDIUM DISODIUM IN-111 1.5 MCI/1.5 ML INTRATHECAL SOLUTION [113146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"A9548","type":"HCPCS"},{"code":"17156-251-08","type":"NDC"}],"standard_charges":[{"gross_charge":2877.0,"discounted_cash":2416.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MILLICURIE"}]},{"description":"PERPHENAZINE 2 MG TABLET [6157]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"0603-5060-21","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"PHENAZOPYRIDINE 100 MG TABLET [6193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51293-810-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENAZOPYRIDINE 100 MG TABLET [6193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42192-801-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION [116596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-145-01","type":"NDC"}],"standard_charges":[{"gross_charge":13995.75,"discounted_cash":11756.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 420 MG"},{"gross_charge":27991.25,"discounted_cash":23512.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 840 MG"}]},{"description":"PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN [185886]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-260-01","type":"NDC"}],"standard_charges":[{"gross_charge":19037.25,"discounted_cash":15991.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PERTUZUMAB 1,200 MG-TRASTUZUMAB 600 MG-HYALURON-ZZXF/15 ML SUBCUT SOLN [185885]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-245-01","type":"NDC"}],"standard_charges":[{"gross_charge":28556.75,"discounted_cash":23987.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PERPHENAZINE 8 MG TABLET [6159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"0603-5062-21","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION [6221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"54288-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":271.5,"discounted_cash":228.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PERPHENAZINE 2 MG TABLET [6157]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"64980-290-01","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"PERPHENAZINE 2 MG TABLET [6157]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"52536-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"PERPHENAZINE 2 MG TABLET [6157]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"0904-6599-61","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"PERPHENAZINE 2 MG TABLET [6157]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0175","type":"HCPCS"},{"code":"0378-5350-01","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION [6221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"54288-137-10","type":"NDC"}],"standard_charges":[{"gross_charge":271.5,"discounted_cash":228.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION [6221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"14789-128-05","type":"NDC"}],"standard_charges":[{"gross_charge":217.25,"discounted_cash":182.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION [6221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"14789-128-07","type":"NDC"}],"standard_charges":[{"gross_charge":217.25,"discounted_cash":182.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 2.5 % EYE DROPS [6246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-201-02","type":"NDC"}],"standard_charges":[{"gross_charge":221.25,"discounted_cash":185.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PHENYLEPHRINE 2.5 % EYE DROPS [6246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42702-102-15","type":"NDC"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"51754-4020-1","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":213.5,"discounted_cash":179.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG/ML"},{"gross_charge":213.5,"discounted_cash":179.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":213.5,"discounted_cash":179.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100000 MCG"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25000 MCG"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"81284-213-01","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"81284-213-00","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"70756-623-86","type":"NDC"}],"standard_charges":[{"gross_charge":212.25,"discounted_cash":178.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"70594-063-02","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"70594-063-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"55150-302-01","type":"NDC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"55150-301-10","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"55150-301-01","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"25021-315-98","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"61990-0211-3","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"61990-0211-0","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"0781-3466-70","type":"NDC"}],"standard_charges":[{"gross_charge":251.75,"discounted_cash":211.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"0641-6189-10","type":"NDC"}],"standard_charges":[{"gross_charge":261.25,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"0641-6189-01","type":"NDC"}],"standard_charges":[{"gross_charge":261.25,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"63323-751-10","type":"NDC"}],"standard_charges":[{"gross_charge":213.25,"discounted_cash":179.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"63323-751-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"63323-751-00","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"42023-215-01","type":"NDC"}],"standard_charges":[{"gross_charge":212.25,"discounted_cash":178.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 2.5 % EYE DROPS [6246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756-629-25","type":"NDC"}],"standard_charges":[{"gross_charge":221.25,"discounted_cash":185.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PHENYLEPHRINE 50 MG/250 ML (200 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [168671]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-9045-05","type":"NDC"}],"standard_charges":[{"gross_charge":271.75,"discounted_cash":228.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION [131296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-036-01","type":"NDC"}],"standard_charges":[{"gross_charge":116.75,"discounted_cash":98.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION [131296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-036-50","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"0641-0493-21","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"0641-2555-45","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"0641-0493-25","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET [11018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7199-07","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET [11018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-156-95","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET [11018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-156-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"42023-214-10","type":"NDC"}],"standard_charges":[{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET [11018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-129-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET [11018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4146-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET [11018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5210-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET [11018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-129-06","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET [11018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0007-40","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PHENYTOIN 125 MG/5 ML ORAL SUSPENSION [6255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-2214-20","type":"NDC"}],"standard_charges":[{"gross_charge":1375.25,"discounted_cash":1155.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION [131296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2233-04","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION [131296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-275-66","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION [131296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-275-63","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION [131296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-275-62","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"42023-214-01","type":"NDC"}],"standard_charges":[{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"0641-6229-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 1 % NASAL SPRAY [127389]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-1352-02","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PHENYLEPHRINE 0.5 % NASAL SPRAY [6244]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0225-0805-47","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PHENYLEPHRINE 0.5 % NASAL SPRAY [6244]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69536-050-15","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PHENYLEPHRINE 0.5 % NASAL SPRAY [6244]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5032300603","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PHENYLEPHRINE 0.25 % RECTAL SUPPOSITORY WRAPPER [183605]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1186-12","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPPOSITORY"}]},{"description":"PHENYLEPHRINE 0.25 % NASAL SPRAY [6243]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0225-0800-47","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PHENTOLAMINE 5 MG INJECTION SOLUTION [10947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"51224-012-20","type":"NDC"}],"standard_charges":[{"gross_charge":3063.0,"discounted_cash":2572.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1531.5,"discounted_cash":1286.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHENTOLAMINE 5 MG INJECTION SOLUTION [10947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"51224-012-10","type":"NDC"}],"standard_charges":[{"gross_charge":3049.75,"discounted_cash":2561.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1525.0,"discounted_cash":1281.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHENTOLAMINE 5 MG INJECTION SOLUTION [10947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"0143-9564-10","type":"NDC"}],"standard_charges":[{"gross_charge":3575.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1787.5,"discounted_cash":1501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHENTOLAMINE 5 MG INJECTION SOLUTION [10947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"0143-9564-01","type":"NDC"}],"standard_charges":[{"gross_charge":3252.75,"discounted_cash":2732.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1626.5,"discounted_cash":1366.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHENOL-PHENOLATE SODIUM MUCOSAL AEROSOL SPRAY [27890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11822-3109-80","type":"NDC"}],"standard_charges":[{"gross_charge":254.75,"discounted_cash":213.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [36976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-748-76","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [36976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67172-111-20","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [36976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1228-58","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [36976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093945944","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [36976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-991-36","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [36976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6305-21","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"PHENOL 1.4 % MUCOSAL AEROSOL SPRAY [36976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7811201103","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"54288-136-10","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"54288-136-01","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494-415-01","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494-415-25","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"0641-0476-21","type":"NDC"}],"standard_charges":[{"gross_charge":172.25,"discounted_cash":144.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION [6224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"0641-0476-25","type":"NDC"}],"standard_charges":[{"gross_charge":172.25,"discounted_cash":144.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 1 % NASAL SPRAY [127389]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69536-100-15","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE [132477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1046-46","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"76014-004-25","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"76014-004-10","type":"NDC"}],"standard_charges":[{"gross_charge":144.25,"discounted_cash":121.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"76014-004-33","type":"NDC"}],"standard_charges":[{"gross_charge":213.5,"discounted_cash":179.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"76014-004-32","type":"NDC"}],"standard_charges":[{"gross_charge":144.25,"discounted_cash":121.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"76014-004-30","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"0641-6142-25","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"0641-6142-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 10 % EYE DROPS [19636]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82260-103-05","type":"NDC"}],"standard_charges":[{"gross_charge":261.25,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE 10 % EYE DROPS [19636]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-206-05","type":"NDC"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":228.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE 10 % EYE DROPS [19636]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42702-103-05","type":"NDC"}],"standard_charges":[{"gross_charge":261.25,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9% NACL SYRINGE WRAPPER [177562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-2046-46","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION [6242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2370","type":"HCPCS"},{"code":"0641-6229-25","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9% NACL SYRINGE WRAPPER [177562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-5736-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE [132477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73177-108-03","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE [132477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-957-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [108065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242-060-01","type":"NDC"}],"standard_charges":[{"gross_charge":2907.25,"discounted_cash":2442.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"},{"gross_charge":11207.5,"discounted_cash":9414.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [108065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242-061-01","type":"NDC"}],"standard_charges":[{"gross_charge":9448.75,"discounted_cash":7936.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [108065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242-060-10","type":"NDC"}],"standard_charges":[{"gross_charge":2907.25,"discounted_cash":2442.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [108065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242-061-10","type":"NDC"}],"standard_charges":[{"gross_charge":9448.75,"discounted_cash":7936.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [182314]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513-207-01","type":"NDC"}],"standard_charges":[{"gross_charge":8272.25,"discounted_cash":6948.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"},{"gross_charge":7972.5,"discounted_cash":6696.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [182314]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513-206-01","type":"NDC"}],"standard_charges":[{"gross_charge":2545.5,"discounted_cash":2138.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION [184170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5118","type":"HCPCS"},{"code":"0069-0315-01","type":"NDC"}],"standard_charges":[{"gross_charge":2237.75,"discounted_cash":1879.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"},{"gross_charge":8626.5,"discounted_cash":7246.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION [184170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"Q5118","type":"HCPCS"},{"code":"0069-0342-01","type":"NDC"}],"standard_charges":[{"gross_charge":7272.5,"discounted_cash":6108.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [173396]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0565","type":"HCPCS"},{"code":"0006-3025-00","type":"NDC"}],"standard_charges":[{"gross_charge":8684.0,"discounted_cash":7294.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [173396]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-3025-00","type":"NDC"}],"standard_charges":[{"gross_charge":11263.25,"discounted_cash":9461.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"BETHANECHOL CHLORIDE 25 MG TABLET [1044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-573-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BETHANECHOL CHLORIDE 10 MG TABLET [1043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0511-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BETHANECHOL CHLORIDE 10 MG TABLET [1043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-516-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BETHANECHOL CHLORIDE 10 MG TABLET [1043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0511-89","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BETHANECHOL CHLORIDE 10 MG TABLET [1043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-572-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BETHANECHOL CHLORIDE 25 MG TABLET [1044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0512-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BETHANECHOL CHLORIDE 25 MG TABLET [1044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0512-89","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [173396]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-3025-01","type":"NDC"}],"standard_charges":[{"gross_charge":11263.25,"discounted_cash":9461.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"BICALUTAMIDE 50 MG TABLET [15746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6019-46","type":"NDC"}],"standard_charges":[{"gross_charge":116.25,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BICALUTAMIDE 50 MG TABLET [15746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-023-10","type":"NDC"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION [1090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1286-36","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BISMUTH TRIBROM-PETROLATUM,WH 5\" X 9\" BANDAGE [128653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8884433605","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BISMUTH TRIBROM-PETROLATUM,WH 5\" X 9\" BANDAGE [128653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8080433605","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BISMUTH TRIBROM-PETROLATUM,WH 5\" X 9\" BANDAGE [128653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8438911249","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BISMUTH TRIBROM-PETROLATUM,WH 5\" X 9\" BANDAGE [128653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8452701495","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51285-040-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.25,"discounted_cash":61.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-189-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-189-13","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0501-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51285-047-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-187-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-187-13","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0704-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0503-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51285-050-02","type":"NDC"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-188-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-188-13","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET [18290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-921-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"65293-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":822.75,"discounted_cash":691.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG/KG"},{"gross_charge":1097.0,"discounted_cash":921.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":711.5,"discounted_cash":597.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"63323-562-15","type":"NDC"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG/KG"},{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION [1090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1756-15","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION [1090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37000-032-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION [1090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-1313-09","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6748-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BICALUTAMIDE 50 MG TABLET [15746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41616-485-83","type":"NDC"}],"standard_charges":[{"gross_charge":130.25,"discounted_cash":109.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BICALUTAMIDE 50 MG TABLET [15746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60429-177-30","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BICALUTAMIDE 50 MG TABLET [15746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-816-01","type":"NDC"}],"standard_charges":[{"gross_charge":128.25,"discounted_cash":107.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [178211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-2501-1","type":"NDC"}],"standard_charges":[{"gross_charge":691.5,"discounted_cash":580.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET [178211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-2501-3","type":"NDC"}],"standard_charges":[{"gross_charge":691.5,"discounted_cash":580.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BIMATOPROST 0.03 % EYE DROPS [29904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-429-01","type":"NDC"}],"standard_charges":[{"gross_charge":553.5,"discounted_cash":464.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY [1080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7050-12","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY [1080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7050-50","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY [1080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8142102102","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY [1080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8142102103","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY [1080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"00597-052-16","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY [1080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-443-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7927-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-441-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6407-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093977544","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-032-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY [1080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-443-55","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"BETHANECHOL CHLORIDE 10 MG TABLET [1043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0511-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES [94141]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6255-49","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 EACH"}]},{"description":"BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES [94141]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7031246129","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 EACH"}]},{"description":"BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY [19696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0283-0679-02","type":"NDC"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 G"}]},{"description":"BENZOCAINE 20 % MUCOSAL GEL [19691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"00000-0004-14","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11.9 G"}]},{"description":"BENZOCAINE 20 % ORAL MUCOSAL LIQUID [127255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0573-0215-41","type":"NDC"}],"standard_charges":[{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"BENZOCAINE 20 % ORAL MUCOSAL LIQUID [127255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5002443201","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"BENZOCAINE 20 % TOPICAL AEROSOL [19677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6373637882","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 G"}]},{"description":"BENZOCAINE 20 % TOPICAL OINTMENT [40267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6373603751","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"BENZOCAINE 20 %-MENTHOL 0.5 % TOPICAL AEROSOL [28048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5140900722","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 78 G"}]},{"description":"BENZOCAINE 20 %-MENTHOL 0.5 % TOPICAL AEROSOL [28048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16864-680-02","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 G"}]},{"description":"BENZOCAINE 20 %-MENTHOL 0.5 % TOPICAL AEROSOL [28048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16864-680-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 78 G"}]},{"description":"BENZOCAINE 20 %-MENTHOL 0.5 % TOPICAL AEROSOL [28048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16864-680-03","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"BENZOCAINE 6 MG-MENTHOL 10 MG LOZENGES [41085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7811201106","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 EACH"}]},{"description":"BENZOCAINE-BENZETHONIUM 20 %-0.2 % TOPICAL AEROSOL [24902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"5140900724","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 78 G"}]},{"description":"BENZOCAINE-BENZETHONIUM 20 %-0.2 % TOPICAL AEROSOL [24902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16864-670-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 78 G"}]},{"description":"BENZOCAINE-MENTHOL LOZENGES WRAPPER [40894141]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-0000-09","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 LOZENGE"}]},{"description":"BENZOCAINE-MENTHOL LOZENGES WRAPPER [40894141]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-0000-06","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 LOZENGE"}]},{"description":"BENZOIN-ALOE VERA-STORAX-TOLU BALSAM 10 %-2 %-8 %-4 % TOPICAL TINCTURE [130592]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0395-0243-92","type":"NDC"}],"standard_charges":[{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 ML"}]},{"description":"BENZONATATE 100 MG CAPSULE [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-247-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZOCAINE 10 % ORAL MUCOSAL LIQUID [81719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0573-0213-41","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"BENZONATATE 100 MG CAPSULE [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-133-88","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZETHONIUM CHLORIDE 0.2 % TOPICAL FILM-FORMING LIQUID [9741]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5140900700","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE [177646]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0517","type":"HCPCS"},{"code":"0310-1730-30","type":"NDC"}],"standard_charges":[{"gross_charge":11998.25,"discounted_cash":10078.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"BARICITINIB 1 MG TABLET [183710]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-4732-30","type":"NDC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":381.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":907.75,"discounted_cash":762.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1815.5,"discounted_cash":1525.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"BARICITINIB 2 MG TABLET [178609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-4182-30","type":"NDC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":190.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":454.0,"discounted_cash":381.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":907.75,"discounted_cash":762.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"BCG VACCINE, LIVE (PF) 50 MG PERCUTANEOUS INJECTION SUSPENSION [119001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9030","type":"HCPCS"},{"code":"0052-0603-02","type":"NDC"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":653.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION [186215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0173-0896-01","type":"NDC"}],"standard_charges":[{"gross_charge":14153.75,"discounted_cash":11889.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":20733.75,"discounted_cash":17416.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.9 MG/KG"}]},{"description":"BELATACEPT 250 MG INTRAVENOUS SOLUTION [110675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0003-0371-13","type":"NDC"}],"standard_charges":[{"gross_charge":10911.75,"discounted_cash":9165.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":5456.0,"discounted_cash":4583.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0490","type":"HCPCS"},{"code":"49401-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":2316.0,"discounted_cash":1945.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"BELIMUMAB 400 MG INTRAVENOUS SOLUTION [108843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0490","type":"HCPCS"},{"code":"49401-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":6271.0,"discounted_cash":5267.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":12087.25,"discounted_cash":10153.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION [168989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63459-348-04","type":"NDC"}],"standard_charges":[{"gross_charge":9024.5,"discounted_cash":7580.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION [168989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42367-520-25","type":"NDC"}],"standard_charges":[{"gross_charge":9024.5,"discounted_cash":7580.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION [168989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-6228-0","type":"NDC"}],"standard_charges":[{"gross_charge":11884.25,"discounted_cash":9982.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BENZETHONIUM CHLORIDE 0.2 % TOPICAL FILM-FORMING LIQUID [9741]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16864-440-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BENZONATATE 100 MG CAPSULE [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-029-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZTROPINE 1 MG TABLET [999]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7289-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BENZTROPINE 1 MG/ML INJECTION SOLUTION [9259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"0143-9729-05","type":"NDC"}],"standard_charges":[{"gross_charge":308.25,"discounted_cash":258.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BENZTROPINE 1 MG/ML INJECTION SOLUTION [9259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"0143-9233-01","type":"NDC"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":186.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BENZTROPINE 1 MG/ML INJECTION SOLUTION [9259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"0143-9233-05","type":"NDC"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":186.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BENZYLPENICILLOYL POLYLYSINE 0.25 ML INTRADERMAL INJECTION SOLUTION [9260]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49471-001-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.01 ML"}]},{"description":"BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"0517-0720-01","type":"NDC"}],"standard_charges":[{"gross_charge":178.5,"discounted_cash":149.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"0085-4320-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"51754-5060-1","type":"NDC"}],"standard_charges":[{"gross_charge":129.75,"discounted_cash":108.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"78206-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":119.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0056-15","type":"NDC"}],"standard_charges":[{"gross_charge":252.75,"discounted_cash":212.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"BETAMETHASONE VALERATE 0.1 % LOTION [1032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54879-004-60","type":"NDC"}],"standard_charges":[{"gross_charge":296.75,"discounted_cash":249.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0040-15","type":"NDC"}],"standard_charges":[{"gross_charge":152.25,"discounted_cash":127.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0040-46","type":"NDC"}],"standard_charges":[{"gross_charge":234.75,"discounted_cash":197.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0326-15","type":"NDC"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":126.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0033-15","type":"NDC"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM [9175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-376-35","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"BETAXOLOL 0.25 % EYE DROPS,SUSPENSION [19703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0246-10","type":"NDC"}],"standard_charges":[{"gross_charge":1400.75,"discounted_cash":1176.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BETAXOLOL 0.25 % EYE DROPS,SUSPENSION [19703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0729-10","type":"NDC"}],"standard_charges":[{"gross_charge":1742.75,"discounted_cash":1463.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BETAXOLOL 0.5 % EYE DROPS [9268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-705-11","type":"NDC"}],"standard_charges":[{"gross_charge":484.75,"discounted_cash":407.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BENZTROPINE 1 MG TABLET [999]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-368-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BENZTROPINE 1 MG TABLET [999]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-368-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BENZONATATE 100 MG CAPSULE [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-346-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZONATATE 100 MG CAPSULE [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-346-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZONATATE 100 MG CAPSULE [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6564-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZONATATE 100 MG CAPSULE [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-714-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZONATATE 100 MG CAPSULE [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51224-010-60","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZONATATE 100 MG CAPSULE [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71205-853-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZTROPINE 0.5 MG TABLET [998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-356-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BENZTROPINE 0.5 MG TABLET [998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-356-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BENZTROPINE 1 MG TABLET [999]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BENZOYL PEROXIDE 10 % TOPICAL GEL [989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1056-56","type":"NDC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"67457-256-00","type":"NDC"}],"standard_charges":[{"gross_charge":799.75,"discounted_cash":671.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG/KG"},{"gross_charge":1066.25,"discounted_cash":895.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":691.5,"discounted_cash":580.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BUMETANIDE 0.5 MG TABLET [9309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-831-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUMETANIDE 0.5 MG TABLET [9309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-130-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUMETANIDE 0.5 MG TABLET [9309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-130-15","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUMETANIDE 0.5 MG TABLET [9309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"14539-700-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":65.75,"discounted_cash":55.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"0409-1412-04","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"},{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1159-02","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0409-1559-10","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-464-31","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-464-37","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323-464-17","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150-167-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-168-30","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0409-1559-18","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0409-1159-18","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1159-19","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUMETANIDE 0.5 MG TABLET [9309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1489-1","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":65.75,"discounted_cash":55.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-464-02","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUMETANIDE 0.5 MG TABLET [9309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"0409-1412-34","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"0409-1412-40","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"70860-405-04","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"70860-405-41","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"70860-406-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"70860-406-41","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"68462-469-40","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"68462-469-54","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"68462-470-40","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"68462-470-54","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"72205-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"72205-101-07","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"72205-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"72205-102-07","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"65219-570-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"65219-570-04","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"65219-572-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"65219-572-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.5 MG TABLET [9309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0128-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1162-02","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1162-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-466-31","type":"NDC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [105633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1746-30","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [105633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0409-9042-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [105633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-468-37","type":"NDC"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":82.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [105633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9042-17","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [105633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1746-71","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [105633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9042-16","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [105633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0409-9042-11","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [105633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-468-02","type":"NDC"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":82.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [106364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9045-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [106364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-462-31","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [106364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-462-37","type":"NDC"}],"standard_charges":[{"gross_charge":105.75,"discounted_cash":88.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [106364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9045-17","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [106364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-462-17","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [106364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9045-16","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [106364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-9045-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [106364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-462-01","type":"NDC"}],"standard_charges":[{"gross_charge":105.75,"discounted_cash":88.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [106364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-462-04","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.75 %-1:200,000 INJECTION SOLUTION [128625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-460-37","type":"NDC"}],"standard_charges":[{"gross_charge":118.75,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.75 %-1:200,000 INJECTION SOLUTION [128625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-460-01","type":"NDC"}],"standard_charges":[{"gross_charge":118.75,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [14984]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1755-50","type":"NDC"}],"standard_charges":[{"gross_charge":148.25,"discounted_cash":124.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [14984]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-463-57","type":"NDC"}],"standard_charges":[{"gross_charge":168.25,"discounted_cash":141.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [14984]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-463-01","type":"NDC"}],"standard_charges":[{"gross_charge":168.25,"discounted_cash":141.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE-MELOXICAM ER 200 MG-6 MG/7 ML SURGICAL SITE INSTILL SOLN [188968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47426-303-01","type":"NDC"}],"standard_charges":[{"gross_charge":755.25,"discounted_cash":634.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION [112781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65250-266-09","type":"NDC"}],"standard_charges":[{"gross_charge":1712.75,"discounted_cash":1438.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION [112781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65250-266-04","type":"NDC"}],"standard_charges":[{"gross_charge":1712.75,"discounted_cash":1438.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION [112781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65250-266-20","type":"NDC"}],"standard_charges":[{"gross_charge":1712.75,"discounted_cash":1438.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJECTION SOLUTION [127123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"55150-249-50","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-466-37","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-466-17","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-169-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-170-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1162-18","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1162-19","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-466-03","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-466-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9331-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9331-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9334-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"0641-6008-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9334-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION [9316]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0409-1761-02","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION [9316]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0409-1761-19","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION [9316]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"36000-092-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION [9316]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"36000-092-10","type":"NDC"}],"standard_charges":[{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION [9316]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0409-1761-18","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION [9316]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0409-3613-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION [9316]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0409-1761-05","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION [9316]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0409-1761-10","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE [130064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0362-0557-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE [130064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0362-9011-50","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJECTION SOLUTION [127123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323-465-57","type":"NDC"}],"standard_charges":[{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION [9316]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0409-3613-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"0641-6008-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"0641-6007-10","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"0641-6007-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BREXPIPRAZOLE 3 MG TABLET [168111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148-039-13","type":"NDC"}],"standard_charges":[{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":170.75,"discounted_cash":143.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":253.75,"discounted_cash":213.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":336.5,"discounted_cash":282.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"BRIMONIDINE 0.1 % EYE DROPS [70262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-9321-05","type":"NDC"}],"standard_charges":[{"gross_charge":835.5,"discounted_cash":701.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE 0.1 % EYE DROPS [70262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-9321-10","type":"NDC"}],"standard_charges":[{"gross_charge":1670.0,"discounted_cash":1402.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BRIMONIDINE 0.1 % EYE DROPS [70262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82182-321-05","type":"NDC"}],"standard_charges":[{"gross_charge":793.75,"discounted_cash":666.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE 0.1 % EYE DROPS [70262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7177-75","type":"NDC"}],"standard_charges":[{"gross_charge":799.25,"discounted_cash":671.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE 0.15 % EYE DROPS [31158]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-9177-05","type":"NDC"}],"standard_charges":[{"gross_charge":890.75,"discounted_cash":748.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE 0.15 % EYE DROPS [31158]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-144-05","type":"NDC"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":661.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE 0.2 % EYE DROPS [17881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-411-05","type":"NDC"}],"standard_charges":[{"gross_charge":122.5,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE 0.2 % EYE DROPS [17881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-143-05","type":"NDC"}],"standard_charges":[{"gross_charge":177.75,"discounted_cash":149.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE 0.2 % EYE DROPS [17881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-143-15","type":"NDC"}],"standard_charges":[{"gross_charge":402.5,"discounted_cash":338.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BRIMONIDINE 0.2 % EYE DROPS [17881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-715-10","type":"NDC"}],"standard_charges":[{"gross_charge":177.75,"discounted_cash":149.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE 0.2 % EYE DROPS [17881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-231-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE 0.2 %-TIMOLOL 0.5 % EYE DROPS [87834]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-9211-05","type":"NDC"}],"standard_charges":[{"gross_charge":877.0,"discounted_cash":736.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION [22953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0275-10","type":"NDC"}],"standard_charges":[{"gross_charge":1474.75,"discounted_cash":1238.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BRINZOLAMIDE 1 %-BRIMONIDINE 0.2 % EYE DROPS,SUSPENSION [121821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-4147-27","type":"NDC"}],"standard_charges":[{"gross_charge":907.5,"discounted_cash":762.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET [9297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5325-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET [9297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0106-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"BREXPIPRAZOLE 2 MG TABLET [168110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148-038-13","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":129.5,"discounted_cash":108.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":253.75,"discounted_cash":213.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":378.0,"discounted_cash":317.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":502.25,"discounted_cash":421.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"67457-256-10","type":"NDC"}],"standard_charges":[{"gross_charge":799.75,"discounted_cash":671.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG/KG"},{"gross_charge":1066.25,"discounted_cash":895.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":691.5,"discounted_cash":580.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65293-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":3201.25,"discounted_cash":2689.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/ML"}]},{"description":"BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"0703-3154-01","type":"NDC"}],"standard_charges":[{"gross_charge":87.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":106.5,"discounted_cash":89.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UNITS"}]},{"description":"BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"61703-332-18","type":"NDC"}],"standard_charges":[{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UNITS"}]},{"description":"BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"63323-136-10","type":"NDC"}],"standard_charges":[{"gross_charge":83.75,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UNITS"}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET [9297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0106-03","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"BLOOD SUGAR DIAGNOSTIC STRIPS [127226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5388524450","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 STRIP"}]},{"description":"BLOOD SUGAR DIAGNOSTIC STRIPS [127226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5388599425","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 STRIP"}]},{"description":"BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION [111348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51144-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":69485.5,"discounted_cash":58367.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.8 MG/KG"}]},{"description":"BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION [111348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9042","type":"HCPCS"},{"code":"51144-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":25034.5,"discounted_cash":21028.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BRETYLIUM TOSYLATE 50 MG/ML INJECTION SOLUTION [1156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62559-870-11","type":"NDC"}],"standard_charges":[{"gross_charge":859.25,"discounted_cash":721.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"BREXPIPRAZOLE 0.5 MG TABLET [168108]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148-036-13","type":"NDC"}],"standard_charges":[{"gross_charge":253.75,"discounted_cash":213.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":502.25,"discounted_cash":421.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":999.5,"discounted_cash":839.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1496.5,"discounted_cash":1257.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":1993.75,"discounted_cash":1674.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"BLOOD SUGAR DIAGNOSTIC STRIPS [127226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5388524510","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 STRIP"}]},{"description":"BALSAM PERU-CASTOR OIL TOPICAL OINTMENT [180277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1647750260","type":"NDC"}],"standard_charges":[{"gross_charge":183.5,"discounted_cash":154.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET [9297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-286-11","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-829-01","type":"NDC"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":280.25,"discounted_cash":235.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":420.25,"discounted_cash":353.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BUDESONIDE DR-ER 9 MG TABLET,DELAYED AND EXTENDED RELEASE [119689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68012-309-30","type":"NDC"}],"standard_charges":[{"gross_charge":294.25,"discounted_cash":247.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0370-28","type":"NDC"}],"standard_charges":[{"gross_charge":785.25,"discounted_cash":659.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 G"}]},{"description":"BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-7370-20","type":"NDC"}],"standard_charges":[{"gross_charge":1442.75,"discounted_cash":1211.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.2 G"}]},{"description":"BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0372-28","type":"NDC"}],"standard_charges":[{"gross_charge":682.75,"discounted_cash":573.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.9 G"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"55390-500-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"55390-500-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"0409-1412-10","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-9855-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-778-10","type":"NDC"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":336.0,"discounted_cash":282.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":503.75,"discounted_cash":423.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET [9297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-286-21","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0093-6815-73","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0093-6815-45","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0781-7515-14","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0781-7515-87","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0487-9601-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"69097-318-87","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0115-1687-74","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0115-1687-76","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"69097-318-86","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0093-6815-19","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"69097-318-32","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"69097-318-53","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0093-6816-45","type":"NDC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0487-9701-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"60687-524-79","type":"NDC"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"60687-524-83","type":"NDC"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":63.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-7155-01","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":254.75,"discounted_cash":213.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":382.0,"discounted_cash":320.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"0093-6815-55","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BALSAM PERU-CASTOR OIL TOPICAL OINTMENT [180277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7583413960","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"BALSAM PERU-CASTOR OIL TOPICAL OINTMENT [180277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58980-780-21","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56.7 G"}]},{"description":"BALANCED SALT SOLUTION NON-SURGICAL NO.3 EYE WASH [10780]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0530-01","type":"NDC"}],"standard_charges":[{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0547-00","type":"NDC"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":363.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":216.5,"discounted_cash":181.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-062-72","type":"NDC"}],"standard_charges":[{"gross_charge":199.75,"discounted_cash":167.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":100.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-062-01","type":"NDC"}],"standard_charges":[{"gross_charge":413.75,"discounted_cash":347.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":207.0,"discounted_cash":173.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-062-18","type":"NDC"}],"standard_charges":[{"gross_charge":413.75,"discounted_cash":347.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":207.0,"discounted_cash":173.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-421-69","type":"NDC"}],"standard_charges":[{"gross_charge":449.5,"discounted_cash":377.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":224.75,"discounted_cash":188.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-534-40","type":"NDC"}],"standard_charges":[{"gross_charge":387.25,"discounted_cash":325.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":193.75,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-534-78","type":"NDC"}],"standard_charges":[{"gross_charge":387.25,"discounted_cash":325.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":193.75,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ATRACURIUM 10 MG/ML INTRAVENOUS SOLUTION [119142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-672-10","type":"NDC"}],"standard_charges":[{"gross_charge":129.75,"discounted_cash":108.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"0409-4910-34","type":"NDC"}],"standard_charges":[{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4911-34","type":"NDC"}],"standard_charges":[{"gross_charge":149.75,"discounted_cash":125.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1630-10","type":"NDC"}],"standard_charges":[{"gross_charge":83.25,"discounted_cash":69.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3339-1","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"0409-4910-11","type":"NDC"}],"standard_charges":[{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4911-11","type":"NDC"}],"standard_charges":[{"gross_charge":149.75,"discounted_cash":125.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1630-15","type":"NDC"}],"standard_charges":[{"gross_charge":83.25,"discounted_cash":69.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3340-1","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"16729-484-90","type":"NDC"}],"standard_charges":[{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"16729-484-31","type":"NDC"}],"standard_charges":[{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATOVAQUONE 250 MG-PROGUANIL 100 MG TABLET [23814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-404-44","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ATOVAQUONE 250 MG-PROGUANIL 100 MG TABLET [23814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-404-67","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-099-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3952-77","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":78.0,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-210-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-210-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6292-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5058-98","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":144.75,"discounted_cash":121.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"70121-1705-1","type":"NDC"}],"standard_charges":[{"gross_charge":77.5,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64253-400-30","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE [730]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64253-400-91","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE 1 MG/ML INTRAVENOUS SOLUTION [187563]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-641-25","type":"NDC"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION [173385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9023","type":"HCPCS"},{"code":"44087-3535-1","type":"NDC"}],"standard_charges":[{"gross_charge":23006.75,"discounted_cash":19325.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":5968.0,"discounted_cash":5013.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"AZACITIDINE 200 MG TABLET [186465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59572-730-14","type":"NDC"}],"standard_charges":[{"gross_charge":4594.5,"discounted_cash":3859.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6891.75,"discounted_cash":5789.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"AZACITIDINE 300 MG TABLET [186464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59572-740-14","type":"NDC"}],"standard_charges":[{"gross_charge":5513.25,"discounted_cash":4631.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"AZACITIDINE 300 MG TABLET [186464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59572-740-07","type":"NDC"}],"standard_charges":[{"gross_charge":5553.0,"discounted_cash":4664.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"AZATHIOPRINE 100 MG SOLUTION FOR INJECTION [767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7501","type":"HCPCS"},{"code":"0143-9566-01","type":"NDC"}],"standard_charges":[{"gross_charge":1071.0,"discounted_cash":899.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":825.75,"discounted_cash":693.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"}]},{"description":"AZATHIOPRINE 50 MG TABLET [9183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"68084-229-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"AZATHIOPRINE 50 MG TABLET [9183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"68084-229-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"AZATHIOPRINE 50 MG TABLET [9183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"68462-502-01","type":"NDC"}],"standard_charges":[{"gross_charge":92.25,"discounted_cash":77.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"AZATHIOPRINE 50 MG TABLET [9183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"51079-620-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"AZATHIOPRINE 50 MG TABLET [9183]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"51079-620-06","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATROPINE 1 MG/ML INTRAVENOUS SOLUTION [187563]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-641-01","type":"NDC"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE 1 MG/ML INTRAVENOUS SOLUTION [187563]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-1001-25","type":"NDC"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE 1 MG/ML INTRAVENOUS SOLUTION [187563]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-1001-01","type":"NDC"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE 1 MG/ML INJECTION SOLUTION [734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-1010-25","type":"NDC"}],"standard_charges":[{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"0517-0401-25","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6006-01","type":"NDC"}],"standard_charges":[{"gross_charge":284.75,"discounted_cash":239.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6006-10","type":"NDC"}],"standard_charges":[{"gross_charge":284.75,"discounted_cash":239.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"99999-0003-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION [731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"7700-0057-30","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION WRAPPER [196363]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"0517-1004-01","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION WRAPPER [196363]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"0517-1004-25","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [187562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"70069-631-01","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [187562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"70069-631-25","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE 1 % EYE DROPS [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-215-02","type":"NDC"}],"standard_charges":[{"gross_charge":260.5,"discounted_cash":218.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE 1 % EYE DROPS [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-215-05","type":"NDC"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE 1 % EYE DROPS [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-215-15","type":"NDC"}],"standard_charges":[{"gross_charge":678.5,"discounted_cash":569.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ATROPINE 1 % EYE DROPS [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0303-55","type":"NDC"}],"standard_charges":[{"gross_charge":238.5,"discounted_cash":200.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE 1 % EYE DROPS [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-6226-0","type":"NDC"}],"standard_charges":[{"gross_charge":247.5,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE 1 % EYE DROPS [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-6226-1","type":"NDC"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":191.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE 1 % EYE DROPS [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60219-1749-3","type":"NDC"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE 1 % EYE DROPS [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76478-015-05","type":"NDC"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE 1 % EYE OINTMENT [735]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-825-55","type":"NDC"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-099-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATOMOXETINE 10 MG CAPSULE [34444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-519-30","type":"NDC"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":173.25,"discounted_cash":145.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":240.5,"discounted_cash":202.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":384.75,"discounted_cash":323.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":577.0,"discounted_cash":484.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE 100 MG CAPSULE [70509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-720-30","type":"NDC"}],"standard_charges":[{"gross_charge":112.75,"discounted_cash":94.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":90.25,"discounted_cash":75.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATOMOXETINE 40 MG CAPSULE [34447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-3229-30","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":116.25,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":174.25,"discounted_cash":146.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE 40 MG CAPSULE [34447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-268-30","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":156.75,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE 40 MG CAPSULE [34447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-758-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":104.5,"discounted_cash":87.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":156.75,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE 10 MG CAPSULE [34444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-755-01","type":"NDC"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":173.25,"discounted_cash":145.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":240.5,"discounted_cash":202.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":384.5,"discounted_cash":322.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":576.75,"discounted_cash":484.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATENOLOL 50 MG TABLET [718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-023-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [181734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-918-01","type":"NDC"}],"standard_charges":[{"gross_charge":1385392.5,"discounted_cash":1163729.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"}]},{"description":"ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [171966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-917-01","type":"NDC"}],"standard_charges":[{"gross_charge":23157.75,"discounted_cash":19452.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"}]},{"description":"ATEZOLIZUMAB 1,875 MG-HYALURONIDASE-TQJS 30,000 UNIT/15 ML SUBCUT SOLN [199917]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-933-01","type":"NDC"}],"standard_charges":[{"gross_charge":23088.75,"discounted_cash":19394.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1875 MG"}]},{"description":"ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [181734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242-918-01","type":"NDC"}],"standard_charges":[{"gross_charge":969795.25,"discounted_cash":814628.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 840 MG"}]},{"description":"ATOMOXETINE 10 MG CAPSULE [34444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-3227-30","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":192.5,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":267.25,"discounted_cash":224.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":427.5,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":641.25,"discounted_cash":538.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE 10 MG CAPSULE [34444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-373-03","type":"NDC"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":173.25,"discounted_cash":145.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":240.5,"discounted_cash":202.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":384.75,"discounted_cash":323.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":577.0,"discounted_cash":484.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE 10 MG CAPSULE [34444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-265-30","type":"NDC"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":173.25,"discounted_cash":145.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":240.5,"discounted_cash":202.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":384.75,"discounted_cash":323.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":577.0,"discounted_cash":484.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATORVASTATIN 10 MG TABLET [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0155-23","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":216.5,"discounted_cash":181.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":432.75,"discounted_cash":363.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":865.5,"discounted_cash":727.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 10 MG TABLET [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-208-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 10 MG TABLET [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5056-98","type":"NDC"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":202.75,"discounted_cash":170.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":405.5,"discounted_cash":340.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0157-23","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":299.75,"discounted_cash":251.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0157-40","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":92.5,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":185.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2580-9","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":78.25,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 40 MG TABLET [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0157-2","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 10 MG TABLET [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-208-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 10 MG TABLET [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-0155-40","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":118.5,"discounted_cash":99.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":237.0,"discounted_cash":199.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":473.75,"discounted_cash":397.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 10 MG TABLET [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6290-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 10 MG TABLET [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2578-8","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":109.5,"discounted_cash":91.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":218.75,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 10 MG TABLET [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2578-9","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":109.5,"discounted_cash":91.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":218.75,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN 10 MG TABLET [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-097-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"BUPIVACAINE-MELOXICAM ER 200 MG-6 MG/7 ML SURGICAL SITE INSTILL SOLN [188968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47426-303-05","type":"NDC"}],"standard_charges":[{"gross_charge":755.25,"discounted_cash":634.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0833-5","type":"NDC"}],"standard_charges":[{"gross_charge":432.75,"discounted_cash":363.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"63323-402-01","type":"NDC"}],"standard_charges":[{"gross_charge":360.75,"discounted_cash":303.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"63323-402-41","type":"NDC"}],"standard_charges":[{"gross_charge":253.25,"discounted_cash":212.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"0409-0830-01","type":"NDC"}],"standard_charges":[{"gross_charge":329.5,"discounted_cash":276.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"0409-0830-11","type":"NDC"}],"standard_charges":[{"gross_charge":329.5,"discounted_cash":276.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"63323-401-41","type":"NDC"}],"standard_charges":[{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG/KG"}]},{"description":"B-COMPLEX WITH VITAMIN C TABLET [807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1191703949","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"B-COMPLEX WITH VITAMIN C TABLET [807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068112600","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BACITRACIN (BACITRACIN ZINC) 500 UNIT/GRAM TOPICAL OINTMENT WRAPPER [408850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0280-31","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"BACITRACIN (BACITRACIN ZINC) 500 UNIT/GRAM TOPICAL OINTMENT WRAPPER [408850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-060-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 G"}]},{"description":"BACITRACIN (BACITRACIN ZINC) 500 UNIT/GRAM TOPICAL OINTMENT WRAPPER [408850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-060-03","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"BACITRACIN (BACITRACIN ZINC) 500 UNIT/GRAM TOPICAL OINTMENT WRAPPER [408850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-154-72","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"BACITRACIN (BACITRACIN ZINC) 500 UNIT/GRAM TOPICAL OINTMENT WRAPPER [408850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2075-2","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"BACITRACIN (BACITRACIN/ZINC) 500 UNIT/GRAM TOPICAL PACKET WRAPPER [408128685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"A6250","type":"HCPCS"},{"code":"45802-060-70","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BACITRACIN (BACITRACIN/ZINC) 500 UNIT/GRAM TOPICAL PACKET WRAPPER [408128685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"A6250","type":"HCPCS"},{"code":"0904-6679-67","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BACITRACIN (BACITRACIN/ZINC) 500 UNIT/GRAM TOPICAL PACKET WRAPPER [408128685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"A6250","type":"HCPCS"},{"code":"57896-111-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BACITRACIN (BACITRACIN/ZINC) 500 UNIT/GRAM TOPICAL PACKET WRAPPER [408128685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"A6250","type":"HCPCS"},{"code":"57896-111-14","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BACITRACIN (BACITRACIN/ZINC) 500 UNIT/GRAM TOPICAL PACKET WRAPPER [408128685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"A6250","type":"HCPCS"},{"code":"0904-7023-67","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BACITRACIN (BACITRACIN/ZINC) 500 UNIT/GRAM TOPICAL PACKET WRAPPER [408128685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"A6250","type":"HCPCS"},{"code":"0904-8804-67","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BACITRACIN (BACITRACIN/ZINC) 500 UNIT/GRAM TOPICAL PACKET WRAPPER [408128685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"A6250","type":"HCPCS"},{"code":"45802-060-00","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BACITRACIN RIVA SYRINGE [408031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00000-0003-80","type":"NDC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":99.0,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25000 UNITS"},{"gross_charge":144.0,"discounted_cash":120.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"},{"gross_charge":135.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75000 UNITS"}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"63323-402-30","type":"NDC"}],"standard_charges":[{"gross_charge":360.75,"discounted_cash":303.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION [851]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0233-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25000 UNITS"},{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"},{"gross_charge":135.75,"discounted_cash":114.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75000 UNITS"}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"63323-402-24","type":"NDC"}],"standard_charges":[{"gross_charge":253.25,"discounted_cash":212.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":253.25,"discounted_cash":212.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":253.25,"discounted_cash":212.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 MG"}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"0003-2570-16","type":"NDC"}],"standard_charges":[{"gross_charge":292.5,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZITHROMYCIN 600 MG TABLET [17387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-314-95","type":"NDC"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":72.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 600 MG TABLET [17387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-084-30","type":"NDC"}],"standard_charges":[{"gross_charge":108.75,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"62756-512-44","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"0003-2560-16","type":"NDC"}],"standard_charges":[{"gross_charge":193.75,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"63323-401-20","type":"NDC"}],"standard_charges":[{"gross_charge":235.25,"discounted_cash":197.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"63323-401-24","type":"NDC"}],"standard_charges":[{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"63323-401-01","type":"NDC"}],"standard_charges":[{"gross_charge":235.25,"discounted_cash":197.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"0409-0829-01","type":"NDC"}],"standard_charges":[{"gross_charge":221.5,"discounted_cash":186.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"0409-0829-11","type":"NDC"}],"standard_charges":[{"gross_charge":221.5,"discounted_cash":186.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"63323-402-20","type":"NDC"}],"standard_charges":[{"gross_charge":360.75,"discounted_cash":303.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION [851]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0233-03","type":"NDC"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25000 UNITS"},{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"},{"gross_charge":135.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75000 UNITS"}]},{"description":"BACLOFEN 10 MG TABLET [860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2406-21","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BACLOFEN 10 MG TABLET [860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-071-04","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BACLOFEN 10 MG TABLET [860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-479-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BACLOFEN 10 MG TABLET [860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6475-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BACLOFEN 10 MG TABLET [860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-320-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BACLOFEN 10,000 MCG/20 ML (500 MCG/ML) INTRATHECAL SOLUTION [107799]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0475","type":"HCPCS"},{"code":"66794-155-02","type":"NDC"}],"standard_charges":[{"gross_charge":1106.75,"discounted_cash":929.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION [129309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0795-15","type":"NDC"}],"standard_charges":[{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION [129309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0795-50","type":"NDC"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":212.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"BACLOFEN 10 MG TABLET [860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-4096-60","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION [851]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-329-31","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25000 UNITS"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"},{"gross_charge":109.5,"discounted_cash":91.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75000 UNITS"}]},{"description":"BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION [851]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70594-026-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25000 UNITS"},{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"},{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75000 UNITS"}]},{"description":"BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION [851]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70594-026-02","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25000 UNITS"},{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"},{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75000 UNITS"}]},{"description":"BACITRACIN RIVA SYRINGE [408031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00000-0003-81","type":"NDC"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":120.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"BACITRACIN RIVA SYRINGE [408031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00000-0003-82","type":"NDC"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":158.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT [856]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-555-55","type":"NDC"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":131.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT [856]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-4021-35","type":"NDC"}],"standard_charges":[{"gross_charge":142.25,"discounted_cash":119.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM TOPICAL OINTMENT WRAPPER [185038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093956833","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM TOPICAL OINTMENT WRAPPER [185038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81079887","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.3 G"}]},{"description":"BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM TOPICAL OINTMENT WRAPPER [185038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2044-2","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM TOPICAL OINTMENT WRAPPER [185038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-1212-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"BACITRACIN 500 UNIT/GRAM EYE OINTMENT [852]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-4022-35","type":"NDC"}],"standard_charges":[{"gross_charge":533.25,"discounted_cash":447.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"AZITHROMYCIN 600 MG TABLET [17387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-314-25","type":"NDC"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":72.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-160-06","type":"NDC"}],"standard_charges":[{"gross_charge":210.5,"discounted_cash":176.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-282-01","type":"NDC"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-282-11","type":"NDC"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-787-10","type":"NDC"}],"standard_charges":[{"gross_charge":210.5,"discounted_cash":176.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-641-30","type":"NDC"}],"standard_charges":[{"gross_charge":210.5,"discounted_cash":176.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-098-15","type":"NDC"}],"standard_charges":[{"gross_charge":199.75,"discounted_cash":167.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":239.75,"discounted_cash":201.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":100.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":120.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-214-30","type":"NDC"}],"standard_charges":[{"gross_charge":432.75,"discounted_cash":363.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"AZITHROMYCIN 1 % EYE DROPS [81880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-307-03","type":"NDC"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":803.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [15797]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3120-1","type":"NDC"}],"standard_charges":[{"gross_charge":189.75,"discounted_cash":159.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [15797]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3140-1","type":"NDC"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [15797]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-149-32","type":"NDC"}],"standard_charges":[{"gross_charge":189.75,"discounted_cash":159.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [15797]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-008-15","type":"NDC"}],"standard_charges":[{"gross_charge":189.75,"discounted_cash":159.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-787-66","type":"NDC"}],"standard_charges":[{"gross_charge":210.5,"discounted_cash":176.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6708-06","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3060-2","type":"NDC"}],"standard_charges":[{"gross_charge":210.25,"discounted_cash":176.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":252.25,"discounted_cash":211.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3060-3","type":"NDC"}],"standard_charges":[{"gross_charge":210.25,"discounted_cash":176.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":252.25,"discounted_cash":211.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323-398-14","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"62756-512-40","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"55150-174-10","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70860-100-10","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70436-019-82","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70860-100-41","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"67457-860-00","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"67457-860-50","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323-398-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323-398-41","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70095-025-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70095-025-02","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 600 MG TABLET [17387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3080-1","type":"NDC"}],"standard_charges":[{"gross_charge":252.25,"discounted_cash":211.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 600 MG TABLET [17387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-789-10","type":"NDC"}],"standard_charges":[{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"0069-3150-84","type":"NDC"}],"standard_charges":[{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"60505-6076-4","type":"NDC"}],"standard_charges":[{"gross_charge":133.75,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"50111-794-78","type":"NDC"}],"standard_charges":[{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323-398-10","type":"NDC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6708-61","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":81.75,"discounted_cash":68.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51224-022-30","type":"NDC"}],"standard_charges":[{"gross_charge":210.25,"discounted_cash":176.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":252.25,"discounted_cash":211.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-251-30","type":"NDC"}],"standard_charges":[{"gross_charge":210.5,"discounted_cash":176.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 250 MG TABLET [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-082-30","type":"NDC"}],"standard_charges":[{"gross_charge":210.5,"discounted_cash":176.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":252.5,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":126.25,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"0069-3150-83","type":"NDC"}],"standard_charges":[{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"BUPIVACAINE-MELOXICAM ER 400 MG-12 MG/14 ML SURGICAL SITE INSTILL SOLN [188966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47426-501-02","type":"NDC"}],"standard_charges":[{"gross_charge":1330.5,"discounted_cash":1117.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3657-21","type":"NDC"}],"standard_charges":[{"gross_charge":470.75,"discounted_cash":395.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR [27634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4123-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR [27634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-8016-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR [27634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-6022-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0511-05","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4124-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5987-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-561-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR [27634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0510-05","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-3854-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"CARBAMAZEPINE 200 MG TABLET [1357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-385-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CARBAMAZEPINE 200 MG TABLET [1357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-385-20","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CARBAMAZEPINE 200 MG TABLET [1357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4005-1","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CARBAMAZEPINE 200 MG TABLET [1357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6172-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CARBAMAZEPINE 200 MG TABLET [1357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-444-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CARBAMAZEPINE 200 MG TABLET [1357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-444-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CARBAMAZEPINE 200 MG TABLET [1357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-221-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION WRAPPER [408732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4047-9","type":"NDC"}],"standard_charges":[{"gross_charge":364.5,"discounted_cash":306.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 ML"}]},{"description":"CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION WRAPPER [408732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-007-59","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION WRAPPER [408732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-007-62","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION WRAPPER [408732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-008-59","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION WRAPPER [408732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-008-62","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION WRAPPER [408732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5210-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR [27635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-561-21","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET [9406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-107-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET [9406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71205-877-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET [9406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-456-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2539-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-093-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-518-18","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-518-88","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0085-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET [9406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0078-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET [9406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-517-88","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR [27633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092-173-12","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR [27633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29033-004-12","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR [27633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-409-32","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4041-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS [1359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4203710478","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS [1359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-339-05","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS [1359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7811273623","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS [1359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6627-35","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS [1359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-1153-1","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS [1359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-1154-1","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET [9406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2538-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS [1359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7811273621","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-870-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"CALCIUM POLYCARBOPHIL 625 MG TABLET [11046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333-120-50","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CALFACTANT 35 MG/ML IN 0.9% SODIUM CHLORIDE INTRATRACHEAL SUSPENSION [23500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61938-456-06","type":"NDC"}],"standard_charges":[{"gross_charge":65708.5,"discounted_cash":55195.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML/KG"},{"gross_charge":131417.0,"discounted_cash":110390.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML/KG"}]},{"description":"CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION [23063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0316-0229-75","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 222 ML"}]},{"description":"CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION [23063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1268-12","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 222 ML"}]},{"description":"CANAGLIFLOZIN 100 MG TABLET [121562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-140-30","type":"NDC"}],"standard_charges":[{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":485.25,"discounted_cash":407.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CANAGLIFLOZIN 100 MG TABLET [121562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-140-90","type":"NDC"}],"standard_charges":[{"gross_charge":161.75,"discounted_cash":135.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":485.25,"discounted_cash":407.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CANAGLIFLOZIN 100 MG TABLET [121562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-140-01","type":"NDC"}],"standard_charges":[{"gross_charge":133.75,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":400.75,"discounted_cash":336.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CANGRELOR 50 MG INTRAVENOUS SOLUTION [168010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9460","type":"HCPCS"},{"code":"10122-620-01","type":"NDC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MCG/KG"}]},{"description":"CANGRELOR 50 MG INTRAVENOUS SOLUTION [168010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9460","type":"HCPCS"},{"code":"10122-620-10","type":"NDC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MCG/KG"}]},{"description":"CAPMATINIB 150 MG TABLET [185302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0078-0709-56","type":"NDC"}],"standard_charges":[{"gross_charge":1195.0,"discounted_cash":1003.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1790.0,"discounted_cash":1503.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":2385.0,"discounted_cash":2003.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CAPMATINIB 200 MG TABLET [185303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0078-0716-56","type":"NDC"}],"standard_charges":[{"gross_charge":897.5,"discounted_cash":753.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1343.75,"discounted_cash":1128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":1790.0,"discounted_cash":1503.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CAPSAICIN 0.025 % TOPICAL CREAM [1350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-2525-25","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"CAPSAICIN 0.025 % TOPICAL CREAM [1350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-195-60","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"CAPTOPRIL 1 MG/ML ORAL SUSPENSION [400478]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-0000-50","type":"NDC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CAPTOPRIL 12.5 MG TABLET [9401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1171-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.25,"discounted_cash":70.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CALCIUM POLYCARBOPHIL 625 MG TABLET [11046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333-120-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CALCIUM POLYCARBOPHIL 625 MG TABLET [11046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-2500-91","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"0143-9180-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9180-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"0143-9180-25","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9180-25","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323-360-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CALCIUM POLYCARBOPHIL 625 MG TABLET [11046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0005-2500-23","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CALCIUM POLYCARBOPHIL 625 MG TABLET [11046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0005-2500-33","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CALCIUM POLYCARBOPHIL 625 MG TABLET [11046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-4306-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CALCIUM POLYCARBOPHIL 625 MG TABLET [11046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-4306-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CAPTOPRIL 25 MG TABLET [9402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1172-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CAPTOPRIL 25 MG TABLET [9402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-864-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CAPTOPRIL 25 MG TABLET [9402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-864-20","type":"NDC"}],"standard_charges":[{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CAPTOPRIL 25 MG-HYDROCHLOROTHIAZIDE 15 MG TABLET [9395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0081-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CAPTOPRIL 12.5 MG TABLET [9401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-304-21","type":"NDC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CAPTOPRIL 12.5 MG TABLET [9401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-863-01","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CAPTOPRIL 12.5 MG TABLET [9401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-863-20","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CAPTOPRIL 12.5 MG TABLET [9401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5045-61","type":"NDC"}],"standard_charges":[{"gross_charge":91.75,"discounted_cash":77.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARBAMAZEPINE 100 MG CHEWABLE TABLET [1355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0778-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"CAPTOPRIL 12.5 MG TABLET [9401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-304-11","type":"NDC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6237-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARVEDILOL 3.125 MG TABLET [18551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-092-05","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 3.125 MG TABLET [18551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6300-61","type":"NDC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":113.75,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 6.25 MG TABLET [15747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0007-4140-20","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 6.25 MG TABLET [15747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0135-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 6.25 MG TABLET [15747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3632-05","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 6.25 MG TABLET [15747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-930-20","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 6.25 MG TABLET [15747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0135-05","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 3.125 MG TABLET [18551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-771-20","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG TABLET [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888-036-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG TABLET [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7307-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 3.125 MG TABLET [18551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0007-4139-20","type":"NDC"}],"standard_charges":[{"gross_charge":231.5,"discounted_cash":194.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":462.75,"discounted_cash":388.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 3.125 MG TABLET [18551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0051-01","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 3.125 MG TABLET [18551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3631-01","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 3.125 MG TABLET [18551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-771-01","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":115.5,"discounted_cash":97.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"72611-702-01","type":"NDC"}],"standard_charges":[{"gross_charge":487.25,"discounted_cash":409.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"0781-3421-01","type":"NDC"}],"standard_charges":[{"gross_charge":481.75,"discounted_cash":404.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":481.75,"discounted_cash":404.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"0781-3423-94","type":"NDC"}],"standard_charges":[{"gross_charge":507.5,"discounted_cash":426.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":507.5,"discounted_cash":426.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"CASTOR OIL 100 % ORAL [98399]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0395-0515-16","type":"NDC"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"CASTOR OIL 100 % ORAL [98399]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0869-0078-16","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 ML"}]},{"description":"CASTOR OIL ORAL [34862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4460-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CEFADROXIL 500 MG CAPSULE [9436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-388-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN 1 GRAM IN 100 ML 0.9 % SODIUM CHLORIDE (PREMIX) [408029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00000-0003-58","type":"NDC"}],"standard_charges":[{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0781-3451-96","type":"NDC"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0143-9924-90","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"63323-237-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505-0749-5","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"25021-101-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567-707-25","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"25021-101-67","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"0781-3423-01","type":"NDC"}],"standard_charges":[{"gross_charge":507.5,"discounted_cash":426.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"67457-832-70","type":"NDC"}],"standard_charges":[{"gross_charge":1351.5,"discounted_cash":1135.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"47781-614-07","type":"NDC"}],"standard_charges":[{"gross_charge":487.25,"discounted_cash":409.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CARVEDILOL 6.25 MG TABLET [15747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6301-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 6.25 MG TABLET [15747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-854-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 6.25 MG TABLET [15747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888-035-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"63323-356-10","type":"NDC"}],"standard_charges":[{"gross_charge":1443.75,"discounted_cash":1212.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"67457-831-50","type":"NDC"}],"standard_charges":[{"gross_charge":1300.75,"discounted_cash":1092.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"70860-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":808.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"47781-613-07","type":"NDC"}],"standard_charges":[{"gross_charge":462.5,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"0781-3421-94","type":"NDC"}],"standard_charges":[{"gross_charge":481.75,"discounted_cash":404.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"72266-106-01","type":"NDC"}],"standard_charges":[{"gross_charge":350.5,"discounted_cash":294.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"63323-356-01","type":"NDC"}],"standard_charges":[{"gross_charge":1443.75,"discounted_cash":1212.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"72611-700-01","type":"NDC"}],"standard_charges":[{"gross_charge":462.5,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"0006-3823-10","type":"NDC"}],"standard_charges":[{"gross_charge":1503.25,"discounted_cash":1262.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"70860-107-10","type":"NDC"}],"standard_charges":[{"gross_charge":1049.75,"discounted_cash":881.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"0006-3822-10","type":"NDC"}],"standard_charges":[{"gross_charge":1446.75,"discounted_cash":1215.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CARVEDILOL 12.5 MG TABLET [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6302-61","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [26371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-923-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [26371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-457-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [26371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-282-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [26371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-282-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [26371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-3919-68","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [26371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-079-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703-339-22","type":"NDC"}],"standard_charges":[{"gross_charge":256.75,"discounted_cash":215.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703-339-50","type":"NDC"}],"standard_charges":[{"gross_charge":450.5,"discounted_cash":378.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703-339-56","type":"NDC"}],"standard_charges":[{"gross_charge":547.75,"discounted_cash":460.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"0703-4248-01","type":"NDC"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":499.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"63323-172-60","type":"NDC"}],"standard_charges":[{"gross_charge":943.75,"discounted_cash":792.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"0703-4244-01","type":"NDC"}],"standard_charges":[{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"0703-4246-01","type":"NDC"}],"standard_charges":[{"gross_charge":238.5,"discounted_cash":200.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"0703-4239-01","type":"NDC"}],"standard_charges":[{"gross_charge":604.25,"discounted_cash":507.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"0703-4239-81","type":"NDC"}],"standard_charges":[{"gross_charge":604.25,"discounted_cash":507.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729-295-12","type":"NDC"}],"standard_charges":[{"gross_charge":649.5,"discounted_cash":545.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729-295-33","type":"NDC"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":213.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [26371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-923-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [26371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0094-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-108-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-661-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-661-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET [9408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-094-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET [9408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-836-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729-295-34","type":"NDC"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":499.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET [9408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-836-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [126194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-978-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [126194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-978-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [126194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-461-88","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [126194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-281-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [126194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-281-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [126194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-078-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"75834-171-19","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"55150-386-01","type":"NDC"}],"standard_charges":[{"gross_charge":475.25,"discounted_cash":399.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"54288-165-01","type":"NDC"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":242.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARMUSTINE 100 MG INTRAVENOUS SOLUTION [28911]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9050","type":"HCPCS"},{"code":"23155-261-41","type":"NDC"}],"standard_charges":[{"gross_charge":7886.0,"discounted_cash":6624.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CARVEDILOL 12.5 MG TABLET [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0007-4141-20","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG TABLET [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7295-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG TABLET [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-931-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG TABLET [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-931-20","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG TABLET [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-094-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARISOPRODOL 350 MG TABLET [1395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69584-111-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MG"}]},{"description":"CARISOPRODOL 350 MG TABLET [1395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657-645-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MG"}]},{"description":"CARISOPRODOL 350 MG TABLET [1395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-109-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MG"}]},{"description":"CARISOPRODOL 350 MG TABLET [1395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-510-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MG"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"54288-166-01","type":"NDC"}],"standard_charges":[{"gross_charge":632.75,"discounted_cash":531.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"60505-6282-3","type":"NDC"}],"standard_charges":[{"gross_charge":317.5,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBOPLATIN 150 MG INTRAVENOUS SOLUTION [9410]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"63323-167-21","type":"NDC"}],"standard_charges":[{"gross_charge":767.75,"discounted_cash":644.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0856-08","type":"NDC"}],"standard_charges":[{"gross_charge":689.0,"discounted_cash":578.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1377.75,"discounted_cash":1157.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0856-05","type":"NDC"}],"standard_charges":[{"gross_charge":689.0,"discounted_cash":578.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1377.75,"discounted_cash":1157.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-698-11","type":"NDC"}],"standard_charges":[{"gross_charge":1366.75,"discounted_cash":1148.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":2733.25,"discounted_cash":2295.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-698-58","type":"NDC"}],"standard_charges":[{"gross_charge":1366.75,"discounted_cash":1148.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":2733.25,"discounted_cash":2295.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"54288-164-01","type":"NDC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":145.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-459-01","type":"NDC"}],"standard_charges":[{"gross_charge":728.25,"discounted_cash":611.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1456.5,"discounted_cash":1223.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-459-10","type":"NDC"}],"standard_charges":[{"gross_charge":728.25,"discounted_cash":611.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1456.5,"discounted_cash":1223.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"0409-2344-62","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/ML"},{"gross_charge":112.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG/ML"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"INDUCTION 4:1 HIGH K (48 MEQ) IN RINGER'S 522.8 ML [177573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71285-0206-1","type":"NDC"}],"standard_charges":[{"gross_charge":362.25,"discounted_cash":304.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 522.8 ML"}]},{"description":"INDUCTION 4:1 HIGH K (48 MEQ) IN RINGER'S 522.8 ML [177573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72196-0206-1","type":"NDC"}],"standard_charges":[{"gross_charge":64189.0,"discounted_cash":53918.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 522.8 ML"}]},{"description":"CARDIOPLEGIA WARM INDUCT 4:1 40 MEQ/500 ML (POTASSIUM) PERFUSION SOLN [192863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"71285-0002-1","type":"NDC"}],"standard_charges":[{"gross_charge":717.25,"discounted_cash":602.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [179380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"76075-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":2226.5,"discounted_cash":1870.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [172100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"76075-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":5311.0,"discounted_cash":4461.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"CARISOPRODOL 250 MG TABLET [88406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51525-5901-1","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":36.25,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MG"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"75834-171-19","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"75834-171-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0135-55","type":"NDC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0415-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0415-60","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3541-60","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-392-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-392-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-737-86","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-737-88","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-751-60","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-536-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0410-60","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3540-60","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-391-20","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-736-86","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-697-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-697-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-288-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6585-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUSPIRONE 10 MG TABLET [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-986-20","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUSPIRONE 10 MG TABLET [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-742-06","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUSPIRONE 10 MG TABLET [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-742-07","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUSPIRONE 5 MG TABLET [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0053-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUSPIRONE 5 MG TABLET [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0053-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUSPIRONE 5 MG TABLET [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1140-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUSPIRONE 10 MG TABLET [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0054-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-752-05","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-752-60","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-175-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7214-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0410-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-101-03","type":"NDC"}],"standard_charges":[{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3331-19","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3331-30","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-414-30","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUSPIRONE 10 MG TABLET [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0054-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0947-55","type":"NDC"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":89.5,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":119.25,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET [34711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"50383-924-93","type":"NDC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":306.25,"discounted_cash":257.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":122.5,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET [34711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"62756-459-83","type":"NDC"}],"standard_charges":[{"gross_charge":243.25,"discounted_cash":204.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":304.0,"discounted_cash":255.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":61.0,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET [34711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"42858-501-03","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET [34711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"60687-481-11","type":"NDC"}],"standard_charges":[{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":165.5,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET [34711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"60687-481-21","type":"NDC"}],"standard_charges":[{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":165.5,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"BUPRENORPHINE HCL 150 MCG BUCCAL FILM [168743]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"59385-022-60","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"}]},{"description":"BUPRENORPHINE HCL 150 MCG BUCCAL FILM [168743]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"59385-022-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"}]},{"description":"BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3657-40","type":"NDC"}],"standard_charges":[{"gross_charge":470.75,"discounted_cash":395.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1203-2","type":"NDC"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":430.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"BUPRENORPHINE 12 MG-NALOXONE 3 MG SUBLINGUAL FILM [119051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-358-03","type":"NDC"}],"standard_charges":[{"gross_charge":118.75,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 FILM"}]},{"description":"BUPRENORPHINE 12 MG-NALOXONE 3 MG SUBLINGUAL FILM [119051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-358-11","type":"NDC"}],"standard_charges":[{"gross_charge":118.75,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 FILM"}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM [106176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7216-64","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 FILM"}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM [106176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7216-06","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 FILM"}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET [34713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0572","type":"HCPCS"},{"code":"65162-416-03","type":"NDC"}],"standard_charges":[{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET [34713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0572","type":"HCPCS"},{"code":"0054-0188-13","type":"NDC"}],"standard_charges":[{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET [34713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0572","type":"HCPCS"},{"code":"50268-144-11","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET [34713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0572","type":"HCPCS"},{"code":"50268-144-15","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET [34713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0572","type":"HCPCS"},{"code":"62756-969-83","type":"NDC"}],"standard_charges":[{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET [34712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"0054-0177-13","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"BUPRENORPHINE 4 MG-NALOXONE 1 MG SUBLINGUAL FILM [119050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-356-03","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 FILM"}]},{"description":"BUPRENORPHINE 4 MG-NALOXONE 1 MG SUBLINGUAL FILM [119050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-8766-16","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 FILM"}]},{"description":"BUPRENORPHINE 4 MG-NALOXONE 1 MG SUBLINGUAL FILM [119050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-8766-93","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 FILM"}]},{"description":"BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-750-40","type":"NDC"}],"standard_charges":[{"gross_charge":264.25,"discounted_cash":221.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-372-01","type":"NDC"}],"standard_charges":[{"gross_charge":341.5,"discounted_cash":286.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-372-04","type":"NDC"}],"standard_charges":[{"gross_charge":341.5,"discounted_cash":286.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET [34714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0574","type":"HCPCS"},{"code":"65162-415-03","type":"NDC"}],"standard_charges":[{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET [34714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0574","type":"HCPCS"},{"code":"0054-0189-13","type":"NDC"}],"standard_charges":[{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET [34714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0574","type":"HCPCS"},{"code":"50268-145-11","type":"NDC"}],"standard_charges":[{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET [34714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0574","type":"HCPCS"},{"code":"50268-145-15","type":"NDC"}],"standard_charges":[{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET [34714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0574","type":"HCPCS"},{"code":"62175-458-32","type":"NDC"}],"standard_charges":[{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION [129811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0592","type":"HCPCS"},{"code":"12496-0757-1","type":"NDC"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"BUPRENORPHINE 4 MG-NALOXONE 1 MG SUBLINGUAL FILM [119050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-356-11","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 FILM"}]},{"description":"BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET [34712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"50383-930-93","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET [34712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"60687-492-11","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"BUPROPION HCL 75 MG TABLET [9322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-943-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 75 MG TABLET [9322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-943-20","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 75 MG TABLET [9322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0158-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 75 MG TABLET [9322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-191-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 75 MG TABLET [9322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-340-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 75 MG TABLET [9322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-340-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 75 MG TABLET [9322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6635-61","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 75 MG TABLET [9322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1053-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 75 MG TABLET [9322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0433-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET [34712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"60687-492-21","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"BUPROPION HCL 100 MG TABLET [9321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1064-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 100 MG TABLET [9321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-944-20","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 100 MG TABLET [9321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0157-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 100 MG TABLET [9321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-192-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET [34712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0571","type":"HCPCS"},{"code":"42858-502-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"BUPROPION HCL 100 MG TABLET [9321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-351-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 100 MG TABLET [9321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-351-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL 100 MG TABLET [9321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6636-61","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPIVACAINE-MELOXICAM ER 400 MG-12 MG/14 ML SURGICAL SITE INSTILL SOLN [188966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47426-501-04","type":"NDC"}],"standard_charges":[{"gross_charge":1330.5,"discounted_cash":1117.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"BUSPIRONE 5 MG TABLET [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-985-20","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) TABLET [1300]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904188361","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) TABLET [1300]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3786482799","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) TABLET [1300]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5164582799","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) TABLET [1300]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"2055500301","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET [19483]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"88165475","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET [19483]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904546052","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET [19483]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904546072","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET [19483]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6373929101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET [19483]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1000670038","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION [1299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0766-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"}]},{"description":"CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION [1299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4766-05","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"}]},{"description":"CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION [1299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4537-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"}]},{"description":"CALCIUM ACETATE 667 MG TABLET [184193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7132180320","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1334 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2001 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 667 MG"}]},{"description":"CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET [9020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1650002322","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET [9020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1650002324","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET [9020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51224-162-12","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"CALCIUM 315 MG (AS CITRATE)-VITAMIN D3 6.25 MCG (250 UNIT) TABLET [81854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026814715","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET [9020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5707400177","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"CALCIUM 315 MG (AS CITRATE)-VITAMIN D3 6.25 MCG (250 UNIT) TABLET [81854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026814711","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCITRIOL 0.5 MCG CAPSULE [9351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-663-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 1 MCG/ML ORAL SOLUTION [16218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-241-59","type":"NDC"}],"standard_charges":[{"gross_charge":1209.25,"discounted_cash":1015.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CALCITRIOL 1 MCG/ML ORAL SOLUTION [16218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-447-15","type":"NDC"}],"standard_charges":[{"gross_charge":2584.75,"discounted_cash":2171.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET [9385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"766074152","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET [9385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66553-004-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET [9385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0135-0071-27","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET [9385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3786400150","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET [9385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1048-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET [9385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6412-92","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET [9385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-0066-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET [9385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-0137-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIUM 315 MG (AS CITRATE)-VITAMIN D3 6.25 MCG (250 UNIT) TABLET [81854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093953244","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM 315 MG (AS CITRATE)-VITAMIN D3 6.25 MCG (250 UNIT) TABLET [81854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733311310","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG TABLET WRAPPER [184629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5952803312","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1334 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2001 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 667 MG"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64253-900-91","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-773-01","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-773-10","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4928-34","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":138.75,"discounted_cash":116.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":1108.25,"discounted_cash":930.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 G"}]},{"description":"CALCIUM GLUCONATE 1 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION [190013]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-622-01","type":"NDC"}],"standard_charges":[{"gross_charge":102.75,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"CALCIUM GLUCONATE 1 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION [190013]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-622-24","type":"NDC"}],"standard_charges":[{"gross_charge":102.75,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323-360-03","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-360-03","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323-360-19","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-360-19","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"75834-171-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4928-11","type":"NDC"}],"standard_charges":[{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":138.75,"discounted_cash":116.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1631-40","type":"NDC"}],"standard_charges":[{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":102.25,"discounted_cash":85.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG TABLET WRAPPER [184629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-621-02","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1334 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2001 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 667 MG"}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG TABLET WRAPPER [184629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-192-22","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1334 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2001 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 667 MG"}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG TABLET WRAPPER [184629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536133632","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1334 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2001 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 667 MG"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1631-10","type":"NDC"}],"standard_charges":[{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":102.25,"discounted_cash":85.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3304-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-6710-01","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-6710-10","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS WRAPPER [179357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64253-900-30","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCITRIOL 0.5 MCG CAPSULE [9351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"30698-144-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-345-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-396-65","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-625-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-253-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71205-981-72","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-553-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-553-13","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE [22294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1552-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE [22294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3219-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY [9328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10223-0201-3","type":"NDC"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":493.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"}]},{"description":"BUTORPHANOL 1 MG/ML INJECTION SOLUTION [9333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0595","type":"HCPCS"},{"code":"0409-1623-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUTORPHANOL 1 MG/ML INJECTION SOLUTION [9333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0595","type":"HCPCS"},{"code":"0409-1623-21","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUTORPHANOL 10 MG/ML NASAL SPRAY [9335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"S0012","type":"HCPCS"},{"code":"0054-3090-36","type":"NDC"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":332.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1695-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-396-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUSPIRONE 5 MG TABLET [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-985-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUSPIRONE 5 MG TABLET [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-180-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUSPIRONE 5 MG TABLET [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-200-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUTORPHANOL 10 MG/ML NASAL SPRAY [9335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"S0012","type":"HCPCS"},{"code":"0378-9639-43","type":"NDC"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"BUSPIRONE 5 MG TABLET [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1115-1","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUTALBITAL 25 MG-ACETAMINOPHEN 325 MG TABLET [169306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68047-752-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2544-21","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3369-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0595","type":"HCPCS"},{"code":"55390-184-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY [15738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0823-6","type":"NDC"}],"standard_charges":[{"gross_charge":487.25,"discounted_cash":409.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.7 ML"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY [15738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-161-11","type":"NDC"}],"standard_charges":[{"gross_charge":487.25,"discounted_cash":409.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.7 ML"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"67457-675-02","type":"NDC"}],"standard_charges":[{"gross_charge":7296.0,"discounted_cash":6128.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"24201-400-02","type":"NDC"}],"standard_charges":[{"gross_charge":3427.25,"discounted_cash":2878.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"43598-051-11","type":"NDC"}],"standard_charges":[{"gross_charge":9708.75,"discounted_cash":8155.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"63323-865-02","type":"NDC"}],"standard_charges":[{"gross_charge":3427.25,"discounted_cash":2878.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0007-13","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0007-25","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"30698-143-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-723-06","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7352-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-662-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-207-13","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-345-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALAMINE 8 %-ZINC OXIDE 8 % LOTION [28055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093914833","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"CALAMINE 8 %-ZINC OXIDE 8 % LOTION [28055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-2533-21","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"CALAMINE 8 %-ZINC OXIDE 8 % LOTION [28055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-011-34","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [1262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-2502-10","type":"NDC"}],"standard_charges":[{"gross_charge":119.25,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":238.5,"discounted_cash":200.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0595","type":"HCPCS"},{"code":"0409-1626-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0595","type":"HCPCS"},{"code":"0409-1626-21","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT [100272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-825-02","type":"NDC"}],"standard_charges":[{"gross_charge":11456534.75,"discounted_cash":9623489.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 UNITS/KG"}]},{"description":"C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS SOLUTION [133775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0597","type":"HCPCS"},{"code":"63833-835-01","type":"NDC"}],"standard_charges":[{"gross_charge":3714829.75,"discounted_cash":3120456.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS"}]},{"description":"C1 ESTERASE INHIBITOR, RECOMBINANT 2,100 UNIT INTRAVENOUS SOLUTION [126566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68012-350-01","type":"NDC"}],"standard_charges":[{"gross_charge":11784.75,"discounted_cash":9899.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"C1 ESTERASE INHIBITOR, RECOMBINANT 2,100 UNIT INTRAVENOUS SOLUTION [126566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68012-350-02","type":"NDC"}],"standard_charges":[{"gross_charge":11784.75,"discounted_cash":9899.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CADEXOMER IODINE 0.9 % TOPICAL GEL [12858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4056512249","type":"NDC"}],"standard_charges":[{"gross_charge":563.5,"discounted_cash":473.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 G"}]},{"description":"CADEXOMER IODINE 0.9 % TOPICAL GEL [12858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4056512256","type":"NDC"}],"standard_charges":[{"gross_charge":143.5,"discounted_cash":120.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION [109034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"63323-407-03","type":"NDC"}],"standard_charges":[{"gross_charge":203.25,"discounted_cash":170.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION [109034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"25021-601-03","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION [109034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"63323-407-04","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION [109034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"51754-0500-1","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION [109034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"55150-187-03","type":"NDC"}],"standard_charges":[{"gross_charge":217.75,"discounted_cash":182.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION [109034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"72485-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION [77411]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51754-0501-3","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION [77411]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-3210-00","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION [77411]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"7700-3210-00","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATENOLOL 50 MG TABLET [718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-023-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG IV WRAPPER [179356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-702-11","type":"NDC"}],"standard_charges":[{"gross_charge":6562.0,"discounted_cash":5512.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG/KG"}]},{"description":"ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG IV WRAPPER [179356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-2804-04","type":"NDC"}],"standard_charges":[{"gross_charge":6910.25,"discounted_cash":5804.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG/KG"},{"gross_charge":7774.0,"discounted_cash":6530.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG/KG"}]},{"description":"ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG IV WRAPPER [179356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-703-10","type":"NDC"}],"standard_charges":[{"gross_charge":6562.0,"discounted_cash":5512.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG/KG"}]},{"description":"ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG IV WRAPPER [179356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-705-01","type":"NDC"}],"standard_charges":[{"gross_charge":4991.25,"discounted_cash":4192.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG/KG"}]},{"description":"ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG IV WRAPPER [179356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-705-11","type":"NDC"}],"standard_charges":[{"gross_charge":4991.25,"discounted_cash":4192.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG/KG"}]},{"description":"ALPHA-1-PROTEINASE INHIBITOR (ZEMAIRA) 1000MG INTRAVENOUS SOLUTION [178025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0053-7201-02","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG/KG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG/KG"}]},{"description":"ALPRAZOLAM 0.25 MG TABLET [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2027-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 0.25 MG TABLET [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1061-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 0.25 MG TABLET [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1061-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 0.25 MG TABLET [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-788-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 0.25 MG TABLET [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3719-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG IV WRAPPER [179356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-2815-01","type":"NDC"}],"standard_charges":[{"gross_charge":6910.25,"discounted_cash":5804.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG/KG"},{"gross_charge":7774.0,"discounted_cash":6530.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG/KG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6571-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43063-935-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-349-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7041-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 300 MG TABLET [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5544-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALLOPURINOL 300 MG TABLET [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-206-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALLOPURINOL 300 MG TABLET [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-206-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALLOPURINOL 300 MG TABLET [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-713-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALLOPURINOL 300 MG TABLET [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-796-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALLOPURINOL 300 MG TABLET [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43063-934-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALLOPURINOL 500 MG INTRAVENOUS SOLUTION [25408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-187-50","type":"NDC"}],"standard_charges":[{"gross_charge":11817.75,"discounted_cash":9926.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":2363.75,"discounted_cash":1985.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ALLOPURINOL 500 MG INTRAVENOUS SOLUTION [25408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9533-01","type":"NDC"}],"standard_charges":[{"gross_charge":11559.75,"discounted_cash":9710.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALLOPURINOL 500 MG INTRAVENOUS SOLUTION [25408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-380-30","type":"NDC"}],"standard_charges":[{"gross_charge":8595.75,"discounted_cash":7220.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALPRAZOLAM 0.25 MG TABLET [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-676-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 2 MG TABLET [327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-0094-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALPROSTADIL 10 MCG INTRACAVERNOSAL KIT [21227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"0009-5181-01","type":"NDC"}],"standard_charges":[{"gross_charge":404.5,"discounted_cash":339.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MCG"}]},{"description":"ALPROSTADIL 20 MCG INTRACAVERNOSAL KIT [21228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"0009-5182-01","type":"NDC"}],"standard_charges":[{"gross_charge":520.75,"discounted_cash":437.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"ALPROSTADIL 500 MCG/ML INJECTION SOLUTION [9001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-3169-06","type":"NDC"}],"standard_charges":[{"gross_charge":793.5,"discounted_cash":666.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":793.5,"discounted_cash":666.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG/ML"},{"gross_charge":793.5,"discounted_cash":666.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG/ML"},{"gross_charge":793.5,"discounted_cash":666.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG/ML"}]},{"description":"ALTEPLASE 10 MG/10 ML INTRAVENOUS SYRINGE [177073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"7700-4500-10","type":"NDC"}],"standard_charges":[{"gross_charge":3210.25,"discounted_cash":2696.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"ALTEPLASE 100 MG *LOADING DOSE* [173443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-085-27","type":"NDC"}],"standard_charges":[{"gross_charge":18058.5,"discounted_cash":15169.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALPRAZOLAM 1 MG TABLET [326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5860-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 0.5 MG TABLET [325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2029-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 0.5 MG TABLET [325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1077-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 0.5 MG TABLET [325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-789-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 0.5 MG TABLET [325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3720-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-410-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALPRAZOLAM 0.5 MG TABLET [325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-677-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 1 MG TABLET [326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1079-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 1 MG TABLET [326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-790-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 1 MG TABLET [326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3721-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALTEPLASE 100 MG INTRAVENOUS SOLUTION [9002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-085-25","type":"NDC"}],"standard_charges":[{"gross_charge":18058.5,"discounted_cash":15169.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-041-12","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516-5214-3","type":"NDC"}],"standard_charges":[{"gross_charge":229.25,"discounted_cash":192.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":458.5,"discounted_cash":385.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516-5214-4","type":"NDC"}],"standard_charges":[{"gross_charge":229.25,"discounted_cash":192.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":458.5,"discounted_cash":385.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"76125-790-25","type":"NDC"}],"standard_charges":[{"gross_charge":236.5,"discounted_cash":198.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":472.75,"discounted_cash":397.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"76125-790-26","type":"NDC"}],"standard_charges":[{"gross_charge":236.5,"discounted_cash":198.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":472.75,"discounted_cash":397.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206-310-91","type":"NDC"}],"standard_charges":[{"gross_charge":386.75,"discounted_cash":324.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":773.5,"discounted_cash":649.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68982-623-03","type":"NDC"}],"standard_charges":[{"gross_charge":342.25,"discounted_cash":287.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":684.5,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"64208-2510-5","type":"NDC"}],"standard_charges":[{"gross_charge":135.75,"discounted_cash":114.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":271.5,"discounted_cash":228.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"0487-9904-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"0487-9904-25","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"0378-6992-52","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"0378-6992-98","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"ALBUTEROL SULFATE 2 MG TABLET [253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-657-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ALBUTEROL SULFATE 2 MG TABLET [253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-657-20","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ALBUTEROL SULFATE 2 MG TABLET [253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-176-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP [252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0825-16","type":"NDC"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":595.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206-310-90","type":"NDC"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":888.0,"discounted_cash":745.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516-5214-2","type":"NDC"}],"standard_charges":[{"gross_charge":229.25,"discounted_cash":192.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":458.5,"discounted_cash":385.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION [35775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0180","type":"HCPCS"},{"code":"58468-0040-1","type":"NDC"}],"standard_charges":[{"gross_charge":112433.75,"discounted_cash":94444.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION [38494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0180","type":"HCPCS"},{"code":"58468-0041-1","type":"NDC"}],"standard_charges":[{"gross_charge":62891.0,"discounted_cash":52828.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":4078.75,"discounted_cash":3426.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"AL HYD-MG TR-ALG AC-SOD BICARB 80 MG-14.2 MG CHEWABLE TABLET [88365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0088-1175-47","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AL HYD-MG TR-ALG AC-SOD BICARB 80 MG-14.2 MG CHEWABLE TABLET [88365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0135-0096-26","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ALBENDAZOLE 200 MG TABLET [8979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-237-72","type":"NDC"}],"standard_charges":[{"gross_charge":817.25,"discounted_cash":686.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALBENDAZOLE 200 MG TABLET [8979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-051-08","type":"NDC"}],"standard_charges":[{"gross_charge":817.25,"discounted_cash":686.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [8981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"0944-0493-04","type":"NDC"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":479.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAPPER [189795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"44206-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":773.5,"discounted_cash":649.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAPPER [189795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"0944-0493-02","type":"NDC"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":479.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAPPER [189795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"64208-2512-7","type":"NDC"}],"standard_charges":[{"gross_charge":230.25,"discounted_cash":193.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAPPER [189795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"64208-2512-8","type":"NDC"}],"standard_charges":[{"gross_charge":230.25,"discounted_cash":193.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAPPER [189795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68516-5216-8","type":"NDC"}],"standard_charges":[{"gross_charge":459.25,"discounted_cash":385.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION WRAPPER [189795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68516-5216-0","type":"NDC"}],"standard_charges":[{"gross_charge":459.25,"discounted_cash":385.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206-310-25","type":"NDC"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":888.0,"discounted_cash":745.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206-310-50","type":"NDC"}],"standard_charges":[{"gross_charge":386.75,"discounted_cash":324.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":773.5,"discounted_cash":649.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION WRAPPER [187744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516-5214-1","type":"NDC"}],"standard_charges":[{"gross_charge":229.25,"discounted_cash":192.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":458.5,"discounted_cash":385.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP [252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4479-05","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"0487-9501-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"76204-200-30","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5543-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-205-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-205-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-156-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-988-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-988-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 100 MG TABLET [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-729-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION [76353]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0221","type":"HCPCS"},{"code":"58468-0160-2","type":"NDC"}],"standard_charges":[{"gross_charge":3008.5,"discounted_cash":2527.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION [76353]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0221","type":"HCPCS"},{"code":"58468-0160-1","type":"NDC"}],"standard_charges":[{"gross_charge":3624.0,"discounted_cash":3044.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALENDRONATE 70 MG TABLET [29048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-342-14","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":79.25,"discounted_cash":66.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"76204-200-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION [129406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7611","type":"HCPCS"},{"code":"0487-9901-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0682-20","type":"NDC"}],"standard_charges":[{"gross_charge":281.25,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 G"}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0682-24","type":"NDC"}],"standard_charges":[{"gross_charge":148.5,"discounted_cash":124.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 G"}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-142-60","type":"NDC"}],"standard_charges":[{"gross_charge":304.25,"discounted_cash":255.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.7 G"}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-963-01","type":"NDC"}],"standard_charges":[{"gross_charge":304.25,"discounted_cash":255.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.5 G"}]},{"description":"ALCOHOL SWABS [28196]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8290326895","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [165407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0202","type":"HCPCS"},{"code":"58468-0200-1","type":"NDC"}],"standard_charges":[{"gross_charge":50427.75,"discounted_cash":42359.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 ML"},{"gross_charge":12658.5,"discounted_cash":10633.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"ALENDRONATE 35 MG TABLET [29072]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-632-01","type":"NDC"}],"standard_charges":[{"gross_charge":139.5,"discounted_cash":117.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":278.75,"discounted_cash":234.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"ALENDRONATE 35 MG TABLET [29072]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-632-02","type":"NDC"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":276.75,"discounted_cash":232.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"ALENDRONATE 70 MG TABLET [29048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-633-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [31310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242-041-64","type":"NDC"}],"standard_charges":[{"gross_charge":793.5,"discounted_cash":666.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALTEPLASE 50 MG INTRAVENOUS SOLUTION [9003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242-044-13","type":"NDC"}],"standard_charges":[{"gross_charge":9029.25,"discounted_cash":7584.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALTEPLASE 50 MG INTRAVENOUS SOLUTION [9003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242-044-06","type":"NDC"}],"standard_charges":[{"gross_charge":9029.25,"discounted_cash":7584.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0147-60","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":100.5,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0147-89","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":107.5,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-227-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-227-14","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-371-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-241-90","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-437-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-437-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-051-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0147-15","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":95.5,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET [9063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-225-30","type":"NDC"}],"standard_charges":[{"gross_charge":302.75,"discounted_cash":254.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":605.5,"discounted_cash":508.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":908.0,"discounted_cash":762.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"},{"gross_charge":1513.25,"discounted_cash":1271.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION [403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0281","type":"HCPCS"},{"code":"0409-4346-73","type":"NDC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"},{"gross_charge":177.0,"discounted_cash":148.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION [407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"0409-5921-01","type":"NDC"}],"standard_charges":[{"gross_charge":147.25,"discounted_cash":123.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION [407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"0409-5921-16","type":"NDC"}],"standard_charges":[{"gross_charge":68.25,"discounted_cash":57.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG/KG"},{"gross_charge":147.25,"discounted_cash":123.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION [128748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"0409-5922-01","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"AMIODARONE 100 MG TABLET [36959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-240-30","type":"NDC"}],"standard_charges":[{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":100.5,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":201.0,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 100 MG TABLET [36959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-843-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":100.5,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":201.0,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV [110257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"43066-150-10","type":"NDC"}],"standard_charges":[{"gross_charge":280.5,"discounted_cash":235.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0147-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":107.5,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMIODARONE 200 MG TABLET [9066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6993-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMITRIPTYLINE 10 MG TABLET [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2212-21","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 10 MG TABLET [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-131-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 10 MG TABLET [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-131-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 10 MG TABLET [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-171-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 10 MG TABLET [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-419-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMISULPRIDE 5 MG/2 ML (2.5 MG/ML) INTRAVENOUS SOLUTION [186170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0184","type":"HCPCS"},{"code":"71390-125-21","type":"NDC"}],"standard_charges":[{"gross_charge":470.75,"discounted_cash":395.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":235.5,"discounted_cash":197.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV [110258]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"43066-360-20","type":"NDC"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":236.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [93084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323-616-03","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [93084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323-616-09","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [93084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457-153-18","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [93084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"0143-9875-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [93084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"0143-9875-25","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [93084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"55150-180-03","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [93084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"55150-181-09","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [93084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323-616-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.8 MG/ML"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [93084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323-616-02","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE 900 MG/500 ML (1.8 MG/ML) IN 0.9 % NORMAL SALINE [1132804]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-4571-50","type":"NDC"}],"standard_charges":[{"gross_charge":296.75,"discounted_cash":249.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"AMIODARONE 900 MG/500 ML (1.8 MG/ML) IN DEXTROSE 5 % INTRAVENOUS SOLN [132802]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"7700-4571-51","type":"NDC"}],"standard_charges":[{"gross_charge":296.75,"discounted_cash":249.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"AMISULPRIDE 10 MG/4 ML (2.5 MG/ML) INTRAVENOUS SOLUTION [188348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0184","type":"HCPCS"},{"code":"71390-125-50","type":"NDC"}],"standard_charges":[{"gross_charge":470.75,"discounted_cash":395.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":235.5,"discounted_cash":197.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMISULPRIDE 10 MG/4 ML (2.5 MG/ML) INTRAVENOUS SOLUTION [188348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0184","type":"HCPCS"},{"code":"71390-125-51","type":"NDC"}],"standard_charges":[{"gross_charge":470.75,"discounted_cash":395.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":235.5,"discounted_cash":197.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMISULPRIDE 5 MG/2 ML (2.5 MG/ML) INTRAVENOUS SOLUTION [186170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0184","type":"HCPCS"},{"code":"71390-125-20","type":"NDC"}],"standard_charges":[{"gross_charge":470.75,"discounted_cash":395.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":235.5,"discounted_cash":197.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMIODARONE 900 MG/500 ML (1.8 MG/ML) IN DEXTROSE 5 % INTRAVENOUS SOLN [132802]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"70092-1005-38","type":"NDC"}],"standard_charges":[{"gross_charge":236.5,"discounted_cash":198.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET [9063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-049-30","type":"NDC"}],"standard_charges":[{"gross_charge":302.75,"discounted_cash":254.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":605.5,"discounted_cash":508.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":908.0,"discounted_cash":762.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"},{"gross_charge":1513.25,"discounted_cash":1271.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1271-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION [37605]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1760-30","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALVIMOPAN 12 MG CAPSULE [91870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67919-020-10","type":"NDC"}],"standard_charges":[{"gross_charge":779.25,"discounted_cash":654.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ALVIMOPAN 12 MG CAPSULE [91870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2312-15","type":"NDC"}],"standard_charges":[{"gross_charge":740.25,"discounted_cash":621.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ALVIMOPAN 12 MG CAPSULE [91870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2312-45","type":"NDC"}],"standard_charges":[{"gross_charge":740.25,"discounted_cash":621.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"AMANTADINE HCL 100 MG CAPSULE [364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2048-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"AMANTADINE HCL 100 MG CAPSULE [364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-069-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"AMANTADINE HCL 100 MG CAPSULE [364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-069-15","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"AMANTADINE HCL 100 MG CAPSULE [364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-142-20","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"AMANTADINE HCL 100 MG CAPSULE [364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42543-493-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"AMANTADINE HCL 100 MG CAPSULE [364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-246-31","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"AMANTADINE HCL 100 MG CAPSULE [364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7042-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION [365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0646-16","type":"NDC"}],"standard_charges":[{"gross_charge":299.5,"discounted_cash":251.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION [365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-807-16","type":"NDC"}],"standard_charges":[{"gross_charge":299.5,"discounted_cash":251.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION [365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-093-16","type":"NDC"}],"standard_charges":[{"gross_charge":289.75,"discounted_cash":243.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION [365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4477-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"AMIFOSTINE CRYSTALLINE 500 MG INTRAVENOUS SOLUTION [20803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0207","type":"HCPCS"},{"code":"47335-581-42","type":"NDC"}],"standard_charges":[{"gross_charge":1613.5,"discounted_cash":1355.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION [108133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"0703-9040-01","type":"NDC"}],"standard_charges":[{"gross_charge":167.75,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION [108133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"0703-9040-03","type":"NDC"}],"standard_charges":[{"gross_charge":167.75,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION [108133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"23155-290-32","type":"NDC"}],"standard_charges":[{"gross_charge":123.75,"discounted_cash":103.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION [108133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"23155-290-42","type":"NDC"}],"standard_charges":[{"gross_charge":123.75,"discounted_cash":103.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION [108133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"0641-6166-01","type":"NDC"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7325-73","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7325-62","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUM, AMMONIUM (BULK) POWDER [122531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"395004912","type":"NDC"}],"standard_charges":[{"gross_charge":506.5,"discounted_cash":425.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 340 G"}]},{"description":"ALUMINUM HYDROX-MAGNESIUM CARB 160 MG-105 MG CHEWABLE TABLET [9016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"88117447","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION [353]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-0091-85","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION [353]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-0091-3","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION [353]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2335-30","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-019-39","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1761-30","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-629-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION [108133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"0641-6166-10","type":"NDC"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-060-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-060-99","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1293-83","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1317-83","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-159-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP [38285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-159-77","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION [108131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"0703-9032-03","type":"NDC"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG/KG"},{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION [108131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"23155-290-41","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION [403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0281","type":"HCPCS"},{"code":"0517-9120-25","type":"NDC"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"},{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION [403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0281","type":"HCPCS"},{"code":"0409-4346-16","type":"NDC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION [403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0281","type":"HCPCS"},{"code":"0517-9120-01","type":"NDC"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"},{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET [9063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49411-050-30","type":"NDC"}],"standard_charges":[{"gross_charge":330.25,"discounted_cash":277.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":660.25,"discounted_cash":554.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":990.25,"discounted_cash":831.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"},{"gross_charge":1650.5,"discounted_cash":1386.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET [9063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69680-115-30","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":193.5,"discounted_cash":162.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":290.25,"discounted_cash":243.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"},{"gross_charge":483.75,"discounted_cash":406.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET [9063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60219-1637-3","type":"NDC"}],"standard_charges":[{"gross_charge":302.75,"discounted_cash":254.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":605.5,"discounted_cash":508.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":908.0,"discounted_cash":762.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"},{"gross_charge":1513.25,"discounted_cash":1271.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION [9062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-447-08","type":"NDC"}],"standard_charges":[{"gross_charge":7456.25,"discounted_cash":6263.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 236.5 ML"}]},{"description":"AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION [186872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0206-04","type":"NDC"}],"standard_charges":[{"gross_charge":742.25,"discounted_cash":623.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION [186872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0206-01","type":"NDC"}],"standard_charges":[{"gross_charge":742.25,"discounted_cash":623.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D10W IN IV SOLUTION [185446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-1145-03","type":"NDC"}],"standard_charges":[{"gross_charge":376.75,"discounted_cash":316.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION [108131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"0641-6167-01","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"AMINO ACID 10 % INTRAVENOUS SOLUTION [127063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-9341-55","type":"NDC"}],"standard_charges":[{"gross_charge":373.75,"discounted_cash":313.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"AMINO ACID 10 % INTRAVENOUS SOLUTION [127063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-1933-10","type":"NDC"}],"standard_charges":[{"gross_charge":362.5,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION [108131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"23155-290-31","type":"NDC"}],"standard_charges":[{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"AMINO ACID 2.75 % NO.2-DEXTROSE 5 %-ELECTROLYTES NO.29 IV SOLUTION [27946]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-1142-03","type":"NDC"}],"standard_charges":[{"gross_charge":360.25,"discounted_cash":302.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"AMINO ACID 2.75 % NO.2-DEXTROSE 5 %-ELECTROLYTES NO.29 IV SOLUTION [27946]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-7020-06","type":"NDC"}],"standard_charges":[{"gross_charge":360.25,"discounted_cash":302.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"AMINO ACID 4.25 % NO.1 IN DEXTROSE 10 % INTRAVENOUS SOLUTION [27928]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-1134-03","type":"NDC"}],"standard_charges":[{"gross_charge":398.25,"discounted_cash":334.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"AMINO ACID 4.25 % NO.1-DEXTROSE 10 %-ELETROLYTES NO.39 IV SOLUTION [27951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-7026-01","type":"NDC"}],"standard_charges":[{"gross_charge":376.75,"discounted_cash":316.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"AMINO ACID 4.25 % NO.1-DEXTROSE 10 %-ELETROLYTES NO.39 IV SOLUTION [27951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-7026-06","type":"NDC"}],"standard_charges":[{"gross_charge":376.75,"discounted_cash":316.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"AMINO ACID 5 % NO.6 IN DEXTROSE 20 % INTRAVENOUS SOLUTION [27933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-1101-04","type":"NDC"}],"standard_charges":[{"gross_charge":545.25,"discounted_cash":458.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"AMINO ACID 5 % NO.6 IN DEXTROSE 20 % INTRAVENOUS SOLUTION [27933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-1138-03","type":"NDC"}],"standard_charges":[{"gross_charge":364.5,"discounted_cash":306.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"AMINO ACID 5 % NO.6-DEXTROSE 20 %-ELECTROLYTES NO.23 IV SOLUTION [27964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-1148-03","type":"NDC"}],"standard_charges":[{"gross_charge":364.5,"discounted_cash":306.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"AMINO ACID 2.75 % NO.2-DEXTROSE 5 %-ELECTROLYTES NO.29 IV SOLUTION [27946]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-7020-01","type":"NDC"}],"standard_charges":[{"gross_charge":360.25,"discounted_cash":302.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION [2367]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7120-07","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 G"},{"gross_charge":195.75,"discounted_cash":164.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2338-32","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-161-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-161-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-033-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-372-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-604-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-604-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG/12.5 ML (12.5 ML) ORAL SOLUTION [134259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-079-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG/12.5 ML (12.5 ML) ORAL SOLUTION [134259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-079-13","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG/12.5 ML (12.5 ML) ORAL SOLUTION [134259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1008-00","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG/12.5 ML (12.5 ML) ORAL SOLUTION [134259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1008-12","type":"NDC"}],"standard_charges":[{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY [104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2116-2","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY [104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2116-4","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY [104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2116-0","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-123-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2338-21","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580-496-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0484-62","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML ORAL SOLUTION [14468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0504-16","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML ORAL SOLUTION [14468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-079-16","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML ORAL SOLUTION [14468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1928-12","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION [132105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0657-05","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION [132105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0657-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION [132105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-054-99","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1781-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-015-62","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1781-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-015-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-015-59","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-231-59","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-231-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-231-62","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-061-59","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-061-62","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [132104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5623-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"}]},{"description":"ACETAMINOPHEN 240 MG-CODEINE 24 MG/10 ML (10 ML) ORAL SOLUTION [134257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-0079-2","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0150-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET [14087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0484-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645-703-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION [132106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-055-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION [132106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-055-99","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION [132106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6739-71","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION [132106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81033-002-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION [132106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81033-002-40","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION [132106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39328-032-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION [132106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39328-032-50","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SUSPENSION [88504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-330-59","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.15 ML"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SUSPENSION [88504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-330-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.15 ML"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-152-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580-449-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16103-376-08","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3786400103","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45044909","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"00000-0004-38","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION [132106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1314-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION [132106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1314-00","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3786400101","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-973-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45049660","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483-340-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML (5 ML) ORAL SOLUTION [134246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-079-06","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-102-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6773-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580-496-98","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580-458-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1327-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG TABLET [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-087-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML (5 ML) ORAL SOLUTION [134246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-079-05","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACARBOSE 25 MG TABLET [22148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0140-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ACARBOSE 25 MG TABLET [22148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50419-863-51","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ACARBOSE 25 MG TABLET [22148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-758-06","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ACEBUTOLOL 200 MG CAPSULE [8939]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"53746-669-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"43825-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":116.75,"discounted_cash":98.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":175.25,"discounted_cash":147.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43825-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":233.5,"discounted_cash":196.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"24201-100-24","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24201-100-24","type":"NDC"}],"standard_charges":[{"gross_charge":87.75,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"55150-307-24","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-307-24","type":"NDC"}],"standard_charges":[{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACARBOSE 100 MG TABLET [15896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-760-06","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ABIRATERONE 250 MG TABLET [109776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57894-150-12","type":"NDC"}],"standard_charges":[{"gross_charge":1968.0,"discounted_cash":1653.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ABACAVIR 20 MG/ML ORAL SOLUTION [24439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-222-48","type":"NDC"}],"standard_charges":[{"gross_charge":724.25,"discounted_cash":608.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"ABACAVIR 20 MG/ML ORAL SOLUTION [24439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-5176-15","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ABACAVIR 20 MG/ML ORAL SOLUTION [24439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-405-24","type":"NDC"}],"standard_charges":[{"gross_charge":645.25,"discounted_cash":542.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"ABACAVIR 300 MG TABLET [24438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-221-18","type":"NDC"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":156.0,"discounted_cash":131.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"55150-307-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ABACAVIR 300 MG TABLET [24438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4105-91","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":140.75,"discounted_cash":118.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ABACAVIR 300 MG TABLET [24438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-073-60","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":140.75,"discounted_cash":118.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ABACAVIR 300 MG TABLET [24438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-514-03","type":"NDC"}],"standard_charges":[{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":135.25,"discounted_cash":113.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ABACAVIR 300 MG-LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET [29167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-217-18","type":"NDC"}],"standard_charges":[{"gross_charge":180.25,"discounted_cash":151.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ABACAVIR 300 MG-LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET [29167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-286-07","type":"NDC"}],"standard_charges":[{"gross_charge":162.75,"discounted_cash":136.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [126772]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-231-13","type":"NDC"}],"standard_charges":[{"gross_charge":644.25,"discounted_cash":541.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-206-13","type":"NDC"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":182.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-288-06","type":"NDC"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":216.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-362-02","type":"NDC"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":216.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5382-56","type":"NDC"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":216.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6730-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-307-01","type":"NDC"}],"standard_charges":[{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"36000-306-60","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"36000-306-60","type":"NDC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"0781-9274-06","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":181.25,"discounted_cash":152.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-9274-06","type":"NDC"}],"standard_charges":[{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9386-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"0143-9386-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9386-10","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY [103]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-732-30","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY [103]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2115-2","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY [103]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2115-0","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML (5 ML) ORAL SOLUTION [134246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0504-05","type":"NDC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML (5 ML) ORAL SOLUTION [134246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-0079-5","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-4100-90","type":"NDC"}],"standard_charges":[{"gross_charge":65.5,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0136","type":"HCPCS"},{"code":"0264-4100-90","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":49.25,"discounted_cash":41.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"0781-3156-95","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":181.25,"discounted_cash":152.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3156-95","type":"NDC"}],"standard_charges":[{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"0781-3156-06","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":181.25,"discounted_cash":152.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3156-06","type":"NDC"}],"standard_charges":[{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"24201-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24201-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":87.75,"discounted_cash":73.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0134","type":"HCPCS"},{"code":"63323-434-00","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-434-00","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0134","type":"HCPCS"},{"code":"63323-434-41","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-434-41","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"67457-940-10","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":122.5,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":183.75,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-940-10","type":"NDC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"AMITRIPTYLINE 10 MG TABLET [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-037-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-204-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6730-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"55150-154-10","type":"NDC"}],"standard_charges":[{"gross_charge":84.25,"discounted_cash":70.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323-325-10","type":"NDC"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-325-10","type":"NDC"}],"standard_charges":[{"gross_charge":236.25,"discounted_cash":198.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323-325-20","type":"NDC"}],"standard_charges":[{"gross_charge":88.25,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-325-20","type":"NDC"}],"standard_charges":[{"gross_charge":176.25,"discounted_cash":148.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-154-10","type":"NDC"}],"standard_charges":[{"gross_charge":167.5,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"55150-155-20","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-155-20","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":105.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323-325-14","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-325-14","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML ORAL SUSPENSION [81428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0520-08","type":"NDC"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACYCLOVIR 200 MG CAPSULE [8969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0042-6","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 200 MG CAPSULE [8969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5789-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 200 MG CAPSULE [8969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-107-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 200 MG CAPSULE [8969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-124-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-810-16","type":"NDC"}],"standard_charges":[{"gross_charge":1600.25,"discounted_cash":1344.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1736-05","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-681-47","type":"NDC"}],"standard_charges":[{"gross_charge":1600.25,"discounted_cash":1344.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"ACYCLOVIR 5 % TOPICAL OINTMENT [8968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-8700-06","type":"NDC"}],"standard_charges":[{"gross_charge":1427.75,"discounted_cash":1199.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"ACYCLOVIR 5 % TOPICAL OINTMENT [8968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-1159-30","type":"NDC"}],"standard_charges":[{"gross_charge":2334.75,"discounted_cash":1961.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"ACYCLOVIR 5 % TOPICAL OINTMENT [8968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-550-68","type":"NDC"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":484.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"ACYCLOVIR 5 % TOPICAL OINTMENT [8968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-550-67","type":"NDC"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":484.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"ACYCLOVIR 5 % TOPICAL OINTMENT [8968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-515-01","type":"NDC"}],"standard_charges":[{"gross_charge":1427.75,"discounted_cash":1199.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"ACYCLOVIR 5 % TOPICAL OINTMENT [8968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-885-01","type":"NDC"}],"standard_charges":[{"gross_charge":1295.75,"discounted_cash":1088.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"ACYCLOVIR 5 % TOPICAL OINTMENT [8968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72578-082-01","type":"NDC"}],"standard_charges":[{"gross_charge":1427.75,"discounted_cash":1199.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"ACYCLOVIR 800 MG TABLET [8972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-5307-1","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 800 MG TABLET [8972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61442-113-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 800 MG TABLET [8972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-778-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 800 MG TABLET [8972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-109-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 800 MG TABLET [8972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-062-11","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 800 MG TABLET [8972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-062-15","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 800 MG TABLET [8972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-792-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323-325-24","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-325-24","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323-325-03","type":"NDC"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION [15330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"0409-1932-02","type":"NDC"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":341.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.84 MG/KG"},{"gross_charge":376.0,"discounted_cash":315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":601.75,"discounted_cash":505.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 96 MG"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION [120087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-087-01","type":"NDC"}],"standard_charges":[{"gross_charge":15148.75,"discounted_cash":12724.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MG/KG"},{"gross_charge":22723.25,"discounted_cash":19087.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.6 MG/KG"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [120086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-088-01","type":"NDC"}],"standard_charges":[{"gross_charge":32822.25,"discounted_cash":27570.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.6 MG/KG"}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE [8975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"25021-301-67","type":"NDC"}],"standard_charges":[{"gross_charge":129.75,"discounted_cash":108.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION [38703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323-651-00","type":"NDC"}],"standard_charges":[{"gross_charge":177.5,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-325-03","type":"NDC"}],"standard_charges":[{"gross_charge":236.25,"discounted_cash":198.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323-325-09","type":"NDC"}],"standard_charges":[{"gross_charge":88.25,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-325-09","type":"NDC"}],"standard_charges":[{"gross_charge":176.25,"discounted_cash":148.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-325-41","type":"NDC"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"ACYCLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION [8974]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55390-612-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ADALIMUMAB 40 MG/0.8 ML SUBCUTANEOUS SYRINGE KIT [34652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J0135","type":"HCPCS"},{"code":"0074-3799-02","type":"NDC"}],"standard_charges":[{"gross_charge":10223.0,"discounted_cash":8587.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION [15330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"0703-8777-01","type":"NDC"}],"standard_charges":[{"gross_charge":453.25,"discounted_cash":380.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.84 MG/KG"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION [15330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"17478-544-30","type":"NDC"}],"standard_charges":[{"gross_charge":590.75,"discounted_cash":496.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.84 MG/KG"}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION [38703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323-651-02","type":"NDC"}],"standard_charges":[{"gross_charge":177.5,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":88.75,"discounted_cash":74.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION [38703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457-855-02","type":"NDC"}],"standard_charges":[{"gross_charge":101.25,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION [38703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457-855-00","type":"NDC"}],"standard_charges":[{"gross_charge":101.25,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION [38703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"25021-318-02","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML ORAL SUSPENSION [81428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0520-76","type":"NDC"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72611-860-04","type":"NDC"}],"standard_charges":[{"gross_charge":483.25,"discounted_cash":405.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"},{"gross_charge":483.25,"discounted_cash":405.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG/KG"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"72611-860-04","type":"NDC"}],"standard_charges":[{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"}]},{"description":"ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"0517-7504-25","type":"NDC"}],"standard_charges":[{"gross_charge":176.25,"discounted_cash":148.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":176.25,"discounted_cash":148.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"0517-7510-03","type":"NDC"}],"standard_charges":[{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"0409-3307-03","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"63323-693-10","type":"NDC"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"63323-695-04","type":"NDC"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":198.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":236.0,"discounted_cash":198.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION [122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"0517-7504-01","type":"NDC"}],"standard_charges":[{"gross_charge":176.25,"discounted_cash":148.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":176.25,"discounted_cash":148.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT [76641]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24208-539-20","type":"NDC"}],"standard_charges":[{"gross_charge":642.5,"discounted_cash":539.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":642.5,"discounted_cash":539.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":642.5,"discounted_cash":539.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580-457-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 500 MG/50 ML (10 MG/ML) INTRAVENOUS SOLUTION [187521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0136","type":"HCPCS"},{"code":"0264-4050-80","type":"NDC"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY [105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-730-30","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY [105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-730-32","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY [105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-730-33","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY [105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-730-00","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 80 MG RECTAL SUPPOSITORY [8946]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2114-2","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 80 MG RECTAL SUPPOSITORY [8946]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2114-4","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 80 MG RECTAL SUPPOSITORY [8946]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2114-0","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAZOLAMIDE 125 MG TABLET [112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4022-1","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAZOLAMIDE 125 MG TABLET [112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-287-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"0574-0805-30","type":"NDC"}],"standard_charges":[{"gross_charge":807.75,"discounted_cash":678.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ACETAZOLAMIDE 125 MG TABLET [112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-833-06","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION [114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"67457-853-50","type":"NDC"}],"standard_charges":[{"gross_charge":260.75,"discounted_cash":219.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":260.75,"discounted_cash":219.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION [114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"23155-313-31","type":"NDC"}],"standard_charges":[{"gross_charge":258.75,"discounted_cash":217.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-120-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29033-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-331-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ACETIC ACID 0.25 % IRRIGATION SOLUTION [8963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0656-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.5,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"ACETIC ACID 2 % EAR SOLUTION [17801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-741-15","type":"NDC"}],"standard_charges":[{"gross_charge":217.75,"discounted_cash":182.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ACETIC ACID 2 % EAR SOLUTION [17801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-889-15","type":"NDC"}],"standard_charges":[{"gross_charge":217.75,"discounted_cash":182.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ACETIC ACID 2 % EAR SOLUTION [17801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-816-15","type":"NDC"}],"standard_charges":[{"gross_charge":261.25,"discounted_cash":219.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION [114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"39822-0190-1","type":"NDC"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":179.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETAMINOPHEN 500 MG TABLET [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6720-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"63323-963-30","type":"NDC"}],"standard_charges":[{"gross_charge":542.75,"discounted_cash":455.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"55150-259-30","type":"NDC"}],"standard_charges":[{"gross_charge":262.75,"discounted_cash":220.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION [129454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0521-08","type":"NDC"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION [129454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0521-76","type":"NDC"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION [129452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0120-04","type":"NDC"}],"standard_charges":[{"gross_charge":450.5,"discounted_cash":378.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":112.75,"discounted_cash":94.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":225.25,"discounted_cash":189.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION [129452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0120-74","type":"NDC"}],"standard_charges":[{"gross_charge":450.5,"discounted_cash":378.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":112.75,"discounted_cash":94.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":225.25,"discounted_cash":189.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION [129452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0520-74","type":"NDC"}],"standard_charges":[{"gross_charge":450.5,"discounted_cash":378.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":112.75,"discounted_cash":94.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":225.25,"discounted_cash":189.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML ORAL SUSPENSION [81428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0120-08","type":"NDC"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML ORAL SUSPENSION [81428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0120-76","type":"NDC"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML ORAL SUSPENSION [81428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-203-08","type":"NDC"}],"standard_charges":[{"gross_charge":441.5,"discounted_cash":370.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":220.75,"discounted_cash":185.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":220.75,"discounted_cash":185.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION [129454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-201-08","type":"NDC"}],"standard_charges":[{"gross_charge":441.5,"discounted_cash":370.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":220.75,"discounted_cash":185.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":220.75,"discounted_cash":185.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"25021-812-30","type":"NDC"}],"standard_charges":[{"gross_charge":493.25,"discounted_cash":414.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"63323-963-21","type":"NDC"}],"standard_charges":[{"gross_charge":542.75,"discounted_cash":455.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"70069-788-01","type":"NDC"}],"standard_charges":[{"gross_charge":273.75,"discounted_cash":229.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"70069-788-04","type":"NDC"}],"standard_charges":[{"gross_charge":273.75,"discounted_cash":229.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"0517-7604-25","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"0409-3308-03","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"63323-690-30","type":"NDC"}],"standard_charges":[{"gross_charge":193.75,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":193.75,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"00000-0003-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"63323-694-04","type":"NDC"}],"standard_charges":[{"gross_charge":129.5,"discounted_cash":108.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":129.5,"discounted_cash":108.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"7700-5769-03","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7608","type":"HCPCS"},{"code":"0517-7604-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ACLIDINIUM BROMIDE 400 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER [117077]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-0800-39","type":"NDC"}],"standard_charges":[{"gross_charge":1160.0,"discounted_cash":974.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION [129454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0121-08","type":"NDC"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION [129454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0121-76","type":"NDC"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ARIPIPRAZOLE 2 MG TABLET [70306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-430-03","type":"NDC"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":729.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1303.5,"discounted_cash":1094.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":174.0,"discounted_cash":146.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1738.0,"discounted_cash":1459.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":434.5,"discounted_cash":364.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148-007-13","type":"NDC"}],"standard_charges":[{"gross_charge":315.5,"discounted_cash":265.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":473.25,"discounted_cash":397.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":631.0,"discounted_cash":530.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":157.75,"discounted_cash":132.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-217-30","type":"NDC"}],"standard_charges":[{"gross_charge":348.75,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":523.25,"discounted_cash":439.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":697.5,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-168-11","type":"NDC"}],"standard_charges":[{"gross_charge":326.25,"discounted_cash":274.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":489.5,"discounted_cash":411.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":65.25,"discounted_cash":54.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":652.5,"discounted_cash":548.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-662-30","type":"NDC"}],"standard_charges":[{"gross_charge":348.75,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":523.25,"discounted_cash":439.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":697.5,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-897-03","type":"NDC"}],"standard_charges":[{"gross_charge":348.5,"discounted_cash":292.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":522.75,"discounted_cash":439.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":696.75,"discounted_cash":585.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":174.25,"discounted_cash":146.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 2 MG TABLET [70306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-216-30","type":"NDC"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":732.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1307.75,"discounted_cash":1098.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1743.75,"discounted_cash":1464.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":436.0,"discounted_cash":366.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 2 MG TABLET [70306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-819-30","type":"NDC"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":732.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1307.75,"discounted_cash":1098.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1743.75,"discounted_cash":1464.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":436.0,"discounted_cash":366.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 2 MG TABLET [70306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-896-03","type":"NDC"}],"standard_charges":[{"gross_charge":871.0,"discounted_cash":731.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1306.5,"discounted_cash":1097.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":174.25,"discounted_cash":146.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1741.75,"discounted_cash":1463.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":435.5,"discounted_cash":365.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 2 MG TABLET [70306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-051-03","type":"NDC"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":732.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1307.75,"discounted_cash":1098.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1743.75,"discounted_cash":1464.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":436.0,"discounted_cash":366.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 2 MG TABLET [70306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-554-30","type":"NDC"}],"standard_charges":[{"gross_charge":871.75,"discounted_cash":732.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1307.75,"discounted_cash":1098.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1743.5,"discounted_cash":1464.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":436.0,"discounted_cash":366.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-897-09","type":"NDC"}],"standard_charges":[{"gross_charge":348.5,"discounted_cash":292.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":522.75,"discounted_cash":439.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":696.75,"discounted_cash":585.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":174.25,"discounted_cash":146.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-431-03","type":"NDC"}],"standard_charges":[{"gross_charge":347.75,"discounted_cash":292.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":521.5,"discounted_cash":438.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":695.25,"discounted_cash":584.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":174.0,"discounted_cash":146.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE ER 400 MG SUSPENSION, EXTENDED REL.INTRAMUSCULAR SYRINGE [165622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59148-072-80","type":"NDC"}],"standard_charges":[{"gross_charge":8579.0,"discounted_cash":7206.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ARIPIPRAZOLE LAUROXIL ER 1,064 MG/3.9 ML SUSPENSION,EXT.REL IM SYRINGE [174562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65757-404-01","type":"NDC"}],"standard_charges":[{"gross_charge":101.25,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1064 MG"},{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 441 MG"},{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 662 MG"},{"gross_charge":84.0,"discounted_cash":70.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 882 MG"}]},{"description":"ARIPIPRAZOLE LAUROXIL ER 1,064 MG/3.9 ML SUSPENSION,EXT.REL IM SYRINGE [174562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65757-404-03","type":"NDC"}],"standard_charges":[{"gross_charge":11377.75,"discounted_cash":9557.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1064 MG"},{"gross_charge":4715.75,"discounted_cash":3961.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 441 MG"},{"gross_charge":7079.0,"discounted_cash":5946.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 662 MG"},{"gross_charge":9431.5,"discounted_cash":7922.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 882 MG"}]},{"description":"ARIPIPRAZOLE LAUROXIL ER 882 MG/3.2 ML SUSPENSION, EXT.REL. IM SYRINGE [168621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65757-403-03","type":"NDC"}],"standard_charges":[{"gross_charge":11377.75,"discounted_cash":9557.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1064 MG"},{"gross_charge":4715.75,"discounted_cash":3961.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 441 MG"},{"gross_charge":7079.0,"discounted_cash":5946.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 662 MG"},{"gross_charge":9431.5,"discounted_cash":7922.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 882 MG"}]},{"description":"ARMODAFINIL 150 MG TABLET [96966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-215-30","type":"NDC"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":204.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":401.75,"discounted_cash":337.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ARMODAFINIL 200 MG TABLET [124465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-220-30","type":"NDC"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":204.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ARMODAFINIL 250 MG TABLET [96967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-225-30","type":"NDC"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":124.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":243.0,"discounted_cash":204.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ARMODAFINIL 50 MG TABLET [96965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63459-205-30","type":"NDC"}],"standard_charges":[{"gross_charge":299.5,"discounted_cash":251.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":495.75,"discounted_cash":416.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-279-01","type":"NDC"}],"standard_charges":[{"gross_charge":348.5,"discounted_cash":292.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":522.5,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":696.75,"discounted_cash":585.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":174.25,"discounted_cash":146.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-555-30","type":"NDC"}],"standard_charges":[{"gross_charge":348.75,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":523.25,"discounted_cash":439.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":697.5,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-052-03","type":"NDC"}],"standard_charges":[{"gross_charge":348.75,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":523.25,"discounted_cash":439.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":697.5,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":174.5,"discounted_cash":146.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG TABLET [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-784-01","type":"NDC"}],"standard_charges":[{"gross_charge":345.75,"discounted_cash":290.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":518.5,"discounted_cash":435.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":691.25,"discounted_cash":580.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":173.0,"discounted_cash":145.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 2 MG TABLET [70306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148-006-13","type":"NDC"}],"standard_charges":[{"gross_charge":788.75,"discounted_cash":662.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1183.25,"discounted_cash":993.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":157.75,"discounted_cash":132.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1577.5,"discounted_cash":1325.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":394.5,"discounted_cash":331.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-627-01","type":"NDC"}],"standard_charges":[{"gross_charge":2575.25,"discounted_cash":2163.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5150.5,"discounted_cash":4326.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7725.5,"discounted_cash":6489.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"},{"gross_charge":10300.75,"discounted_cash":8652.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 1,500 (600 VWF) UNIT/10 ML INTRAVENOUS SOLN [88338]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68516-4619-2","type":"NDC"}],"standard_charges":[{"gross_charge":2559.75,"discounted_cash":2150.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5119.5,"discounted_cash":4300.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7679.25,"discounted_cash":6450.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 2,000 (800 VWF) UNIT/10 ML INTRAVENOUS SOLN [126821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68516-4610-2","type":"NDC"}],"standard_charges":[{"gross_charge":2559.75,"discounted_cash":2150.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5119.5,"discounted_cash":4300.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7679.25,"discounted_cash":6450.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 2,000 (800 VWF) UNIT/10 ML INTRAVENOUS SOLN [126821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68516-4620-2","type":"NDC"}],"standard_charges":[{"gross_charge":2559.75,"discounted_cash":2150.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5119.5,"discounted_cash":4300.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7679.25,"discounted_cash":6450.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68516-4606-1","type":"NDC"}],"standard_charges":[{"gross_charge":2559.75,"discounted_cash":2150.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5119.5,"discounted_cash":4300.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7679.25,"discounted_cash":6450.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68516-4617-1","type":"NDC"}],"standard_charges":[{"gross_charge":2559.75,"discounted_cash":2150.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5119.5,"discounted_cash":4300.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7679.25,"discounted_cash":6450.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-616-02","type":"NDC"}],"standard_charges":[{"gross_charge":2575.25,"discounted_cash":2163.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5150.5,"discounted_cash":4326.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7725.5,"discounted_cash":6489.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-626-01","type":"NDC"}],"standard_charges":[{"gross_charge":2575.25,"discounted_cash":2163.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5150.5,"discounted_cash":4326.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7725.5,"discounted_cash":6489.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-617-02","type":"NDC"}],"standard_charges":[{"gross_charge":2575.25,"discounted_cash":2163.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5150.5,"discounted_cash":4326.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7725.5,"discounted_cash":6489.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"},{"gross_charge":10300.75,"discounted_cash":8652.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 500 (+/-) UNIT IV SOLUTION - ADVATE [408736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3052-02","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 500 (+/-) UNIT IV SOLUTION - ADVATE [408736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3052-03","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 500 (+/-) UNIT IV SOLUTION - ADVATE [408736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3052-04","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-603-20","type":"NDC"}],"standard_charges":[{"gross_charge":2328.75,"discounted_cash":1956.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 621 INT'L UNITS"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 1,000 (400 VWF) UNIT/10 ML INTRAVENOUS SOLN [88337]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68516-4607-2","type":"NDC"}],"standard_charges":[{"gross_charge":2559.75,"discounted_cash":2150.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5119.5,"discounted_cash":4300.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7679.25,"discounted_cash":6450.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 1,000 (400 VWF) UNIT/10 ML INTRAVENOUS SOLN [88337]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68516-4613-2","type":"NDC"}],"standard_charges":[{"gross_charge":2344.0,"discounted_cash":1968.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":4687.75,"discounted_cash":3937.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7031.75,"discounted_cash":5906.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 1,000 (400 VWF) UNIT/10 ML INTRAVENOUS SOLN [88337]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68516-4618-2","type":"NDC"}],"standard_charges":[{"gross_charge":2559.75,"discounted_cash":2150.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 VWF:RCO UNITS/KG"},{"gross_charge":5119.5,"discounted_cash":4300.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 VWF:RCO UNITS/KG"},{"gross_charge":7679.25,"discounted_cash":6450.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 VWF:RCO UNITS/KG"}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-602-50","type":"NDC"}],"standard_charges":[{"gross_charge":2330.0,"discounted_cash":1957.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 621 INT'L UNITS"}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-606-12","type":"NDC"}],"standard_charges":[{"gross_charge":3322.5,"discounted_cash":2790.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 621 INT'L UNITS"}]},{"description":"ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [109817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0892","type":"HCPCS"},{"code":"16729-430-11","type":"NDC"}],"standard_charges":[{"gross_charge":850.75,"discounted_cash":714.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [109817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0892","type":"HCPCS"},{"code":"16729-430-43","type":"NDC"}],"standard_charges":[{"gross_charge":850.75,"discounted_cash":714.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION [28947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0884","type":"HCPCS"},{"code":"0143-9674-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.25,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/ML"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG/KG"},{"gross_charge":88.25,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MCG/KG"}]},{"description":"ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION [28947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0884","type":"HCPCS"},{"code":"63323-526-03","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG/KG"},{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MCG/KG"}]},{"description":"ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION [28947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0884","type":"HCPCS"},{"code":"0143-9288-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG/KG"},{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MCG/KG"}]},{"description":"ARGATROBAN 50 MG/50 ML (1 MG/ML) IN SODIUM CHLORIDE IV WRAPPER [179980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0884","type":"HCPCS"},{"code":"0143-9559-01","type":"NDC"}],"standard_charges":[{"gross_charge":850.75,"discounted_cash":714.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ARGATROBAN 50 MG/50 ML (1 MG/ML) IN SODIUM CHLORIDE IV WRAPPER [179980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0899","type":"HCPCS"},{"code":"55150-241-01","type":"NDC"}],"standard_charges":[{"gross_charge":837.75,"discounted_cash":703.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ARGATROBAN 50 MG/50 ML (1 MG/ML) IN SODIUM CHLORIDE IV WRAPPER [179980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0899","type":"HCPCS"},{"code":"55150-241-10","type":"NDC"}],"standard_charges":[{"gross_charge":1047.25,"discounted_cash":879.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION [28947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9674-01","type":"NDC"}],"standard_charges":[{"gross_charge":808.25,"discounted_cash":678.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/ML"}]},{"description":"ARIPIPRAZOLE 15 MG TABLET [34370]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-433-03","type":"NDC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":174.0,"discounted_cash":146.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":231.75,"discounted_cash":194.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [109817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0884","type":"HCPCS"},{"code":"65219-429-50","type":"NDC"}],"standard_charges":[{"gross_charge":594.25,"discounted_cash":499.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [109817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0884","type":"HCPCS"},{"code":"25021-414-50","type":"NDC"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":631.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"APALUTAMIDE 60 MG TABLET [178224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59676-600-12","type":"NDC"}],"standard_charges":[{"gross_charge":2509.5,"discounted_cash":2107.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"APIXABAN 2.5 MG TABLET [119040]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-0893-21","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"APIXABAN 2.5 MG TABLET [119040]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-0893-31","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"APIXABAN 5 MG TABLET [119614]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-0894-21","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"APIXABAN 5 MG TABLET [119614]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-0894-31","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"APRACLONIDINE 0.5 % EYE DROPS [9119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-665-05","type":"NDC"}],"standard_charges":[{"gross_charge":356.75,"discounted_cash":299.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"APRACLONIDINE 1 % EYE DROPS IN A DROPPERETTE [9120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0660-10","type":"NDC"}],"standard_charges":[{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"},{"gross_charge":180.75,"discounted_cash":151.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DROP"}]},{"description":"APREPITANT 125 MG CAPSULE [35489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"0781-2323-68","type":"NDC"}],"standard_charges":[{"gross_charge":1136.75,"discounted_cash":954.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":727.5,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13533-605-21","type":"NDC"}],"standard_charges":[{"gross_charge":3322.5,"discounted_cash":2790.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 621 INT'L UNITS"}]},{"description":"APREPITANT 80 MG CAPSULE [35488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"68462-584-40","type":"NDC"}],"standard_charges":[{"gross_charge":1136.75,"discounted_cash":954.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":727.5,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"APREPITANT 80 MG CAPSULE [35488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"68462-584-58","type":"NDC"}],"standard_charges":[{"gross_charge":1136.75,"discounted_cash":954.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":364.0,"discounted_cash":305.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":727.75,"discounted_cash":611.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"APREPITANT 80 MG CAPSULE [35488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"68462-584-76","type":"NDC"}],"standard_charges":[{"gross_charge":1136.75,"discounted_cash":954.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":727.5,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ARGATROBAN 1 MG/ML FLUSH SYRINGE [179976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0884","type":"HCPCS"},{"code":"7700-7092-02","type":"NDC"}],"standard_charges":[{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ARSENIC TRIOXIDE 2 MG/ML INTRAVENOUS SOLUTION [177745]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"63459-601-06","type":"NDC"}],"standard_charges":[{"gross_charge":4656.0,"discounted_cash":3911.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL [21058]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0429-47","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET [679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-434-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET [679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6794-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-173-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1284353637","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-981-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-980-53","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093944144","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483-481-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-046-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-046-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6751-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1234-41","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-689-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-212-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-066-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG TABLET,DELAYED RELEASE [9151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-212-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ATAZANAVIR 150 MG CAPSULE [36149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-3624-12","type":"NDC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":159.0,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":212.0,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":318.0,"discounted_cash":267.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":424.0,"discounted_cash":356.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ATAZANAVIR 150 MG CAPSULE [36149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-860-01","type":"NDC"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":82.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":147.5,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":196.5,"discounted_cash":165.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":294.75,"discounted_cash":247.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":393.0,"discounted_cash":330.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET [679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6794-89","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET [679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6794-80","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-015-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1232-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6784-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET [679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-911-36","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET [679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66553-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET [679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-498-07","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET [679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-434-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET [679]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0113-0259-68","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ATENOLOL 25 MG TABLET [717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0787-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATENOLOL 25 MG TABLET [717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-022-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATENOLOL 50 MG TABLET [718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1506-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATENOLOL 50 MG TABLET [718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1506-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATENOLOL 50 MG TABLET [718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-684-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATENOLOL 50 MG TABLET [718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-684-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATENOLOL 25 MG TABLET [717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-759-20","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATAZANAVIR 200 MG CAPSULE [36150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-3631-12","type":"NDC"}],"standard_charges":[{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":119.25,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":159.0,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":238.5,"discounted_cash":200.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":318.0,"discounted_cash":267.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ATAZANAVIR 300 MG CAPSULE [77648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-3622-12","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":66.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":158.5,"discounted_cash":133.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":237.75,"discounted_cash":199.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":317.0,"discounted_cash":266.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ATENOLOL 25 MG TABLET [717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1078-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-523-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ATENOLOL 25 MG TABLET [717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1078-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATENOLOL 25 MG TABLET [717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-759-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 1,000 MG TABLET [662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068116600","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 1,000 MG TABLET [662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"761037920","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904052360","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904052361","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904052372","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904052380","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 1,000 MG TABLET [662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10939-90044","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS [27980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0998-0408-15","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ASCORBIC ACID (VITAMIN C) 1,000 MG TABLET [662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4329222327","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 1,000 MG TABLET [662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026886215","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 1,000 MG TABLET [662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74312-01707","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 1,000 MG TABLET [662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43292-56467","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ARSENIC TRIOXIDE 2 MG/ML INTRAVENOUS SOLUTION [177745]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"63459-601-11","type":"NDC"}],"standard_charges":[{"gross_charge":4656.0,"discounted_cash":3911.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5789684101","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASPIRIN 325 MG TABLET [681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-901-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ASPIRIN 325 MG TABLET [681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66553-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ASPIRIN 325 MG TABLET [681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-001-23","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ASPIRIN 325 MG TABLET [681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093924333","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-126-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-126-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-921-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-921-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 325 MG TABLET [681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-901-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ASPIRIN 325 MG TABLET [681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-001-14","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7985430035","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74312-01510","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL SYRUP [128699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5789684216","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASENAPINE 10 MG SUBLINGUAL TABLET [99755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-2410-60","type":"NDC"}],"standard_charges":[{"gross_charge":142.25,"discounted_cash":119.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ASPIRIN 1 MG/1 ML PO SUSPENSION [400641]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-9000-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE [27644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-596-06","type":"NDC"}],"standard_charges":[{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE [27644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-850-60","type":"NDC"}],"standard_charges":[{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"ASPIRIN 300 MG RECTAL SUPPOSITORY [693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7034-12","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ASPIRIN 325 MG TABLET [681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-150-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505-6142-0","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-451-20","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-122-05","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-122-16","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-198-05","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-198-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-056-09","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-238-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-238-90","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6370-61","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-451-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 2.5 MG TABLET [9070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-1520-68","type":"NDC"}],"standard_charges":[{"gross_charge":274.75,"discounted_cash":230.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":68.75,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 2.5 MG TABLET [9070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-5208-77","type":"NDC"}],"standard_charges":[{"gross_charge":46.75,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 2.5 MG TABLET [9070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-1520-1","type":"NDC"}],"standard_charges":[{"gross_charge":46.75,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 2.5 MG TABLET [9070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-121-16","type":"NDC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 2.5 MG TABLET [9070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-197-90","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 2.5 MG TABLET [9070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6369-61","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-1530-41","type":"NDC"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":68.75,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-1530-68","type":"NDC"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":68.75,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE 5 MG TABLET [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-242-10","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION [33230]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-293-02","type":"NDC"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [25246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4161-76","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [25246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-9887-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [25246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-9887-50","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [25246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-6157-52","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [25246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-071-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [25246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-071-75","type":"NDC"}],"standard_charges":[{"gross_charge":49.25,"discounted_cash":41.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"AMOXICILLIN 500 MG CAPSULE [451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2613-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 500 MG CAPSULE [451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-299-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 500 MG CAPSULE [451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-031-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 500 MG CAPSULE [451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-299-08","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2274-34","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1831-20","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66685-1002-2","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-477-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-494-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-161-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION [31177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-6139-54","type":"NDC"}],"standard_charges":[{"gross_charge":341.25,"discounted_cash":286.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"}]},{"description":"AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION [31177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-294-01","type":"NDC"}],"standard_charges":[{"gross_charge":270.75,"discounted_cash":227.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION [33230]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-293-01","type":"NDC"}],"standard_charges":[{"gross_charge":193.75,"discounted_cash":162.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION [33230]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-9982-75","type":"NDC"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":173.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION [33230]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-9982-50","type":"NDC"}],"standard_charges":[{"gross_charge":205.5,"discounted_cash":172.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION [33230]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66685-1012-1","type":"NDC"}],"standard_charges":[{"gross_charge":254.75,"discounted_cash":213.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR INHALATION [439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822-9900-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 AMPULE"}]},{"description":"AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR INHALATION [439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822-9900-2","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 AMPULE"}]},{"description":"AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR INHALATION [439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"73874309001","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 AMPULE"}]},{"description":"AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR INHALATION [439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-4024-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 AMPULE"}]},{"description":"AMMONIUM LACTATE 12 % LOTION [10380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4580252555","type":"NDC"}],"standard_charges":[{"gross_charge":122.75,"discounted_cash":103.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 227 G"}]},{"description":"AMMONIUM LACTATE 12 % LOTION [10380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63044-484-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 G"}]},{"description":"AMMONIUM LACTATE 12 % LOTION [10380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-419-54","type":"NDC"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 G"}]},{"description":"AMMONIUM LACTATE 12 % LOTION [10380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904598426","type":"NDC"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":174.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 226 G"}]},{"description":"AMOXICILLIN 125 MG-POTASSIUM CLAVULANATE 31.25 MG/5 ML ORAL SUSP [9079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-012-51","type":"NDC"}],"standard_charges":[{"gross_charge":1523.25,"discounted_cash":1279.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION [453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-9888-80","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 ML"}]},{"description":"AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SUSPENSION [33229]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2277-73","type":"NDC"}],"standard_charges":[{"gross_charge":244.75,"discounted_cash":205.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMOXICILLIN 250 MG CAPSULE [450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2020-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 250 MG CAPSULE [450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2020-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 250 MG CAPSULE [450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-016-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 250 MG CAPSULE [450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-298-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 250 MG CHEWABLE TABLET [452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2268-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION [454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-707-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION [33230]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66685-1012-0","type":"NDC"}],"standard_charges":[{"gross_charge":191.25,"discounted_cash":160.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"AMIVANTAMAB-VMJW 50 MG/ML INTRAVENOUS SOLUTION [188986]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"57894-501-01","type":"NDC"}],"standard_charges":[{"gross_charge":11283.25,"discounted_cash":9477.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"AMIVANTAMAB-VMJW 50 MG/ML INTRAVENOUS SOLUTION [188986]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"57894-501-00","type":"NDC"}],"standard_charges":[{"gross_charge":11283.25,"discounted_cash":9477.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"AMITRIPTYLINE 25 MG TABLET [435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-0201-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 25 MG TABLET [435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-447-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 25 MG TABLET [435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-172-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 25 MG TABLET [435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-433-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 25 MG TABLET [435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-433-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 25 MG TABLET [435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-107-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 10 MG TABLET [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-037-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 100 MG TABLET [433]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2216-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 25 MG TABLET [435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756-202-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 150 MG TABLET [434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-2695-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 25 MG TABLET [435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-107-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION [31177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-294-02","type":"NDC"}],"standard_charges":[{"gross_charge":331.5,"discounted_cash":278.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"}]},{"description":"AMITRIPTYLINE 50 MG TABLET [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-448-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 50 MG TABLET [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 50 MG TABLET [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756-203-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 50 MG TABLET [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-039-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 50 MG TABLET [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-039-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 50 MG TABLET [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-0202-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 50 MG TABLET [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2214-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 50 MG TABLET [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1488-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 50 MG TABLET [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-133-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE 50 MG TABLET [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-133-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION [31177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-535-13","type":"NDC"}],"standard_charges":[{"gross_charge":341.25,"discounted_cash":286.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"}]},{"description":"AMOXICILLIN 875 MG TABLET [23458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-015-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 875 MG"}]},{"description":"ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION [189543]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-3040-00","type":"NDC"}],"standard_charges":[{"gross_charge":10945.5,"discounted_cash":9194.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,000 (+/-) UNIT IV SOLUTION [76367]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0026-3785-55","type":"NDC"}],"standard_charges":[{"gross_charge":1580.75,"discounted_cash":1327.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2371.0,"discounted_cash":1991.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3161.25,"discounted_cash":2655.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":3951.5,"discounted_cash":3319.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":4741.75,"discounted_cash":3983.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":7902.75,"discounted_cash":6638.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,000 (+/-) UNIT IV SOLUTION - ADVATE [408737]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3053-02","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,000 (+/-) UNIT IV SOLUTION - ADVATE [408737]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3053-03","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANASTROZOLE 1 MG TABLET [16205]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-209-06","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,000 (+/-) UNIT IV SOLUTION - ADVATE [408737]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3053-04","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANASTROZOLE 1 MG TABLET [16205]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-620-33","type":"NDC"}],"standard_charges":[{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ANASTROZOLE 1 MG TABLET [16205]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7536-56","type":"NDC"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"63323-369-20","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0409-2998-03","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021-143-30","type":"NDC"}],"standard_charges":[{"gross_charge":65.75,"discounted_cash":55.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2700 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0641-6117-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0641-6117-10","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150-117-20","type":"NDC"}],"standard_charges":[{"gross_charge":98.75,"discounted_cash":82.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"44567-211-10","type":"NDC"}],"standard_charges":[{"gross_charge":129.5,"discounted_cash":108.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0049-0014-81","type":"NDC"}],"standard_charges":[{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"67457-349-10","type":"NDC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"71288-006-30","type":"NDC"}],"standard_charges":[{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"66794-207-02","type":"NDC"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"66794-207-41","type":"NDC"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"71288-006-31","type":"NDC"}],"standard_charges":[{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"66794-206-41","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"ANAGRELIDE 0.5 MG CAPSULE [20446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092-063-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":134.25,"discounted_cash":112.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ANAGRELIDE 0.5 MG CAPSULE [20446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-5241-60","type":"NDC"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":151.0,"discounted_cash":126.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ANASTROZOLE 1 MG TABLET [16205]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-035-10","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 3,000 (+/-) UNIT IV SOLUTION [99576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0026-3787-75","type":"NDC"}],"standard_charges":[{"gross_charge":1580.75,"discounted_cash":1327.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2371.0,"discounted_cash":1991.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3161.25,"discounted_cash":2655.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":3951.5,"discounted_cash":3319.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":4741.75,"discounted_cash":3983.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":7902.75,"discounted_cash":6638.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 3,000 (+/-) UNIT IV SOLUTION - ADVATE [408739]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3046-10","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 3,000 (+/-) UNIT IV SOLUTION - ADVATE [408739]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3046-11","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 500 (+/-) UNIT IV SOLUTION [76366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0026-3783-35","type":"NDC"}],"standard_charges":[{"gross_charge":1580.75,"discounted_cash":1327.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2371.0,"discounted_cash":1991.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3161.25,"discounted_cash":2655.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":3951.5,"discounted_cash":3319.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":4741.75,"discounted_cash":3983.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":7902.75,"discounted_cash":6638.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION - ADVATE [408738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3045-11","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION [78225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0026-3786-65","type":"NDC"}],"standard_charges":[{"gross_charge":1580.75,"discounted_cash":1327.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2371.0,"discounted_cash":1991.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3161.25,"discounted_cash":2655.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":3951.5,"discounted_cash":3319.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":4741.75,"discounted_cash":3983.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":7902.75,"discounted_cash":6638.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION - ADVATE [408738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3045-10","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [9084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0049-0014-83","type":"NDC"}],"standard_charges":[{"gross_charge":118.25,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION - ADVATE [408738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0944-3045-12","type":"NDC"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1522.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 INT'L UNITS/KG"},{"gross_charge":2718.0,"discounted_cash":2283.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 INT'L UNITS/KG"},{"gross_charge":3623.75,"discounted_cash":3043.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 INT'L UNITS/KG"},{"gross_charge":4529.75,"discounted_cash":3804.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 INT'L UNITS/KG"},{"gross_charge":5435.75,"discounted_cash":4566.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 INT'L UNITS/KG"},{"gross_charge":9059.25,"discounted_cash":7609.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 INT'L UNITS/KG"}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0289","type":"HCPCS"},{"code":"0469-3051-30","type":"NDC"}],"standard_charges":[{"gross_charge":1363.75,"discounted_cash":1145.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":6308.25,"discounted_cash":5298.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"}]},{"description":"AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0285","type":"HCPCS"},{"code":"39822-1055-5","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG/KG"},{"gross_charge":227.75,"discounted_cash":191.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG/KG"},{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"AMPICILLIN (OMNIPEN) 30 MG/ML IV SYRINGE (NEO/PED) [179307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"7700-4343-01","type":"NDC"}],"standard_charges":[{"gross_charge":6746.5,"discounted_cash":5667.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"25021-136-10","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-3404-95","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-9261-85","type":"NDC"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-9261-95","type":"NDC"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"44567-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1800 MG"},{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-3408-95","type":"NDC"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":95.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"55150-114-20","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-9273-80","type":"NDC"}],"standard_charges":[{"gross_charge":687.0,"discounted_cash":577.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-9273-95","type":"NDC"}],"standard_charges":[{"gross_charge":687.0,"discounted_cash":577.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67457-352-02","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67457-352-10","type":"NDC"}],"standard_charges":[{"gross_charge":107.75,"discounted_cash":90.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"65219-020-03","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0289","type":"HCPCS"},{"code":"62756-233-01","type":"NDC"}],"standard_charges":[{"gross_charge":1091.5,"discounted_cash":916.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMOXICILLIN 875 MG TABLET [23458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-219-14","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 875 MG"}]},{"description":"AMOXICILLIN 875 MG TABLET [23458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-029-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 875 MG"}]},{"description":"AMOXICILLIN 875 MG TABLET [23458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-029-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 875 MG"}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2275-34","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1852-20","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66685-1001-0","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66685-1001-1","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-297-02","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-503-20","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-478-02","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-162-42","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"65219-020-23","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMOXICILLIN 875 MG TABLET [23458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2264-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 875 MG"}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"72485-422-01","type":"NDC"}],"standard_charges":[{"gross_charge":57.75,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0049-0013-83","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"63323-368-20","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021-142-20","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0641-6116-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0641-6116-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150-116-20","type":"NDC"}],"standard_charges":[{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"44567-210-10","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0049-0013-81","type":"NDC"}],"standard_charges":[{"gross_charge":62.75,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"67457-348-15","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"67457-348-10","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021-186-20","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"71288-005-20","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"66794-206-02","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"71288-005-21","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150-116-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [9083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150-116-10","type":"NDC"}],"standard_charges":[{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [14057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0049-0024-28","type":"NDC"}],"standard_charges":[{"gross_charge":358.25,"discounted_cash":300.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [14057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021-144-99","type":"NDC"}],"standard_charges":[{"gross_charge":275.75,"discounted_cash":231.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [14057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150-118-99","type":"NDC"}],"standard_charges":[{"gross_charge":292.25,"discounted_cash":245.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [14057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"71288-007-75","type":"NDC"}],"standard_charges":[{"gross_charge":273.25,"discounted_cash":229.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [14057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"66794-208-15","type":"NDC"}],"standard_charges":[{"gross_charge":228.25,"discounted_cash":191.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM INTRAVENOUS SOLUTION [27282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"0409-2689-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"AMPICILLIN 250 MG CAPSULE [465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2144-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 250 MG SOLUTION FOR INJECTION [473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-3402-95","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":872.25,"discounted_cash":732.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"},{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"AMPICILLIN 250 MG SOLUTION FOR INJECTION [473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"25021-134-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 250 MG SOLUTION FOR INJECTION [473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"55150-111-10","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 250 MG SOLUTION FOR INJECTION [473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-9242-78","type":"NDC"}],"standard_charges":[{"gross_charge":227.5,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 250 MG SOLUTION FOR INJECTION [473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-9242-95","type":"NDC"}],"standard_charges":[{"gross_charge":227.5,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 500 MG CAPSULE [466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2145-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67850-024-10","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":432.5,"discounted_cash":363.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG/KG"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-3407-95","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-9250-78","type":"NDC"}],"standard_charges":[{"gross_charge":239.25,"discounted_cash":200.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0781-9250-95","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0409-3718-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"0409-3718-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67850-024-00","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"55150-112-10","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505-6142-5","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CEFAZOLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [25365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0264-3103-11","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET [127622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-948-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":70.5,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET [127622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11534-190-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULE,EXTEND RELEASE [31587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3059-11","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULE,EXTEND RELEASE [31587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2335-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 15 MG 24HR CAPSULE,EXTEND RELEASE [33006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3063-11","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET [127622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-339-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET [127159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-723-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET [127622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0971-02","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET [127622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-068-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET [127622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4541-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":83.5,"discounted_cash":70.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 20 MG 24HR CAPSULE,EXTEND RELEASE [31588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3060-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 5 MG 24HR CAPSULE,EXTEND RELEASE [33005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-839-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":67.75,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 5 MG 24HR CAPSULE,EXTEND RELEASE [33005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-055-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 5 MG 24HR CAPSULE,EXTEND RELEASE [33005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-0790-37","type":"NDC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":165.75,"discounted_cash":139.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":207.25,"discounted_cash":174.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":248.75,"discounted_cash":208.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 5 MG 24HR CAPSULE,EXTEND RELEASE [33005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010-029-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":194.75,"discounted_cash":163.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":243.25,"discounted_cash":204.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":292.0,"discounted_cash":245.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 5 MG 24HR CAPSULE,EXTEND RELEASE [33005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-594-02","type":"NDC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":165.75,"discounted_cash":139.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":207.25,"discounted_cash":174.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":248.75,"discounted_cash":208.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 25 MG 24HR CAPSULE,EXTEND RELEASE [33007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3064-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 30 MG 24HR CAPSULE,EXTEND RELEASE [31589]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3061-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET [127159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72516-014-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 5 MG 24HR CAPSULE,EXTEND RELEASE [33005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3062-11","type":"NDC"}],"standard_charges":[{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":190.5,"discounted_cash":160.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":238.25,"discounted_cash":200.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":285.75,"discounted_cash":240.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR [9773]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824-171-63","type":"NDC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":104.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 89 ML"}]},{"description":"DEXMETHYLPHENIDATE ER 25 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50 [111306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0608-05","type":"NDC"}],"standard_charges":[{"gross_charge":53.25,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":77.5,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":149.75,"discounted_cash":125.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":174.0,"discounted_cash":146.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXMETHYLPHENIDATE ER 30 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50 [100548]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0433-05","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":31.75,"discounted_cash":26.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXMETHYLPHENIDATE ER 35 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50 [111307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0609-05","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXMETHYLPHENIDATE ER 40 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50 [106195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0434-05","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":84.25,"discounted_cash":70.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":100.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":131.75,"discounted_cash":110.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXMETHYLPHENIDATE 2.5 MG TABLET [31845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0380-05","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXMETHYLPHENIDATE 5 MG TABLET [31846]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0381-05","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXMETHYLPHENIDATE ER 10 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50 [41548]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0431-05","type":"NDC"}],"standard_charges":[{"gross_charge":111.75,"discounted_cash":93.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":167.75,"discounted_cash":140.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":223.5,"discounted_cash":187.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXMETHYLPHENIDATE ER 15 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50 [77104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0493-05","type":"NDC"}],"standard_charges":[{"gross_charge":81.75,"discounted_cash":68.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":120.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXMETHYLPHENIDATE ER 15 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50 [77104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010-006-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":74.25,"discounted_cash":62.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXMETHYLPHENIDATE ER 20 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50 [41549]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0432-05","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":120.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXMETHYLPHENIDATE ER 5 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50 [41545]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0430-05","type":"NDC"}],"standard_charges":[{"gross_charge":225.25,"discounted_cash":189.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":335.25,"discounted_cash":281.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":445.25,"discounted_cash":374.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":115.25,"discounted_cash":96.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET [127159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0972-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET [127159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET [127159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-804-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET [127159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-950-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET [127159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-341-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":41.75,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE SULFATE ER 5 MG CAPSULE,EXTENDED RELEASE [32415]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8960-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXRAZOXANE HCL 250 MG INTRAVENOUS SOLUTION [15156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1190","type":"HCPCS"},{"code":"0143-9247-01","type":"NDC"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION [15157]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1190","type":"HCPCS"},{"code":"51991-942-98","type":"NDC"}],"standard_charges":[{"gross_charge":2001.0,"discounted_cash":1680.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION [15157]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1190","type":"HCPCS"},{"code":"72266-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":1672.75,"discounted_cash":1405.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION [15157]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1190","type":"HCPCS"},{"code":"72611-716-01","type":"NDC"}],"standard_charges":[{"gross_charge":1709.5,"discounted_cash":1435.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEXTROAMPHETAMINE SULFATE 10 MG TABLET [2353]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8959-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE SULFATE 15 MG TABLET [124400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-854-10","type":"NDC"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"}]},{"description":"DEXTROAMPHETAMINE SULFATE 2.5 MG TABLET [122224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-850-10","type":"NDC"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEXTROAMPHETAMINE SULFATE 20 MG TABLET [125798]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-855-10","type":"NDC"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DEXTROAMPHETAMINE SULFATE 5 MG TABLET [2354]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8958-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE SULFATE 7.5 MG TABLET [122225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-852-10","type":"NDC"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"DEXTROAMPHETAMINE SULFATE ER 10 MG CAPSULE,EXTENDED RELEASE [32416]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8961-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE SULFATE ER 15 MG CAPSULE,EXTENDED RELEASE [32427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8962-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":44.25,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROAMPHETAMINE SULFATE 30 MG TABLET [125799]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338-856-10","type":"NDC"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR [9773]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824-175-63","type":"NDC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":104.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 89 ML"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR [9773]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824-175-65","type":"NDC"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 148 ML"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR [9773]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824-171-65","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 148 ML"}]},{"description":"DIAZEPAM 12.5 MG-15 MG-17.5 MG-20 MG RECTAL KIT [87869]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0187-0659-20","type":"NDC"}],"standard_charges":[{"gross_charge":1502.75,"discounted_cash":1262.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIAZEPAM 12.5 MG-15 MG-17.5 MG-20 MG RECTAL KIT [87869]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-655-20","type":"NDC"}],"standard_charges":[{"gross_charge":1299.75,"discounted_cash":1091.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIAZEPAM 2 MG TABLET [2404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-3925-60","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 2 MG TABLET [2404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-284-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 2 MG TABLET [2404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-284-20","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG TABLET [2405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-3926-60","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG TABLET [2405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-285-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG TABLET [2405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-285-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG TABLET [2405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-073-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 10 MG TABLET [2403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-286-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG TABLET [2405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5880-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION [2367]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7918-19","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION [2365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6648-02","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION [2365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7936-19","type":"NDC"}],"standard_charges":[{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"},{"gross_charge":186.0,"discounted_cash":156.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE [128315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4902-34","type":"NDC"}],"standard_charges":[{"gross_charge":74.25,"discounted_cash":62.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":148.5,"discounted_cash":124.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE [128315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7517-16","type":"NDC"}],"standard_charges":[{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":145.25,"discounted_cash":122.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE [128315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3301-1","type":"NDC"}],"standard_charges":[{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":107.5,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE [128315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-6150-50","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE [128315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1475-50","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":117.25,"discounted_cash":98.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE [128315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-953-50","type":"NDC"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":101.25,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE [128315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7517-66","type":"NDC"}],"standard_charges":[{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":145.25,"discounted_cash":122.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE [128315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4902-64","type":"NDC"}],"standard_charges":[{"gross_charge":74.25,"discounted_cash":62.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":148.5,"discounted_cash":124.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE [128315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3302-1","type":"NDC"}],"standard_charges":[{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION [2367]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0719-06","type":"NDC"}],"standard_charges":[{"gross_charge":216.25,"discounted_cash":181.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION [2367]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-7387-50","type":"NDC"}],"standard_charges":[{"gross_charge":175.75,"discounted_cash":147.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT [87867]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0187-0658-20","type":"NDC"}],"standard_charges":[{"gross_charge":1502.75,"discounted_cash":1262.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"76045-204-00","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"76045-204-20","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"43598-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"43598-106-11","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML ORAL CONCENTRATE [127481]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3185-44","type":"NDC"}],"standard_charges":[{"gross_charge":290.5,"discounted_cash":244.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"DIAZOXIDE 50 MG/ML ORAL SUSPENSION [19713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0575-6200-30","type":"NDC"}],"standard_charges":[{"gross_charge":1775.25,"discounted_cash":1491.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"DIAZOXIDE 50 MG/ML ORAL SUSPENSION [19713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13517-100-30","type":"NDC"}],"standard_charges":[{"gross_charge":1330.25,"discounted_cash":1117.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"DIAZOXIDE 50 MG/ML ORAL SUSPENSION [19713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0254-1010-19","type":"NDC"}],"standard_charges":[{"gross_charge":1331.75,"discounted_cash":1118.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"DIBUCAINE 1 % TOPICAL OINTMENT [2412]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-050-03","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DIBUCAINE 1 % TOPICAL OINTMENT [2412]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1211-95","type":"NDC"}],"standard_charges":[{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DIBUCAINE 1 % TOPICAL OINTMENT [2412]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399-2829-1","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DIBUCAINE 1 % TOPICAL OINTMENT [2412]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-131-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DICLOFENAC 0.1 % EYE DROPS [19714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-014-25","type":"NDC"}],"standard_charges":[{"gross_charge":243.75,"discounted_cash":204.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"DICLOFENAC 0.1 % EYE DROPS [19714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-101-25","type":"NDC"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":208.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63481-684-47","type":"NDC"}],"standard_charges":[{"gross_charge":266.5,"discounted_cash":223.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-833-66","type":"NDC"}],"standard_charges":[{"gross_charge":225.25,"discounted_cash":189.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-524-44","type":"NDC"}],"standard_charges":[{"gross_charge":216.25,"discounted_cash":181.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-160-00","type":"NDC"}],"standard_charges":[{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76282-663-39","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-976-01","type":"NDC"}],"standard_charges":[{"gross_charge":218.75,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"0641-6244-10","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"0641-6244-01","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT [87867]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-652-20","type":"NDC"}],"standard_charges":[{"gross_charge":1299.75,"discounted_cash":1091.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLUTION [2402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3188-63","type":"NDC"}],"standard_charges":[{"gross_charge":320.75,"discounted_cash":269.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [114047]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-750-59","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [114047]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-750-62","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [114047]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1955-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SOLUTION [2401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"0409-3213-12","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SOLUTION [2401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SOLUTION [2401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339-137-05","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROSE 5% AND 0.3 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"7700-0991-05","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"0409-1273-32","type":"NDC"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":184.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":110.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"0409-1273-03","type":"NDC"}],"standard_charges":[{"gross_charge":219.75,"discounted_cash":184.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":110.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339-136-02","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339-136-32","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339-136-03","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339-136-34","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DEXTROSE 5% AND 0.3 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"7700-4619-10","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5% AND 0.3 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0081-03","type":"NDC"}],"standard_charges":[{"gross_charge":128.5,"discounted_cash":107.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 10 % IV BOLUS [400302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7930-09","type":"NDC"}],"standard_charges":[{"gross_charge":85.5,"discounted_cash":71.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML/KG"},{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML/KG"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 10 % IV BOLUS [400302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7930-03","type":"NDC"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":106.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML/KG"},{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":90.75,"discounted_cash":76.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML/KG"},{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 15 GRAM/32 ML ORAL GEL PACKET [178062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56151-1625-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 ML"}]},{"description":"DEXTROSE 2.5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0073-04","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE [2361]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1775-10","type":"NDC"}],"standard_charges":[{"gross_charge":151.75,"discounted_cash":127.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE [2361]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1775-40","type":"NDC"}],"standard_charges":[{"gross_charge":151.75,"discounted_cash":127.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROSE 40 % ORAL GEL [27466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574006930","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 G"}]},{"description":"DEXTROSE 40 % ORAL GEL [27466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574006945","type":"NDC"}],"standard_charges":[{"gross_charge":79.75,"discounted_cash":66.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112.5 G"}]},{"description":"DEXTROSE 40 % ORAL GEL [27466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574007030","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 G"}]},{"description":"DEXTROSE 40 % ORAL GEL [27466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574006915","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 G"}]},{"description":"DEXTROSE 40 % ORAL GEL [27466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574007015","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 G"}]},{"description":"DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9812]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0077-03","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9812]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0077-04","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % AND 0.45 % NACL IV BOLUS [400295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7926-09","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7612-00","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 10 % IV BOLUS [400302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7930-03","type":"NDC"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML/KG"},{"gross_charge":76.25,"discounted_cash":64.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML/KG"},{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR [9773]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4602-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR [9773]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0031-8655-10","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 89 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID [127148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6056906204","type":"NDC"}],"standard_charges":[{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID [127148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6980-72","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0638-05","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49348-017-39","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 354 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093932233","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 354 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2055-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0638-00","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1276-00","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0085-03","type":"NDC"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1276-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION [2357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0023-03","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION [2357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0023-04","type":"NDC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML/KG"},{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML/KG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-150-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0085-04","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7926-09","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7922-03","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-624-07","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7923-13","type":"NDC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-624-04","type":"NDC"}],"standard_charges":[{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-624-06","type":"NDC"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-460-05","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-460-20","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-464-05","type":"NDC"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-464-50","type":"NDC"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IV BOLUS [400293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7922-03","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IV BOLUS [400293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7922-09","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % IV BOLUS [400293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7923-37","type":"NDC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IV BOLUS [400293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7922-02","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE 5 % IV BOLUS [400293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7923-13","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % IV BOLUS [400293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7922-61","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"DEXTROSE 5 % IV BOLUS [400293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-6346-02","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE 5 % IV BOLUS [400293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-6346-03","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IV BOLUS [400293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-624-75","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7922-61","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7922-02","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":81.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-624-50","type":"NDC"}],"standard_charges":[{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-624-05","type":"NDC"}],"standard_charges":[{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % AND 0.9 % NACL IV BOLUS [400294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7941-09","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [9815]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"0338-0089-04","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % AND 0.9 % NACL IV BOLUS [400294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"0409-7941-09","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION [9788]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0125-04","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION [9788]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7929-09","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK [129939]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0551-18","type":"NDC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK [129939]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7100-04","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7510-10","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-02","type":"NDC"}],"standard_charges":[{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-03","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-04","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-18","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-31","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-38","type":"NDC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-41","type":"NDC"}],"standard_charges":[{"gross_charge":76.25,"discounted_cash":64.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-624-10","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK [129939]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0409-7100-02","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXMETHYLPHENIDATE 10 MG TABLET [31847]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0382-05","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16714-892-01","type":"NDC"}],"standard_charges":[{"gross_charge":1769.5,"discounted_cash":1486.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72572-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9378-01","type":"NDC"}],"standard_charges":[{"gross_charge":228.25,"discounted_cash":191.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-2757-01","type":"NDC"}],"standard_charges":[{"gross_charge":388.75,"discounted_cash":326.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288-016-15","type":"NDC"}],"standard_charges":[{"gross_charge":195.5,"discounted_cash":164.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-813-50","type":"NDC"}],"standard_charges":[{"gross_charge":615.25,"discounted_cash":516.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":379.5,"discounted_cash":318.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG/KG"}]},{"description":"DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN [185287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"57894-503-01","type":"NDC"}],"standard_charges":[{"gross_charge":21693.75,"discounted_cash":18222.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1800 MG"}]},{"description":"DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION [168878]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894-502-05","type":"NDC"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":1848.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION [168878]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894-502-20","type":"NDC"}],"standard_charges":[{"gross_charge":6973.0,"discounted_cash":5857.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION [168878]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"57894-502-20","type":"NDC"}],"standard_charges":[{"gross_charge":21361.25,"discounted_cash":17943.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG/KG"}]},{"description":"DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE [108044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-025-01","type":"NDC"}],"standard_charges":[{"gross_charge":2823.75,"discounted_cash":2371.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE [108044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-025-04","type":"NDC"}],"standard_charges":[{"gross_charge":2823.75,"discounted_cash":2371.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-027-01","type":"NDC"}],"standard_charges":[{"gross_charge":4235.5,"discounted_cash":3557.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"}]},{"description":"DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-027-04","type":"NDC"}],"standard_charges":[{"gross_charge":4235.5,"discounted_cash":3557.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"}]},{"description":"DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108047]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-028-01","type":"NDC"}],"standard_charges":[{"gross_charge":5647.25,"discounted_cash":4743.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513-057-01","type":"NDC"}],"standard_charges":[{"gross_charge":831.5,"discounted_cash":698.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"}]},{"description":"DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE [108041]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513-057-04","type":"NDC"}],"standard_charges":[{"gross_charge":831.5,"discounted_cash":698.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"}]},{"description":"DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE [108048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":6882.5,"discounted_cash":5781.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"}]},{"description":"DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE [108042]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513-021-04","type":"NDC"}],"standard_charges":[{"gross_charge":1330.25,"discounted_cash":1117.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MCG"}]},{"description":"DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION [76963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":1330.25,"discounted_cash":1117.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MCG"}]},{"description":"DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION [76963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513-003-04","type":"NDC"}],"standard_charges":[{"gross_charge":1330.25,"discounted_cash":1117.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MCG"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16729-435-05","type":"NDC"}],"standard_charges":[{"gross_charge":1625.25,"discounted_cash":1365.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE [76334]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-032-01","type":"NDC"}],"standard_charges":[{"gross_charge":3441.25,"discounted_cash":2890.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":4588.5,"discounted_cash":3854.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":6882.5,"discounted_cash":5781.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"},{"gross_charge":11470.75,"discounted_cash":9635.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-413-11","type":"NDC"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":413.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67919-012-02","type":"NDC"}],"standard_charges":[{"gross_charge":1625.25,"discounted_cash":1365.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPSONE 100 MG TABLET [2131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49938-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPSONE 100 MG TABLET [2131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-136-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPSONE 100 MG TABLET [2131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-136-20","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPSONE 25 MG TABLET [2132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49938-102-30","type":"NDC"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPSONE 25 MG TABLET [2132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13925-504-30","type":"NDC"}],"standard_charges":[{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPSONE 25 MG TABLET [2132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60429-495-30","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPSONE 25 MG TABLET [2132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-135-10","type":"NDC"}],"standard_charges":[{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67919-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":1625.25,"discounted_cash":1365.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67919-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":1625.25,"discounted_cash":1365.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DECITABINE 35 MG-CEDAZURIDINE 100 MG TABLET [186175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64842-0727-9","type":"NDC"}],"standard_charges":[{"gross_charge":5142.5,"discounted_cash":4319.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"62856-600-01","type":"NDC"}],"standard_charges":[{"gross_charge":5071.5,"discounted_cash":4260.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"55111-556-10","type":"NDC"}],"standard_charges":[{"gross_charge":2189.0,"discounted_cash":1838.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"43598-427-37","type":"NDC"}],"standard_charges":[{"gross_charge":2189.0,"discounted_cash":1838.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"16729-224-05","type":"NDC"}],"standard_charges":[{"gross_charge":5929.75,"discounted_cash":4980.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"0781-3296-80","type":"NDC"}],"standard_charges":[{"gross_charge":1115.75,"discounted_cash":937.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DECITABINE 50 MG INTRAVENOUS SOLUTION [76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"70860-219-20","type":"NDC"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":719.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEFERASIROX 500 MG DISPERSIBLE TABLET [43417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0470-15","type":"NDC"}],"standard_charges":[{"gross_charge":886.75,"discounted_cash":744.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DEFERASIROX 500 MG DISPERSIBLE TABLET [43417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-161-13","type":"NDC"}],"standard_charges":[{"gross_charge":711.5,"discounted_cash":597.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION [9722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"0409-2337-25","type":"NDC"}],"standard_charges":[{"gross_charge":253.25,"discounted_cash":212.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"0409-2336-10","type":"NDC"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"0078-0467-91","type":"NDC"}],"standard_charges":[{"gross_charge":226.75,"discounted_cash":190.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"63323-597-10","type":"NDC"}],"standard_charges":[{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"0078-0467-61","type":"NDC"}],"standard_charges":[{"gross_charge":226.75,"discounted_cash":190.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"47781-623-07","type":"NDC"}],"standard_charges":[{"gross_charge":101.25,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"0409-2336-01","type":"NDC"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"60505-6236-0","type":"NDC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION [9723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"60505-6236-6","type":"NDC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEGARELIX 120 MG SUBCUTANEOUS SOLUTION [96987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55566-8403-1","type":"NDC"}],"standard_charges":[{"gross_charge":5560.25,"discounted_cash":4670.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"DEGARELIX 120 MG SUBCUTANEOUS SOLUTION [96987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55566-8402-0","type":"NDC"}],"standard_charges":[{"gross_charge":5560.25,"discounted_cash":4670.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"DEGARELIX 80 MG SUBCUTANEOUS SOLUTION [96986]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9155","type":"HCPCS"},{"code":"55566-8303-1","type":"NDC"}],"standard_charges":[{"gross_charge":1782.0,"discounted_cash":1496.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"DATOPOTAMAB DERUXTECAN-DLNK 100 MG INTRAVENOUS SOLUTION [200962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65597-801-01","type":"NDC"}],"standard_charges":[{"gross_charge":10036.5,"discounted_cash":8430.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DASATINIB 50 MG TABLET [76718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-0528-11","type":"NDC"}],"standard_charges":[{"gross_charge":2896.5,"discounted_cash":2433.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4053.0,"discounted_cash":3404.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"},{"gross_charge":583.5,"discounted_cash":490.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1450.75,"discounted_cash":1218.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":2029.0,"discounted_cash":1704.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"},{"gross_charge":2318.25,"discounted_cash":1947.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE [108043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0882","type":"HCPCS"},{"code":"55513-023-04","type":"NDC"}],"standard_charges":[{"gross_charge":1694.25,"discounted_cash":1423.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MCG"}]},{"description":"DARUNAVIR 100 MG/ML ORAL SUSPENSION [119037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-565-01","type":"NDC"}],"standard_charges":[{"gross_charge":4373.5,"discounted_cash":3673.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"DARUNAVIR 600 MG TABLET [92851]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-562-01","type":"NDC"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":318.25,"discounted_cash":267.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"DARUNAVIR 800 MG TABLET [119168]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-566-30","type":"NDC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":301.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"DARUNAVIR 800 MG TABLET [119168]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-705-30","type":"NDC"}],"standard_charges":[{"gross_charge":314.5,"discounted_cash":264.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"DARUNAVIR 800 MG TABLET [119168]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-185-30","type":"NDC"}],"standard_charges":[{"gross_charge":314.5,"discounted_cash":264.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"DARUNAVIR 800 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO ALAFEN 10 MG TABLET [179545]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-800-30","type":"NDC"}],"standard_charges":[{"gross_charge":773.75,"discounted_cash":649.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET [165359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-575-30","type":"NDC"}],"standard_charges":[{"gross_charge":409.75,"discounted_cash":344.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"DASATINIB 100 MG TABLET [92897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-0852-22","type":"NDC"}],"standard_charges":[{"gross_charge":2224.0,"discounted_cash":1868.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3111.5,"discounted_cash":2613.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"},{"gross_charge":449.0,"discounted_cash":377.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1114.5,"discounted_cash":936.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":1558.25,"discounted_cash":1308.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"},{"gross_charge":1780.25,"discounted_cash":1495.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"DAPSONE 100 MG TABLET [2131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13925-505-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DASATINIB 140 MG TABLET [108422]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-0857-22","type":"NDC"}],"standard_charges":[{"gross_charge":1590.0,"discounted_cash":1335.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2224.0,"discounted_cash":1868.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"},{"gross_charge":322.0,"discounted_cash":270.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":797.5,"discounted_cash":669.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":1114.5,"discounted_cash":936.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"},{"gross_charge":1273.0,"discounted_cash":1069.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"DAPSONE 100 MG TABLET [2131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49938-101-30","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION [96982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703-305-38","type":"NDC"}],"standard_charges":[{"gross_charge":120.25,"discounted_cash":101.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION [96982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703-305-58","type":"NDC"}],"standard_charges":[{"gross_charge":120.25,"discounted_cash":101.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DABIGATRAN ETEXILATE 150 MG CAPSULE [106491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0360-55","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DABIGATRAN ETEXILATE 150 MG CAPSULE [106491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0360-82","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DABIGATRAN ETEXILATE 150 MG CAPSULE [106491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-752-32","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DABIGATRAN ETEXILATE 150 MG CAPSULE [106491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-752-33","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DABIGATRAN ETEXILATE 75 MG CAPSULE [106490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0355-56","type":"NDC"}],"standard_charges":[{"gross_charge":53.75,"discounted_cash":45.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DABRAFENIB 50 MG CAPSULE [122206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0682-66","type":"NDC"}],"standard_charges":[{"gross_charge":335.25,"discounted_cash":281.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":497.75,"discounted_cash":418.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":173.0,"discounted_cash":145.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":254.25,"discounted_cash":213.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DABRAFENIB 75 MG CAPSULE [122207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0681-66","type":"NDC"}],"standard_charges":[{"gross_charge":289.5,"discounted_cash":243.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":429.0,"discounted_cash":360.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":219.75,"discounted_cash":184.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYPROHEPTADINE 4 MG TABLET [2033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72789-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"CYPROHEPTADINE 4 MG TABLET [2033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-638-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"CYPROHEPTADINE 4 MG TABLET [2033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1110-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"CYPROHEPTADINE 4 MG TABLET [2033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-190-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"CYCLOSPORINE 25 MG CAPSULE [9707]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"0078-0240-61","type":"NDC"}],"standard_charges":[{"gross_charge":145.5,"discounted_cash":122.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7516","type":"HCPCS"},{"code":"0078-0109-01","type":"NDC"}],"standard_charges":[{"gross_charge":344.25,"discounted_cash":289.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7516","type":"HCPCS"},{"code":"0574-0866-10","type":"NDC"}],"standard_charges":[{"gross_charge":255.5,"discounted_cash":214.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7516","type":"HCPCS"},{"code":"0078-0109-61","type":"NDC"}],"standard_charges":[{"gross_charge":344.25,"discounted_cash":289.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7516","type":"HCPCS"},{"code":"0517-0866-01","type":"NDC"}],"standard_charges":[{"gross_charge":255.5,"discounted_cash":214.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7516","type":"HCPCS"},{"code":"0517-0866-10","type":"NDC"}],"standard_charges":[{"gross_charge":255.5,"discounted_cash":214.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"0093-5742-65","type":"NDC"}],"standard_charges":[{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"60505-4632-3","type":"NDC"}],"standard_charges":[{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"0172-7313-20","type":"NDC"}],"standard_charges":[{"gross_charge":1072.5,"discounted_cash":900.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"0078-0246-15","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"0078-0246-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"0093-5740-65","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP [2032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-504-48","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP [2032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2045-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP [2032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39328-044-16","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"CYPROHEPTADINE 4 MG TABLET [2033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-838-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"0093-5740-19","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEMECLOCYCLINE 150 MG TABLET [9726]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0701-02","type":"NDC"}],"standard_charges":[{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"DACARBAZINE 200 MG INTRAVENOUS SOLUTION [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"0703-5075-01","type":"NDC"}],"standard_charges":[{"gross_charge":133.25,"discounted_cash":111.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DACARBAZINE 200 MG INTRAVENOUS SOLUTION [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"61703-327-22","type":"NDC"}],"standard_charges":[{"gross_charge":214.25,"discounted_cash":179.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DANTROLENE 25 MG CAPSULE [9718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-4411-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANTROLENE 25 MG CAPSULE [9718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-300-11","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANTROLENE 25 MG CAPSULE [9718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-300-21","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANTROLENE 25 MG CAPSULE [9718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42023-124-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANTROLENE 25 MG CAPSULE [9718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-217-15","type":"NDC"}],"standard_charges":[{"gross_charge":64.25,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANTROLENE 25 MG CAPSULE [9718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7211-04","type":"NDC"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANTROLENE 250 MG INTRAVENOUS SUSPENSION [126579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42367-540-32","type":"NDC"}],"standard_charges":[{"gross_charge":3029.75,"discounted_cash":2544.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":7574.25,"discounted_cash":6362.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"},{"gross_charge":9089.0,"discounted_cash":7634.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"}]},{"description":"DANTROLENE 20 MG INTRAVENOUS SOLUTION [9716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9297-01","type":"NDC"}],"standard_charges":[{"gross_charge":1345.0,"discounted_cash":1129.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":3362.25,"discounted_cash":2824.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"},{"gross_charge":4034.75,"discounted_cash":3389.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"}]},{"description":"DACARBAZINE 200 MG INTRAVENOUS SOLUTION [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"63323-128-20","type":"NDC"}],"standard_charges":[{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DACARBAZINE 200 MG INTRAVENOUS SOLUTION [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"0143-9245-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DACARBAZINE 200 MG INTRAVENOUS SOLUTION [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"0143-9245-10","type":"NDC"}],"standard_charges":[{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DALBAVANCIN 500 MG INTRAVENOUS SOLUTION [126244]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"57970-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":5273.5,"discounted_cash":4429.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":10546.75,"discounted_cash":8859.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"DALBAVANCIN 500 MG INTRAVENOUS SOLUTION [126244]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0875","type":"HCPCS"},{"code":"57970-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":3955.25,"discounted_cash":3322.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"}]},{"description":"DALTEPARIN (PORCINE) 5,000 ANTI-XA UNIT/0.2 ML SUBCUTANEOUS SYRINGE [108032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1645","type":"HCPCS"},{"code":"0069-0196-01","type":"NDC"}],"standard_charges":[{"gross_charge":723.5,"discounted_cash":607.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 INT'L UNITS/KG"},{"gross_charge":964.5,"discounted_cash":810.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 INT'L UNITS/KG"},{"gross_charge":312.75,"discounted_cash":262.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 INT'L UNITS"}]},{"description":"DACARBAZINE 200 MG INTRAVENOUS SOLUTION [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"0703-5075-03","type":"NDC"}],"standard_charges":[{"gross_charge":133.25,"discounted_cash":111.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DALTEPARIN (PORCINE) 5,000 ANTI-XA UNIT/0.2 ML SUBCUTANEOUS SYRINGE [108032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1645","type":"HCPCS"},{"code":"0069-0196-02","type":"NDC"}],"standard_charges":[{"gross_charge":723.5,"discounted_cash":607.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 INT'L UNITS/KG"},{"gross_charge":964.5,"discounted_cash":810.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 INT'L UNITS/KG"},{"gross_charge":312.75,"discounted_cash":262.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 INT'L UNITS"}]},{"description":"DANAZOL 100 MG CAPSULE [9714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0634-02","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANAZOL 200 MG CAPSULE [2120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0635-02","type":"NDC"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":61.5,"discounted_cash":51.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANTROLENE 20 MG INTRAVENOUS SOLUTION [9716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-123-06","type":"NDC"}],"standard_charges":[{"gross_charge":1681.25,"discounted_cash":1412.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/KG"},{"gross_charge":4203.0,"discounted_cash":3530.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG/KG"},{"gross_charge":5043.75,"discounted_cash":4236.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG/KG"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-953-01","type":"NDC"}],"standard_charges":[{"gross_charge":99.25,"discounted_cash":83.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DEMECLOCYCLINE 150 MG TABLET [9726]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION ***FOR ORAL USE ONLY*** [4082331]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"0641-0367-21","type":"NDC"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":412.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION ***FOR ORAL USE ONLY*** [4082331]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-420-10","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION ***FOR ORAL USE ONLY*** [4082331]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-420-00","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323-165-01","type":"NDC"}],"standard_charges":[{"gross_charge":260.25,"discounted_cash":218.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323-165-05","type":"NDC"}],"standard_charges":[{"gross_charge":1300.5,"discounted_cash":1092.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457-422-54","type":"NDC"}],"standard_charges":[{"gross_charge":1300.5,"discounted_cash":1092.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457-423-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457-423-12","type":"NDC"}],"standard_charges":[{"gross_charge":260.25,"discounted_cash":218.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457-422-00","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150-237-01","type":"NDC"}],"standard_charges":[{"gross_charge":260.25,"discounted_cash":218.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"0641-6145-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"0641-6145-25","type":"NDC"}],"standard_charges":[{"gross_charge":260.25,"discounted_cash":218.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323-165-02","type":"NDC"}],"standard_charges":[{"gross_charge":260.25,"discounted_cash":218.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457-419-00","type":"NDC"}],"standard_charges":[{"gross_charge":260.25,"discounted_cash":218.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":2601.0,"discounted_cash":2184.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457-419-01","type":"NDC"}],"standard_charges":[{"gross_charge":260.25,"discounted_cash":218.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION ***FOR ORAL USE ONLY*** [4082331]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"0641-0367-25","type":"NDC"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":412.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE 4 MG TABLET [2327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"0904-7266-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"DEXAMETHASONE 4 MG TABLET [2327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"72578-171-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION FOR ORAL USE [408116345]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323-506-01","type":"NDC"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":412.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION FOR ORAL USE [408116345]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323-506-16","type":"NDC"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":412.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION FOR ORAL USE [408116345]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069-021-01","type":"NDC"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":412.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION FOR ORAL USE [408116345]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069-021-25","type":"NDC"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":412.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [116345]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323-506-41","type":"NDC"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":412.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 0.1 % EYE DROPS [2335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-720-02","type":"NDC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":223.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-251-00","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":122.25,"discounted_cash":102.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-251-02","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":122.25,"discounted_cash":102.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-9557-12","type":"NDC"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-671-00","type":"NDC"}],"standard_charges":[{"gross_charge":448.75,"discounted_cash":376.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-671-01","type":"NDC"}],"standard_charges":[{"gross_charge":448.75,"discounted_cash":376.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71225-126-03","type":"NDC"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71225-126-06","type":"NDC"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1660-35","type":"NDC"}],"standard_charges":[{"gross_charge":300.75,"discounted_cash":252.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70121-1389-1","type":"NDC"}],"standard_charges":[{"gross_charge":458.75,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70121-1389-7","type":"NDC"}],"standard_charges":[{"gross_charge":458.75,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-975-58","type":"NDC"}],"standard_charges":[{"gross_charge":448.75,"discounted_cash":376.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-187-01","type":"NDC"}],"standard_charges":[{"gross_charge":448.75,"discounted_cash":376.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-187-10","type":"NDC"}],"standard_charges":[{"gross_charge":448.75,"discounted_cash":376.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-925-00","type":"NDC"}],"standard_charges":[{"gross_charge":458.75,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-925-10","type":"NDC"}],"standard_charges":[{"gross_charge":458.75,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9525-01","type":"NDC"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9525-10","type":"NDC"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-297-01","type":"NDC"}],"standard_charges":[{"gross_charge":313.25,"discounted_cash":263.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-297-10","type":"NDC"}],"standard_charges":[{"gross_charge":313.25,"discounted_cash":263.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70121-1712-1","type":"NDC"}],"standard_charges":[{"gross_charge":228.25,"discounted_cash":191.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70121-1712-3","type":"NDC"}],"standard_charges":[{"gross_charge":228.25,"discounted_cash":191.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-605-03","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MCG/ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7032-10","type":"NDC"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":505.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121732]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1660-10","type":"NDC"}],"standard_charges":[{"gross_charge":300.75,"discounted_cash":252.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE 200 MCG/50 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1660-55","type":"NDC"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":199.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXMEDETOMIDINE 200 MCG/50 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7031-05","type":"NDC"}],"standard_charges":[{"gross_charge":328.25,"discounted_cash":275.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-421-02","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":99.75,"discounted_cash":83.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-209-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16729-239-30","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16729-239-93","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXAMETHASONE 4 MG TABLET [2327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"0054-8175-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-605-41","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"66794-230-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"66794-230-42","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288-505-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [123049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288-505-03","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG/KG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG/KG"}]},{"description":"DEXMEDETOMIDINE 120 MCG SUBLINGUAL FILM [191678]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81092-1120-1","type":"NDC"}],"standard_charges":[{"gross_charge":516.75,"discounted_cash":434.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MCG"},{"gross_charge":258.5,"discounted_cash":217.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MCG"}]},{"description":"DEXMEDETOMIDINE 200 MCG/50 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV [121731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1660-50","type":"NDC"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":199.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DESMOPRESSIN 0.1 MG TABLET [16052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-606-21","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"DESMOPRESSIN 0.1 MG TABLET [16052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-489-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"DESMOPRESSIN 0.1 MG TABLET [16052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-169-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"DESMOPRESSIN 0.1 MG TABLET [16052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-883-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"DESMOPRESSIN 0.1 MG TABLET [16052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-249-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"DESMOPRESSIN 0.2 MG TABLET [16053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-604-21","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"DESMOPRESSIN 0.2 MG TABLET [16053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-490-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-342-05","type":"NDC"}],"standard_charges":[{"gross_charge":881.75,"discounted_cash":740.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) [21135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-788-91","type":"NDC"}],"standard_charges":[{"gross_charge":881.75,"discounted_cash":740.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DESMOPRESSIN 150 MCG/SPRAY (0.1 ML) NASAL SPRAY [13506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0053-6871-00","type":"NDC"}],"standard_charges":[{"gross_charge":2670.5,"discounted_cash":2243.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"62756-529-40","type":"NDC"}],"standard_charges":[{"gross_charge":2924.5,"discounted_cash":2456.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DESMOPRESSIN 0.1 MG TABLET [16052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-606-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"DEMECLOCYCLINE 150 MG TABLET [9726]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-554-10","type":"NDC"}],"standard_charges":[{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":127.25,"discounted_cash":106.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"DEMECLOCYCLINE 150 MG TABLET [9726]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-143-01","type":"NDC"}],"standard_charges":[{"gross_charge":127.25,"discounted_cash":106.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":254.25,"discounted_cash":213.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-730-01","type":"NDC"}],"standard_charges":[{"gross_charge":10223.0,"discounted_cash":8587.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513-710-01","type":"NDC"}],"standard_charges":[{"gross_charge":5557.5,"discounted_cash":4668.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-710-01","type":"NDC"}],"standard_charges":[{"gross_charge":11115.0,"discounted_cash":9336.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513-710-21","type":"NDC"}],"standard_charges":[{"gross_charge":5557.5,"discounted_cash":4668.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55513-710-21","type":"NDC"}],"standard_charges":[{"gross_charge":11115.0,"discounted_cash":9336.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"}]},{"description":"DESIPRAMINE 10 MG TABLET [2283]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-710-01","type":"NDC"}],"standard_charges":[{"gross_charge":112.75,"discounted_cash":94.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":56.5,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":84.75,"discounted_cash":71.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"55566-2200-0","type":"NDC"}],"standard_charges":[{"gross_charge":2314.25,"discounted_cash":1943.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MCG/KG"},{"gross_charge":400.25,"discounted_cash":336.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DESIPRAMINE 25 MG TABLET [2286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45963-342-02","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DESMOPRESSIN 0.1 MG TABLET [16052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0257-1","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"DESMOPRESSIN 0.1 MG TABLET [16052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2464-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 MG"},{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918-899-10","type":"NDC"}],"standard_charges":[{"gross_charge":248.25,"discounted_cash":208.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"43598-931-09","type":"NDC"}],"standard_charges":[{"gross_charge":248.25,"discounted_cash":208.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE 0.5 MG TABLET [2322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0054-4179-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"DEXAMETHASONE 0.5 MG TABLET [2322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0054-8179-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"DEXAMETHASONE 0.5 MG TABLET [2322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72603-212-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION [2320]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0054-3177-63","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXAMETHASONE 20 MG CAPSULE [186386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"7700-7234-20","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":33.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DEXAMETHASONE 4 MG TABLET [2327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"0054-4184-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [19596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0925-25","type":"NDC"}],"standard_charges":[{"gross_charge":340.5,"discounted_cash":286.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [19596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0998-0615-05","type":"NDC"}],"standard_charges":[{"gross_charge":390.75,"discounted_cash":328.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0400-22","type":"NDC"}],"standard_charges":[{"gross_charge":166.5,"discounted_cash":139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"43598-931-11","type":"NDC"}],"standard_charges":[{"gross_charge":248.25,"discounted_cash":208.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-495-35","type":"NDC"}],"standard_charges":[{"gross_charge":239.75,"discounted_cash":201.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"DESVENLAFAXINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [121684]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-191-30","type":"NDC"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":65.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [91074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-312-90","type":"NDC"}],"standard_charges":[{"gross_charge":77.5,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR [91074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0401-13","type":"NDC"}],"standard_charges":[{"gross_charge":80.75,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918-899-01","type":"NDC"}],"standard_charges":[{"gross_charge":248.25,"discounted_cash":208.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-430-30","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0008-1211-30","type":"NDC"}],"standard_charges":[{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":123.5,"discounted_cash":103.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"35356-491-30","type":"NDC"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":221.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":134.5,"discounted_cash":112.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43063-262-30","type":"NDC"}],"standard_charges":[{"gross_charge":122.25,"discounted_cash":102.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":63.75,"discounted_cash":53.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-430-60","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-311-33","type":"NDC"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0067-8152-02","type":"NDC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1294-97","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-7126-11","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":71.75,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-7126-13","type":"NDC"}],"standard_charges":[{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":45.25,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0473-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-767-08","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-534-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-415-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":39.0,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6364-45","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6363-61","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-510-10","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-533-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-310-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-310-11","type":"NDC"}],"standard_charges":[{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6363-45","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":39.5,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-755-10","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-595-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DOCETAXEL 20 MG/2 ML (10 MG/ML) INTRAVENOUS SOLUTION [108910]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"0409-0201-02","type":"NDC"}],"standard_charges":[{"gross_charge":645.5,"discounted_cash":542.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"}]},{"description":"DOCUSATE SODIUM 100 MG CAPSULE [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 100 MG CAPSULE [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1062-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 100 MG CAPSULE [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6457-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 100 MG CAPSULE [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-129-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 100 MG CAPSULE [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-129-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 100 MG CAPSULE [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6455-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 100 MG CAPSULE [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6961804401","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 100 MG CAPSULE [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6998-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 100 MG CAPSULE [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7115-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 100 MG CAPSULE [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7183-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0544-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-771-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-771-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-771-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1957-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-349-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-349-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1870-00","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1870-10","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV [18315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"0409-2347-31","type":"NDC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":187.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV [18315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"0409-2347-32","type":"NDC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":187.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV [18315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"0338-1075-02","type":"NDC"}],"standard_charges":[{"gross_charge":315.25,"discounted_cash":264.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"70436-203-82","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-757-10","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6364-61","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-260-11","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-260-13","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"0409-2344-02","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"0409-2025-20","type":"NDC"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"0409-2025-60","type":"NDC"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"70436-203-80","type":"NDC"}],"standard_charges":[{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7279-66","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0472-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":49.75,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DISULFIRAM 250 MG TABLET [2540]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-607-30","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":59.75,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE [27631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-6114-13","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE [27631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-532-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE [27631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-106-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE [27631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-313-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE [27631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-313-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE [27631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2243-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE [27631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-995-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"DIVALPROEX 125 MG TABLET,DELAYED RELEASE [2551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-796-88","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 125 MG TABLET,DELAYED RELEASE [2551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-138-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 125 MG TABLET,DELAYED RELEASE [2551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-7122-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DISULFIRAM 250 MG TABLET [2540]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51285-523-02","type":"NDC"}],"standard_charges":[{"gross_charge":76.25,"discounted_cash":64.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":147.25,"discounted_cash":123.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DISOPYRAMIDE PHOSPHATE ER 150 MG CAPSULE,EXTENDED RELEASE [37653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-2742-31","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"DIPHTH,PERTUSSIS(ACELL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML IM SUSP [129774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160-842-01","type":"NDC"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":194.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPHTH,PERTUSSIS,TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML INJECTION [172682]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160-842-11","type":"NDC"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":194.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPHTH,PERTUSSIS,TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML INJECTION [172682]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160-842-52","type":"NDC"}],"standard_charges":[{"gross_charge":238.75,"discounted_cash":200.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPHTH,PERTUSSIS,TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML INJECTION [172682]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160-842-43","type":"NDC"}],"standard_charges":[{"gross_charge":238.75,"discounted_cash":200.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPYRIDAMOLE 25 MG TABLET [2528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-133-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DIPYRIDAMOLE 25 MG TABLET [2528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1070-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DIPYRIDAMOLE 5 MG/ML INTRAVENOUS SOLUTION [9891]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1245","type":"HCPCS"},{"code":"0641-2569-44","type":"NDC"}],"standard_charges":[{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPYRIDAMOLE 5 MG/ML INTRAVENOUS SOLUTION [9891]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1245","type":"HCPCS"},{"code":"0641-2569-41","type":"NDC"}],"standard_charges":[{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPYRIDAMOLE 50 MG TABLET [2529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-134-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DISOPYRAMIDE PHOSPHATE 100 MG CAPSULE [2535]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3127-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"DISOPYRAMIDE PHOSPHATE 150 MG CAPSULE [2536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3129-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"DIVALPROEX 125 MG TABLET,DELAYED RELEASE [2551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-211-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 500 MG TABLET,DELAYED RELEASE [2553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-048-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 500 MG TABLET,DELAYED RELEASE [2553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-048-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 500 MG TABLET,DELAYED RELEASE [2553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-7124-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 500 MG TABLET,DELAYED RELEASE [2553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-782-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-3826-11","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":105.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":31.5,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-3826-13","type":"NDC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":77.25,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX 500 MG TABLET,DELAYED RELEASE [2553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-798-88","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 250 MG TABLET,DELAYED RELEASE [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6860-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 125 MG TABLET,DELAYED RELEASE [2551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-211-21","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 250 MG TABLET,DELAYED RELEASE [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-797-88","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 250 MG TABLET,DELAYED RELEASE [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-139-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 250 MG TABLET,DELAYED RELEASE [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-047-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 250 MG TABLET,DELAYED RELEASE [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-7123-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":29.25,"discounted_cash":24.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 250 MG TABLET,DELAYED RELEASE [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-7123-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX 250 MG TABLET,DELAYED RELEASE [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-7123-89","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7279-72","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOFETILIDE 125 MCG CAPSULE [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5800-43","type":"NDC"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":178.0,"discounted_cash":149.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":355.75,"discounted_cash":298.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOXAZOSIN 4 MG TABLET [9896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-2770-66","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":87.25,"discounted_cash":73.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 4 MG TABLET [9896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-959-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 4 MG TABLET [9896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-959-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 4 MG TABLET [9896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0095-0","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 4 MG TABLET [9896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2068-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 4 MG TABLET [9896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-213-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 4 MG TABLET [9896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-785-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 1 MG TABLET [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-222-15","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 1 MG TABLET [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0093-0","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 1 MG TABLET [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2070-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 1 MG TABLET [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-211-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 1 MG TABLET [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5522-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 1 MG TABLET [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-783-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 1 MG TABLET [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-783-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXEPIN 25 MG CAPSULE [2611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3125-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN 25 MG CAPSULE [2611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-437-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN 25 MG CAPSULE [2611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-437-20","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":39.25,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN 25 MG CAPSULE [2611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1170-9","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN 25 MG CAPSULE [2611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4218-1","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXAZOSIN 4 MG TABLET [9896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-224-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 4 MG TABLET [9896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-224-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXEPIN 10 MG CAPSULE [2608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1049-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN 10 MG CAPSULE [2608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-436-20","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN 10 MG CAPSULE [2608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1166-9","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN 10 MG CAPSULE [2608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-132-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXAZOSIN 1 MG TABLET [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-957-20","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":203.5,"discounted_cash":170.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOFETILIDE 250 MCG CAPSULE [26966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-412-60","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 500 MCG CAPSULE [26967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5820-43","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":89.0,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 500 MCG CAPSULE [26967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5820-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 500 MCG CAPSULE [26967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0039-2","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 500 MCG CAPSULE [26967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-133-17","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 500 MCG CAPSULE [26967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-842-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 500 MCG CAPSULE [26967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-413-60","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOLUTEGRAVIR 50 MG TABLET [122784]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-228-13","type":"NDC"}],"standard_charges":[{"gross_charge":381.5,"discounted_cash":320.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DONEPEZIL 5 MG TABLET [18786]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0245-3","type":"NDC"}],"standard_charges":[{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DOFETILIDE 250 MCG CAPSULE [26966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5810-61","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":128.75,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 250 MCG CAPSULE [26966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5810-43","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":89.0,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":178.0,"discounted_cash":149.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 125 MCG CAPSULE [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5800-60","type":"NDC"}],"standard_charges":[{"gross_charge":84.75,"discounted_cash":71.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":169.5,"discounted_cash":142.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":338.75,"discounted_cash":284.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 125 MCG CAPSULE [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-5800-61","type":"NDC"}],"standard_charges":[{"gross_charge":64.5,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":128.75,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":257.25,"discounted_cash":216.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 125 MCG CAPSULE [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-840-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":236.0,"discounted_cash":198.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 125 MCG CAPSULE [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-411-60","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":231.25,"discounted_cash":194.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 125 MCG CAPSULE [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-061-86","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":115.75,"discounted_cash":97.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":231.5,"discounted_cash":194.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 125 MCG CAPSULE [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-039-60","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":131.75,"discounted_cash":110.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":263.5,"discounted_cash":221.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 125 MCG CAPSULE [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-490-12","type":"NDC"}],"standard_charges":[{"gross_charge":55.25,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":110.25,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":220.5,"discounted_cash":185.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DONEPEZIL 5 MG TABLET [18786]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-102-30","type":"NDC"}],"standard_charges":[{"gross_charge":105.25,"discounted_cash":88.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DONEPEZIL 5 MG TABLET [18786]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-275-03","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DORZOLAMIDE 2 % EYE DROPS [14471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-019-10","type":"NDC"}],"standard_charges":[{"gross_charge":274.5,"discounted_cash":230.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE 2 % EYE DROPS [14471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-485-10","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":209.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE 2 % EYE DROPS [14471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-141-26","type":"NDC"}],"standard_charges":[{"gross_charge":274.75,"discounted_cash":230.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-233-10","type":"NDC"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":423.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-486-10","type":"NDC"}],"standard_charges":[{"gross_charge":277.5,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-605-10","type":"NDC"}],"standard_charges":[{"gross_charge":853.75,"discounted_cash":717.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-051-01","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-147-26","type":"NDC"}],"standard_charges":[{"gross_charge":501.5,"discounted_cash":421.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-305-10","type":"NDC"}],"standard_charges":[{"gross_charge":501.5,"discounted_cash":421.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS [22982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-946-01","type":"NDC"}],"standard_charges":[{"gross_charge":501.5,"discounted_cash":421.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOSTARLIMAB-GXLY 50 MG/ML INTRAVENOUS SOLUTION [188855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9272","type":"HCPCS"},{"code":"0173-0898-03","type":"NDC"}],"standard_charges":[{"gross_charge":24202.25,"discounted_cash":20329.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":24202.25,"discounted_cash":20329.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DOXAZOSIN 1 MG TABLET [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-2750-66","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":51.5,"discounted_cash":43.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":103.0,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":205.75,"discounted_cash":172.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN 1 MG TABLET [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-957-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":203.5,"discounted_cash":170.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DORZOLAMIDE 2 % EYE DROPS [14471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-232-10","type":"NDC"}],"standard_charges":[{"gross_charge":274.75,"discounted_cash":230.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE 2 % EYE DROPS [14471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-3519-36","type":"NDC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":314.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION [12211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7639","type":"HCPCS"},{"code":"50242-100-39","type":"NDC"}],"standard_charges":[{"gross_charge":658.25,"discounted_cash":552.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":1316.5,"discounted_cash":1105.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION [12211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7639","type":"HCPCS"},{"code":"50242-100-40","type":"NDC"}],"standard_charges":[{"gross_charge":658.25,"discounted_cash":552.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"DONEPEZIL 5 MG TABLET [18786]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-275-09","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DONEPEZIL 5 MG TABLET [18786]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-292-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DONEPEZIL 5 MG TABLET [18786]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-292-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DONEPEZIL 5 MG TABLET [18786]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6477-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION [2595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0409-5820-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION [2595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0409-5820-11","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION [2595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0143-9252-01","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.6 MG/ML"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION [131624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0409-9104-20","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION [131624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0409-9104-21","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION [131624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0143-9254-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION [131624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0143-9254-25","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN [14845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0338-1007-02","type":"NDC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN [14845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0409-7809-22","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN [14845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0409-7809-11","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE 800 MG/500 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN [131626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0338-1007-03","type":"NDC"}],"standard_charges":[{"gross_charge":203.75,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION [2595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0143-9252-25","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIPHTH,PERTUSSIS(ACEL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE [41293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160-842-05","type":"NDC"}],"standard_charges":[{"gross_charge":249.5,"discounted_cash":209.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-562-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-481-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-717-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-717-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0641-6013-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0641-6013-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6014-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-129-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0318-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0023-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-745-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-745-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-079-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 30 MG TABLET [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-006-10","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6014-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"70860-301-43","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":16.0,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"25021-319-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 90 MG TABLET [2477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-747-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM 90 MG TABLET [2477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-747-20","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62037-597-05","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62037-597-90","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"70860-301-41","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0641-6015-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0641-6015-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"17478-937-26","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"7700-1000-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"70860-301-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"DILTIAZEM 125 MG/125 ML (1 MG/ML) IN DEXTROSE 5 % IV [129633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1575-36","type":"NDC"}],"standard_charges":[{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"}]},{"description":"DICYCLOMINE 10 MG CAPSULE [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6987-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLUTION [42119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-1161-58","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLUTION [42119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-1815-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"58914-080-52","type":"NDC"}],"standard_charges":[{"gross_charge":207.5,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":414.75,"discounted_cash":348.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"0641-6173-01","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":66.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"0641-6173-10","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":66.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":158.25,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"0517-1980-01","type":"NDC"}],"standard_charges":[{"gross_charge":132.75,"discounted_cash":111.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":265.25,"discounted_cash":222.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"0517-1980-05","type":"NDC"}],"standard_charges":[{"gross_charge":132.75,"discounted_cash":111.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":265.25,"discounted_cash":222.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"14789-010-02","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"14789-010-07","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"17478-015-02","type":"NDC"}],"standard_charges":[{"gross_charge":186.75,"discounted_cash":156.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":373.25,"discounted_cash":313.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG CAPSULE [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-369-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG CAPSULE [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-369-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-977-10","type":"NDC"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":81.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1294-34","type":"NDC"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-0108-1","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC EPOLAMINE 1.3 % TRANSDERMAL 12 HOUR PATCH [100614]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60793-411-05","type":"NDC"}],"standard_charges":[{"gross_charge":306.75,"discounted_cash":257.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 EACH"}]},{"description":"DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE [15341]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2551-06","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE [15341]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-201-06","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DICLOXACILLIN 250 MG CAPSULE [2414]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3123-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DICLOXACILLIN 250 MG CAPSULE [2414]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2248-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DICYCLOMINE 10 MG CAPSULE [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1610-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG CAPSULE [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-0586-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG CAPSULE [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0794-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG CAPSULE [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG CAPSULE [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-118-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"63323-842-02","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":254.75,"discounted_cash":213.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"63323-842-21","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":254.75,"discounted_cash":213.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1162","type":"HCPCS"},{"code":"50633-120-11","type":"NDC"}],"standard_charges":[{"gross_charge":10206.75,"discounted_cash":8573.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":61240.0,"discounted_cash":51441.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1162","type":"HCPCS"},{"code":"50633-121-11","type":"NDC"}],"standard_charges":[{"gross_charge":10206.75,"discounted_cash":8573.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1162","type":"HCPCS"},{"code":"50633-120-12","type":"NDC"}],"standard_charges":[{"gross_charge":10206.75,"discounted_cash":8573.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"0574-0850-05","type":"NDC"}],"standard_charges":[{"gross_charge":323.25,"discounted_cash":271.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":646.25,"discounted_cash":542.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"0574-0850-10","type":"NDC"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":257.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":614.0,"discounted_cash":515.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"0143-9273-01","type":"NDC"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":309.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":735.75,"discounted_cash":618.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"0143-9273-10","type":"NDC"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":309.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":735.75,"discounted_cash":618.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"61990-0411-0","type":"NDC"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":309.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":735.75,"discounted_cash":618.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"61990-0411-1","type":"NDC"}],"standard_charges":[{"gross_charge":408.75,"discounted_cash":343.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":817.5,"discounted_cash":686.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"81284-411-00","type":"NDC"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":384.0,"discounted_cash":322.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"81284-411-05","type":"NDC"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":384.0,"discounted_cash":322.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DILTIAZEM 125 MG/125 ML (1 MG/ML) IN 100 ML 0.9 % SODIUM CHLORIDE (PREMIX) [186831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69194-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"}]},{"description":"DILTIAZEM 125 MG/125 ML (1 MG/ML) IN DEXTROSE 5 % IV [129633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1007-36","type":"NDC"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"}]},{"description":"DILTIAZEM 125 MG/125 ML (1 MG/ML) IN DEXTROSE 5 % IV [129633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71019-055-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":136.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4217-05","type":"NDC"}],"standard_charges":[{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-2047-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-327-02","type":"NDC"}],"standard_charges":[{"gross_charge":1004.75,"discounted_cash":843.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION [9853]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"70515-262-10","type":"NDC"}],"standard_charges":[{"gross_charge":621.75,"discounted_cash":522.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION [9853]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"70515-263-10","type":"NDC"}],"standard_charges":[{"gross_charge":704.75,"discounted_cash":591.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET [2444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1324-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET [2444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1240-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET [2444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5921-61","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET [2444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-437-88","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET [2444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-590-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET [2444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-590-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET [2444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82685-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 250 MCG (0.25 MG) TABLET [2445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1325-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 250 MCG (0.25 MG) TABLET [2445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-680-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 250 MCG (0.25 MG) TABLET [2445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6156-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 250 MCG (0.25 MG) TABLET [2445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-591-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 250 MCG (0.25 MG) TABLET [2445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1992-1","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 250 MCG (0.25 MG) TABLET [2445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-748-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [127243]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"0641-1410-35","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [127243]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"0781-3059-95","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [127243]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"0641-1410-31","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0057-46","type":"NDC"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":953.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"DIGOXIN 250 MCG (0.25 MG) TABLET [2445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-441-88","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DICLOFENAC 1 % TOPICAL GEL [100611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0067-8152-03","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-993-98","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50580-534-08","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 236 ML"}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"57896-780-16","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"57896-980-16","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-267-48","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-267-56","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69339-152-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69339-152-17","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE 25 MG TABLET/CAPSULE WRAPPER [171578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0904-5551-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 25 MG TABLET/CAPSULE WRAPPER [171578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0113-0431-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 25 MG TABLET/CAPSULE WRAPPER [171578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45084310","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 25 MG TABLET/CAPSULE WRAPPER [171578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0536-1214-29","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 25 MG TABLET/CAPSULE WRAPPER [171578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68094-018-59","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 25 MG TABLET/CAPSULE WRAPPER [171578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68094-018-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-0376-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49348-045-34","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-664-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR [2511]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0121-0978-10","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPH,PERTUS(ACEL),TET,POLIO(PF) 15 LF-48 MCG-5 LF UNIT/0.5 ML IM SUSP [135038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49281-562-58","type":"NDC"}],"standard_charges":[{"gross_charge":298.5,"discounted_cash":250.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DILTIAZEM ER 180 MG TABLET,EXTENDED RELEASE 24 HR [35178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-705-30","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":38.75,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM ER 240 MG CAPSULE,24 HR,EXTENDED RELEASE [29273]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-671-81","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DIMENHYDRINATE 50 MG TABLET [2485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-2051-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIMENHYDRINATE 50 MG/ML INJECTION SOLUTION [2483]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1240","type":"HCPCS"},{"code":"63323-366-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":106.75,"discounted_cash":89.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DIMETHYL SULFOXIDE 50 % INTRAVESICAL SOLUTION [131519]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"67457-177-50","type":"NDC"}],"standard_charges":[{"gross_charge":2662.25,"discounted_cash":2236.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED RELEASE [27467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55566-2800-0","type":"NDC"}],"standard_charges":[{"gross_charge":2007.25,"discounted_cash":1686.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED RELEASE [27467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55566-2800-1","type":"NDC"}],"standard_charges":[{"gross_charge":2007.25,"discounted_cash":1686.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"DIP,PERT(A)TET-HEPB-POLIO-HIB PED(PF) 15-5 UNIT-10 MCG/0.5 ML IM SYRNG [187324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63361-243-15","type":"NDC"}],"standard_charges":[{"gross_charge":769.25,"discounted_cash":646.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIP,PERT(A)TET-HEPB-POLIO-HIB PED(PF) 15-5 UNIT-10 MCG/0.5 ML IM SYRNG [187324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63361-243-88","type":"NDC"}],"standard_charges":[{"gross_charge":769.25,"discounted_cash":646.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIP-PERT-TET-POLIO-HIB(PF) 15 LF-20 MCG-5 LF-62 DU-10MCG/0.5 ML IM KIT [184831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90698","type":"HCPCS"},{"code":"49281-511-05","type":"NDC"}],"standard_charges":[{"gross_charge":589.25,"discounted_cash":494.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPH,PERTUS(ACEL),TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE [19451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90700","type":"HCPCS"},{"code":"58160-810-52","type":"NDC"}],"standard_charges":[{"gross_charge":190.75,"discounted_cash":160.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPH,PERTUS(ACEL),TET PEDI (PF) 15 LF UNIT-10 MCG-5 LF/0.5 ML IM SUSP [131264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90700","type":"HCPCS"},{"code":"49281-286-10","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPH,PERTUS(ACEL),TET PEDI (PF) 15 LF UNIT-10 MCG-5 LF/0.5 ML IM SUSP [131264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90700","type":"HCPCS"},{"code":"49281-286-58","type":"NDC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPH,PERTUS(ACEL),TET,POLIO(PF) 15 LF-48 MCG-5 LF UNIT/0.5 ML IM SUSP [135038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49281-562-10","type":"NDC"}],"standard_charges":[{"gross_charge":298.5,"discounted_cash":250.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR [2511]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0121-0978-00","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM [16299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5354-31","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM [16299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-358-03","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM [16299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1093919844","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET [2516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0415-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET [2516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-1061-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET [2516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0590-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET [2516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-1236-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET [2516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71205-909-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET [2516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71205-909-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET [2516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-618-12","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG/5 ML ORAL LIQUID [2515]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3194-46","type":"NDC"}],"standard_charges":[{"gross_charge":345.25,"discounted_cash":290.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG/5 ML ORAL LIQUID [2515]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4216-05","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":189.0,"discounted_cash":158.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-664-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-124-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-0376-21","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-664-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-101-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-664-41","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR [29274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-250-90","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-195-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979-026-07","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62037-598-90","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-830-09","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-830-05","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-195-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-829-05","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-829-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-829-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-184-90","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-830-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":13.75,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR [29274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-186-90","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR [29274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-217-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR [29274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-217-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR [29274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-016-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR [29274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62037-599-90","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-206-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-206-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-249-90","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7218-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"CYCLOSPORINE 25 MG CAPSULE [9707]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"60505-0133-0","type":"NDC"}],"standard_charges":[{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 100 MG TABLET [1654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"0781-5916-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 100 MG TABLET [1654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"69238-1060-1","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":100.75,"discounted_cash":84.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 100 MG TABLET [1654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"16714-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":99.0,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 100 MG TABLET [1654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"0527-2964-37","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":100.75,"discounted_cash":84.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 25 MG TABLET [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"0832-0301-00","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":206.5,"discounted_cash":173.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 25 MG TABLET [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"51079-519-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":258.5,"discounted_cash":217.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":64.75,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":129.25,"discounted_cash":108.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 25 MG TABLET [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"51079-519-20","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":258.5,"discounted_cash":217.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":64.75,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":129.25,"discounted_cash":108.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 100 MG TABLET [1654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"51079-516-20","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":150.25,"discounted_cash":126.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 10 MG TABLET [1653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"51079-518-20","type":"NDC"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":448.0,"discounted_cash":376.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":224.0,"discounted_cash":188.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 10 MG TABLET [1653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"16714-047-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":287.25,"discounted_cash":241.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 10 MG TABLET [1653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"0832-6017-00","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":284.0,"discounted_cash":238.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 100 MG TABLET [1654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"0832-0303-00","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":100.75,"discounted_cash":84.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":50.5,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 100 MG TABLET [1654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"51079-516-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":150.25,"discounted_cash":126.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 25 MG TABLET [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"0832-0301-89","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":299.5,"discounted_cash":251.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":149.75,"discounted_cash":125.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 50 MG TABLET [1657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"51079-130-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":187.0,"discounted_cash":157.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":46.75,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":93.5,"discounted_cash":78.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 50 MG TABLET [1657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"51079-130-20","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":187.0,"discounted_cash":157.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":46.75,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":93.5,"discounted_cash":78.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 50 MG TABLET [1657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"69238-1058-1","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORTHALIDONE 25 MG TABLET [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0222-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORTHALIDONE 25 MG TABLET [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-058-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORTHALIDONE 25 MG TABLET [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-058-20","type":"NDC"}],"standard_charges":[{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORTHALIDONE 25 MG TABLET [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-317-25","type":"NDC"}],"standard_charges":[{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORTHALIDONE 25 MG TABLET [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-317-95","type":"NDC"}],"standard_charges":[{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 50 MG TABLET [1657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"0832-0302-00","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 25 MG TABLET [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"69238-1056-1","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":206.5,"discounted_cash":173.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 25 MG TABLET [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"60687-430-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":192.25,"discounted_cash":161.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":96.25,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 25 MG TABLET [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"60687-430-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":192.25,"discounted_cash":161.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":48.25,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":96.25,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 10 MG TABLET [1653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"0832-0300-00","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":284.0,"discounted_cash":238.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 25 MG TABLET [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"0832-6018-00","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":206.5,"discounted_cash":173.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":103.25,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION [1649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"0641-1398-35","type":"NDC"}],"standard_charges":[{"gross_charge":216.25,"discounted_cash":181.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION [1649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"0641-1398-31","type":"NDC"}],"standard_charges":[{"gross_charge":216.25,"discounted_cash":181.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION [1649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"55150-319-01","type":"NDC"}],"standard_charges":[{"gross_charge":216.25,"discounted_cash":181.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0159-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0159-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-141-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-141-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CHLORDIAZEPOXIDE 5 MG CAPSULE [1624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0158-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORDIAZEPOXIDE 5 MG CAPSULE [1624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-374-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORDIAZEPOXIDE 5 MG CAPSULE [1624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-374-20","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORDIAZEPOXIDE 5 MG CAPSULE [1624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0033-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-837-16","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4442-05","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CETIRIZINE 10 MG TABLET [9506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3637-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CETIRIZINE 10 MG TABLET [9506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-597-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CETIRIZINE 10 MG TABLET [9506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-597-20","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CETIRIZINE 10 MG TABLET [9506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-919-39","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CETIRIZINE 10 MG TABLET [9506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-271-02","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":13.5,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CEVIMELINE 30 MG CAPSULE [27253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63395-201-13","type":"NDC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"CEVIMELINE 30 MG CAPSULE [27253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63629-1379-1","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"CEVIMELINE 30 MG CAPSULE [27253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0334-25","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"CHERRY FLAVOR (BULK) ORAL LIQUID [1562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"395266216","type":"NDC"}],"standard_charges":[{"gross_charge":111.75,"discounted_cash":93.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"CHLORAMBUCIL 2 MG TABLET [9513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76388-635-25","type":"NDC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":145.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CHLORAMPHENICOL SODIUM SUCCINATE 1 GRAM INTRAVENOUS SOLUTION [25518]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0720","type":"HCPCS"},{"code":"63323-011-15","type":"NDC"}],"standard_charges":[{"gross_charge":239.5,"discounted_cash":201.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CHLORDIAZEPOXIDE-CLIDINIUM 5 MG-2.5 MG CAPSULE [1738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11534-197-01","type":"NDC"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"},{"gross_charge":431.75,"discounted_cash":362.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"CHLOROPROCAINE 20 MG/ML (2 %) INJECTION SOLUTION [127115]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"63323-476-37","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"CHLOROQUINE 250 MG TABLET [1637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-177-50","type":"NDC"}],"standard_charges":[{"gross_charge":253.25,"discounted_cash":212.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":129.25,"discounted_cash":108.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CHLOROQUINE 500 MG TABLET [1638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-178-02","type":"NDC"}],"standard_charges":[{"gross_charge":327.25,"discounted_cash":274.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":85.75,"discounted_cash":72.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":166.25,"discounted_cash":139.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CHLOROQUINE PHOSPHATE 15 MG/ML COMPOUNDED ORAL SUSPENSION [184657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7153-10","type":"NDC"}],"standard_charges":[{"gross_charge":515.5,"discounted_cash":433.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CHLOROQUINE PHOSPHATE 15 MG/ML COMPOUNDED ORAL SUSPENSION [184657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7153-33","type":"NDC"}],"standard_charges":[{"gross_charge":343.75,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":172.0,"discounted_cash":144.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION [9525]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649-311-12","type":"NDC"}],"standard_charges":[{"gross_charge":558.75,"discounted_cash":469.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION [9525]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4847-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION [9526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"63323-658-20","type":"NDC"}],"standard_charges":[{"gross_charge":1275.5,"discounted_cash":1071.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION [9526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"47335-330-40","type":"NDC"}],"standard_charges":[{"gross_charge":511.5,"discounted_cash":429.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION [9526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"63323-658-94","type":"NDC"}],"standard_charges":[{"gross_charge":182.25,"discounted_cash":153.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION [9526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"0517-1820-01","type":"NDC"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":688.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CHLORPHENIRAMINE 4 MG TABLET [1645]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-0012-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"CHLORPHENIRAMINE 4 MG TABLET [1645]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-0012-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"CHLORPHENIRAMINE 4 MG TABLET [1645]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8113118721","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [1635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-478-01","type":"NDC"}],"standard_charges":[{"gross_charge":146.25,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [1635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2400","type":"HCPCS"},{"code":"0143-9210-10","type":"NDC"}],"standard_charges":[{"gross_charge":146.25,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [1635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2400","type":"HCPCS"},{"code":"0143-9210-01","type":"NDC"}],"standard_charges":[{"gross_charge":146.25,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"CHLORDIAZEPOXIDE-CLIDINIUM 5 MG-2.5 MG CAPSULE [1738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-731-01","type":"NDC"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"},{"gross_charge":431.75,"discounted_cash":362.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"CHLORDIAZEPOXIDE-CLIDINIUM 5 MG-2.5 MG CAPSULE [1738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60219-1677-1","type":"NDC"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"},{"gross_charge":431.75,"discounted_cash":362.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"CHLORDIAZEPOXIDE-CLIDINIUM 5 MG-2.5 MG CAPSULE [1738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-639-11","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"},{"gross_charge":87.25,"discounted_cash":73.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"CHLORDIAZEPOXIDE-CLIDINIUM 5 MG-2.5 MG CAPSULE [1738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-639-94","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"},{"gross_charge":87.25,"discounted_cash":73.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0116-2001-16","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-3672-15","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-138-15","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-138-19","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0893-00","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0893-15","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-052-69","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-052-74","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-714-16","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-714-44","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52380-1272-4","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0234-0575-04","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67618-200-04","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [1635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-478-27","type":"NDC"}],"standard_charges":[{"gross_charge":146.25,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-138-17","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CHLORTHALIDONE 25 MG TABLET [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-109-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CIPROFLOXACIN 250 MG TABLET [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-411-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 250 MG TABLET [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-651-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.75,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 250 MG TABLET [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-076-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":31.0,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 250 MG TABLET [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-700-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 250 MG TABLET [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-528-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":73.75,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":110.75,"discounted_cash":93.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 250 MG TABLET [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657-675-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 250 MG TABLET [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-308-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 250 MG TABLET [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-126-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":60.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CINACALCET 60 MG TABLET [38101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-380-83","type":"NDC"}],"standard_charges":[{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":251.5,"discounted_cash":211.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":377.25,"discounted_cash":316.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CIPROFLOXACIN 0.3 % EYE DROPS [9610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-656-05","type":"NDC"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CIPROFLOXACIN 0.3 % EYE DROPS [9610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-656-25","type":"NDC"}],"standard_charges":[{"gross_charge":136.25,"discounted_cash":114.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"CIPROFLOXACIN 0.3 % EYE DROPS [9610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-308-02","type":"NDC"}],"standard_charges":[{"gross_charge":85.25,"discounted_cash":71.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"CIPROFLOXACIN 0.3 % EYE DROPS [9610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-308-10","type":"NDC"}],"standard_charges":[{"gross_charge":143.75,"discounted_cash":120.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CIPROFLOXACIN 0.3 % EYE OINTMENT [23234]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758-071-38","type":"NDC"}],"standard_charges":[{"gross_charge":1168.0,"discounted_cash":981.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-8533-02","type":"NDC"}],"standard_charges":[{"gross_charge":1070.25,"discounted_cash":899.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-326-75","type":"NDC"}],"standard_charges":[{"gross_charge":963.25,"discounted_cash":809.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0799-75","type":"NDC"}],"standard_charges":[{"gross_charge":1070.25,"discounted_cash":899.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-628-01","type":"NDC"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":839.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-831-53","type":"NDC"}],"standard_charges":[{"gross_charge":1003.25,"discounted_cash":842.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72485-625-13","type":"NDC"}],"standard_charges":[{"gross_charge":632.5,"discounted_cash":531.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"36000-008-24","type":"NDC"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021-192-82","type":"NDC"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":65.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"0409-2300-01","type":"NDC"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CIPROFLOXACIN 250 MG TABLET [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-9927-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":93.25,"discounted_cash":78.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 250 MG/5 ML ORAL SUSPENSION [22987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50419-777-01","type":"NDC"}],"standard_charges":[{"gross_charge":643.25,"discounted_cash":540.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-077-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-652-04","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":33.5,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":50.25,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-182-20","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-559-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43063-547-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7083-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7243-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-652-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"0409-4777-02","type":"NDC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":78.5,"discounted_cash":65.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021-114-87","type":"NDC"}],"standard_charges":[{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":119.75,"discounted_cash":100.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"36000-009-24","type":"NDC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG/KG"},{"gross_charge":82.5,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG/KG"}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"0409-3300-01","type":"NDC"}],"standard_charges":[{"gross_charge":86.75,"discounted_cash":72.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"0409-3300-24","type":"NDC"}],"standard_charges":[{"gross_charge":86.75,"discounted_cash":72.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021-192-87","type":"NDC"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-9928-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":54.5,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-127-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CINACALCET 60 MG TABLET [38101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6196-93","type":"NDC"}],"standard_charges":[{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":251.5,"discounted_cash":211.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":377.25,"discounted_cash":316.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":10.75,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":21.5,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":32.25,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 500 MG TABLET [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-412-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":52.75,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CINACALCET 60 MG TABLET [38101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-884-04","type":"NDC"}],"standard_charges":[{"gross_charge":125.75,"discounted_cash":105.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":251.5,"discounted_cash":211.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":377.25,"discounted_cash":316.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [76950]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068116900","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [76950]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068116801","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHOLESTYRAMINE 4 GRAM ORAL POWDER [201577]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-529-42","type":"NDC"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 231 G"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0939-98","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-465-65","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0536-60","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-465-64","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0536-89","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-134-21","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-134-36","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-266-95","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-298-09","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-298-60","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [76950]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"2055503300","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [76950]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1000670033","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHLORTHALIDONE 25 MG TABLET [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-170-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET [24559]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4329255881","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET [24559]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904582360","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET [24559]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7985401162","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET [24559]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733394810","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET [24559]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733394825","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS [96930]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87086644","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS [96930]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5038391750","type":"NDC"}],"standard_charges":[{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS [96930]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5483800650","type":"NDC"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS [96930]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7139974015","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [76950]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904582460","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [76950]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536333401","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [76950]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4843310401","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"}]},{"description":"CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-292-51","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CHOLESTYRAMINE 4 GRAM POWDER FOR SUSP IN A PACKET (WRAPPER) [958801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-266-98","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":45.5,"discounted_cash":38.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE/PETROLATUM 20% TOPICAL OINTMENT [178569]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-6060-60","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"CINACALCET 30 MG TABLET [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-883-04","type":"NDC"}],"standard_charges":[{"gross_charge":166.5,"discounted_cash":139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":333.0,"discounted_cash":279.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":499.5,"discounted_cash":419.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CINACALCET 30 MG TABLET [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-379-83","type":"NDC"}],"standard_charges":[{"gross_charge":166.5,"discounted_cash":139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":333.0,"discounted_cash":279.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":499.5,"discounted_cash":419.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CINACALCET 30 MG TABLET [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-525-11","type":"NDC"}],"standard_charges":[{"gross_charge":168.5,"discounted_cash":141.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":336.75,"discounted_cash":282.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CINACALCET 30 MG TABLET [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-525-21","type":"NDC"}],"standard_charges":[{"gross_charge":168.5,"discounted_cash":141.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":336.75,"discounted_cash":282.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CINACALCET 30 MG TABLET [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-440-10","type":"NDC"}],"standard_charges":[{"gross_charge":166.5,"discounted_cash":139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":333.0,"discounted_cash":279.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":499.5,"discounted_cash":419.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CINACALCET 30 MG TABLET [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-103-30","type":"NDC"}],"standard_charges":[{"gross_charge":166.5,"discounted_cash":139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":333.0,"discounted_cash":279.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":499.5,"discounted_cash":419.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CINACALCET 60 MG TABLET [38101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55513-074-30","type":"NDC"}],"standard_charges":[{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":264.75,"discounted_cash":222.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":397.0,"discounted_cash":333.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CINACALCET 30 MG TABLET [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-410-02","type":"NDC"}],"standard_charges":[{"gross_charge":166.5,"discounted_cash":139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":333.0,"discounted_cash":279.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":499.5,"discounted_cash":419.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CINACALCET 30 MG TABLET [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436-007-04","type":"NDC"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":336.0,"discounted_cash":282.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":504.0,"discounted_cash":423.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE [28923]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8065183905","type":"NDC"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":715.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION [1685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4093-01","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":135.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CICLOPIROX 0.77 % TOPICAL CREAM [9598]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-138-35","type":"NDC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":144.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CICLOPIROX 0.77 % TOPICAL GEL [27426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-2061-30","type":"NDC"}],"standard_charges":[{"gross_charge":331.75,"discounted_cash":278.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"CICLOPIROX 8 % TOPICAL SOLUTION [27158]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-141-67","type":"NDC"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":582.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.6 ML"}]},{"description":"CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [17378]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0740","type":"HCPCS"},{"code":"23155-216-31","type":"NDC"}],"standard_charges":[{"gross_charge":2775.25,"discounted_cash":2331.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [17378]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0740","type":"HCPCS"},{"code":"67457-210-05","type":"NDC"}],"standard_charges":[{"gross_charge":3708.0,"discounted_cash":3114.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"CILOSTAZOL 100 MG TABLET [24474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0223-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CILOSTAZOL 100 MG TABLET [24474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0044-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CILOSTAZOL 100 MG TABLET [24474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2064-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CILOSTAZOL 50 MG TABLET [24473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2065-06","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CILOSTAZOL 50 MG TABLET [24473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-176-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CILOSTAZOL 50 MG TABLET [24473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-176-15","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":15.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CINACALCET 30 MG TABLET [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55513-073-30","type":"NDC"}],"standard_charges":[{"gross_charge":175.25,"discounted_cash":147.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":350.5,"discounted_cash":294.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":525.75,"discounted_cash":441.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2102-8","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":7.75,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CEFPODOXIME 200 MG TABLET [9469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-096-20","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFPODOXIME 200 MG TABLET [9469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5439-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFPODOXIME 200 MG TABLET [9469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5439-20","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFPODOXIME 200 MG TABLET [9469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-395-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":57.25,"discounted_cash":48.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFPODOXIME 50 MG/5 ML ORAL SUSPENSION [9467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-140-50","type":"NDC"}],"standard_charges":[{"gross_charge":246.5,"discounted_cash":207.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CEFPODOXIME 50 MG/5 ML ORAL SUSPENSION [9467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-402-02","type":"NDC"}],"standard_charges":[{"gross_charge":354.5,"discounted_cash":297.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0712","type":"HCPCS"},{"code":"0456-0400-10","type":"NDC"}],"standard_charges":[{"gross_charge":556.5,"discounted_cash":467.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":832.25,"discounted_cash":699.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":1103.0,"discounted_cash":926.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1108.0,"discounted_cash":930.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0712","type":"HCPCS"},{"code":"0456-0600-01","type":"NDC"}],"standard_charges":[{"gross_charge":556.5,"discounted_cash":467.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":740.5,"discounted_cash":622.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1103.0,"discounted_cash":926.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1108.0,"discounted_cash":930.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0712","type":"HCPCS"},{"code":"0456-0400-01","type":"NDC"}],"standard_charges":[{"gross_charge":556.5,"discounted_cash":467.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":832.25,"discounted_cash":699.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":1108.0,"discounted_cash":930.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEFPODOXIME 100 MG TABLET [9468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-878-20","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFPODOXIME 100 MG TABLET [9468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-394-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFOTETAN 2 GRAM SOLUTION FOR INJECTION [9460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-386-20","type":"NDC"}],"standard_charges":[{"gross_charge":119.25,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":238.5,"discounted_cash":200.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":183.75,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG/KG"}]},{"description":"CEFOTETAN IVPB CUSTOM DOSE FROM PREMIX 2 GRAM IN D5W [408686]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-3175-11","type":"NDC"}],"standard_charges":[{"gross_charge":262.5,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"63323-341-25","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":56.75,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"60505-0759-5","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"63323-341-29","type":"NDC"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"0143-9878-01","type":"NDC"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"25021-110-20","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"0143-9877-25","type":"NDC"}],"standard_charges":[{"gross_charge":160.5,"discounted_cash":134.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"63323-342-25","type":"NDC"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":95.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"63323-342-29","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFPODOXIME 100 MG TABLET [9468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-095-20","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFPODOXIME 100 MG TABLET [9468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5438-20","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION [165544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0695","type":"HCPCS"},{"code":"67919-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":627.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0409-7332-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":47.75,"discounted_cash":40.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0409-7332-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505-0752-4","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0143-9857-25","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567-701-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021-106-67","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0143-9857-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505-0752-3","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505-6148-0","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":209.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION [9487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505-6148-4","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":209.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 GRAM/10 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE [177567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"7700-7056-10","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFTRIAXONE 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOT) INTRAVENOUS PIGGYBACK [9492]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0264-3153-11","type":"NDC"}],"standard_charges":[{"gross_charge":3655.75,"discounted_cash":3070.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFTRIAXONE 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOT) INTRAVENOUS PIGGYBACK [9492]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0338-5002-41","type":"NDC"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":95.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION [165907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0714","type":"HCPCS"},{"code":"0456-2700-10","type":"NDC"}],"standard_charges":[{"gross_charge":1779.5,"discounted_cash":1494.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 G"}]},{"description":"CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0712","type":"HCPCS"},{"code":"0456-0600-10","type":"NDC"}],"standard_charges":[{"gross_charge":556.5,"discounted_cash":467.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":740.5,"discounted_cash":622.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1108.0,"discounted_cash":930.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"0409-5082-16","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":80.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG/KG"}]},{"description":"CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021-127-20","type":"NDC"}],"standard_charges":[{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"44567-235-25","type":"NDC"}],"standard_charges":[{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021-127-66","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"0409-5082-11","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOTETAN 2 GRAM SOLUTION FOR INJECTION [9460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0121-0977-55","type":"NDC"}],"standard_charges":[{"gross_charge":248.5,"discounted_cash":208.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"44567-236-10","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021-128-50","type":"NDC"}],"standard_charges":[{"gross_charge":89.25,"discounted_cash":74.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021-128-67","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"52565-107-01","type":"NDC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":129.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"52565-107-10","type":"NDC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":129.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION [165907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0714","type":"HCPCS"},{"code":"0456-2700-01","type":"NDC"}],"standard_charges":[{"gross_charge":1779.5,"discounted_cash":1494.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 G"}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"0409-5084-11","type":"NDC"}],"standard_charges":[{"gross_charge":77.5,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOTETAN 2 GRAM SOLUTION FOR INJECTION [9460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0121-0977-10","type":"NDC"}],"standard_charges":[{"gross_charge":248.5,"discounted_cash":208.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFOTETAN 2 GRAM SOLUTION FOR INJECTION [9460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-386-01","type":"NDC"}],"standard_charges":[{"gross_charge":238.5,"discounted_cash":200.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFAZOLIN 500 MG SOLUTION FOR INJECTION [1448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0143-9923-90","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN 500 MG SOLUTION FOR INJECTION [1448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0781-3450-70","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN 500 MG SOLUTION FOR INJECTION [1448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0781-3450-95","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN 500 MG SOLUTION FOR INJECTION [1448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567-706-25","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN IV SYRING 20 MG/ML FROM PREMIX (NEO/PED) [172664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0689","type":"HCPCS"},{"code":"0338-3503-41","type":"NDC"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":76.5,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CEFAZOLIN IV SYRINGE 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE (PREMIX) [408131727]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"7700-7064-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFAZOLIN IV SYRINGE 2 GRAM/20 ML WRAPPER [1312141]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"7700-7064-20","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFAZOLIN IV SYRINGE 2 GRAM/20 ML WRAPPER [1312141]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1604-47","type":"NDC"}],"standard_charges":[{"gross_charge":125.25,"discounted_cash":105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFDINIR 125 MG/5 ML ORAL SUSPENSION [22290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4136-64","type":"NDC"}],"standard_charges":[{"gross_charge":209.75,"discounted_cash":176.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CEFDINIR 125 MG/5 ML ORAL SUSPENSION [22290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-392-01","type":"NDC"}],"standard_charges":[{"gross_charge":209.75,"discounted_cash":176.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CEFDINIR 250 MG/5 ML ORAL SUSPENSION [39522]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-6078-61","type":"NDC"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":343.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CEFDINIR 250 MG/5 ML ORAL SUSPENSION [39522]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-393-01","type":"NDC"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":343.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CEFDINIR 300 MG CAPSULE [22289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3160-06","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFDINIR 300 MG CAPSULE [22289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2176-60","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFDINIR 300 MG CAPSULE [22289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-177-60","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFAZOLIN 5 MG/ML SOLUTION FOR INJECTION - FOR DISCOGRAM [4081445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505-0749-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION [1446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"63323-238-61","type":"NDC"}],"standard_charges":[{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION [1446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505-0769-0","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION [1446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0143-9983-03","type":"NDC"}],"standard_charges":[{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION [1446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0781-3452-95","type":"NDC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION [1446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"25021-102-99","type":"NDC"}],"standard_charges":[{"gross_charge":97.5,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION [1446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505-6143-0","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION [1446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505-6143-4","type":"NDC"}],"standard_charges":[{"gross_charge":142.5,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION [1446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"63323-238-01","type":"NDC"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 2 GRAM IN 100 ML 0.9 % SODIUM CHLORIDE (PREMIX-RIVA) [408006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"99999-0013-01","type":"NDC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFAZOLIN 2 GRAM IN 100 ML 0.9 % SODIUM CHLORIDE (PREMIX-RIVA) [408006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"7700-6081-10","type":"NDC"}],"standard_charges":[{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFAZOLIN 2 GRAM SOLUTION FOR INJECTION [191028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505-6231-0","type":"NDC"}],"standard_charges":[{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 2 GRAM SOLUTION FOR INJECTION [191028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505-6231-5","type":"NDC"}],"standard_charges":[{"gross_charge":49.5,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 2 GRAM/100 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [129631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1622-03","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [168823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0689","type":"HCPCS"},{"code":"0338-3508-41","type":"NDC"}],"standard_charges":[{"gross_charge":129.25,"discounted_cash":108.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFAZOLIN 20 GRAM SOLUTION FOR INJECTION [1447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"63323-449-61","type":"NDC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION [194320]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0143-9140-01","type":"NDC"}],"standard_charges":[{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION [194320]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0143-9140-25","type":"NDC"}],"standard_charges":[{"gross_charge":71.25,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN 2 GRAM IN 100 ML 0.9 % SODIUM CHLORIDE (PREMIX-RIVA) [408006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"0000-0003-73","type":"NDC"}],"standard_charges":[{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION [9491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0409-7334-10","type":"NDC"}],"standard_charges":[{"gross_charge":140.5,"discounted_cash":118.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFDINIR 300 MG CAPSULE [22289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-391-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFDINIR 300 MG CAPSULE [22289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-391-02","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION [16371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"44567-241-10","type":"NDC"}],"standard_charges":[{"gross_charge":79.5,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION [16371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"25021-122-67","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION [16371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"63323-340-21","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION [16371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"0409-9735-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.5,"discounted_cash":68.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION [16371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"0409-9735-10","type":"NDC"}],"standard_charges":[{"gross_charge":81.5,"discounted_cash":68.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":73.5,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1800 MG"},{"gross_charge":81.5,"discounted_cash":68.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFEPIME 2 GRAM/100 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [93838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0701","type":"HCPCS"},{"code":"0338-1301-48","type":"NDC"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"0409-0219-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":161.25,"discounted_cash":135.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [184195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59630-266-01","type":"NDC"}],"standard_charges":[{"gross_charge":1002.5,"discounted_cash":842.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [184195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59630-266-10","type":"NDC"}],"standard_charges":[{"gross_charge":1002.5,"discounted_cash":842.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOTETAN 1 GRAM SOLUTION FOR INJECTION [9458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9670-10","type":"NDC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":156.0,"discounted_cash":131.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFOTETAN 1 GRAM SOLUTION FOR INJECTION [9458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-385-10","type":"NDC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":158.0,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFOTETAN 1 GRAM SOLUTION FOR INJECTION [9458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9670-01","type":"NDC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":156.0,"discounted_cash":131.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION [16371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"63323-340-20","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION [16371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"25021-122-50","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFDINIR 300 MG CAPSULE [22289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-099-60","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFDINIR 300 MG CAPSULE [22289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-543-60","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFDINIR 300 MG CAPSULE [22289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-699-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFDINIR 300 MG CAPSULE [22289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-699-21","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":54.75,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"25021-121-20","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"44567-240-10","type":"NDC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"25021-121-66","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"60505-6146-0","type":"NDC"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"60505-6146-4","type":"NDC"}],"standard_charges":[{"gross_charge":137.5,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [93837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0701","type":"HCPCS"},{"code":"0338-1301-41","type":"NDC"}],"standard_charges":[{"gross_charge":198.75,"discounted_cash":166.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION [9491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021-108-99","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CELECOXIB 200 MG CAPSULE [24501]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-1525-34","type":"NDC"}],"standard_charges":[{"gross_charge":66.75,"discounted_cash":56.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":133.25,"discounted_cash":111.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":266.25,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 200 MG CAPSULE [24501]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-1517-1","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 200 MG CAPSULE [24501]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7166-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 200 MG CAPSULE [24501]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-7150-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 200 MG CAPSULE [24501]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-421-07","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 200 MG CAPSULE [24501]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6503-61","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 200 MG CAPSULE [24501]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-909-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 200 MG CAPSULE [24501]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-157-11","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":51.25,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":102.5,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [180213]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61755-008-01","type":"NDC"}],"standard_charges":[{"gross_charge":22486.75,"discounted_cash":18888.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MG"},{"gross_charge":22486.75,"discounted_cash":18888.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"CELECOXIB 200 MG CAPSULE [24501]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-1525-31","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":53.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":126.75,"discounted_cash":106.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":253.5,"discounted_cash":212.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION [127551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0697","type":"HCPCS"},{"code":"0143-9977-90","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0697","type":"HCPCS"},{"code":"0143-9979-22","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0697","type":"HCPCS"},{"code":"25021-118-10","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0697","type":"HCPCS"},{"code":"0143-9979-90","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CELECOXIB 100 MG CAPSULE [24500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-1520-31","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":324.75,"discounted_cash":272.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 100 MG CAPSULE [24500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-1520-34","type":"NDC"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":162.5,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":324.75,"discounted_cash":272.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 100 MG CAPSULE [24500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7165-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 100 MG CAPSULE [24500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6502-61","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 100 MG CAPSULE [24500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-441-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":62.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":124.75,"discounted_cash":104.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CELECOXIB 100 MG CAPSULE [24500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-732-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":62.25,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":124.5,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEPHALEXIN 250 MG CAPSULE [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3145-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3147-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3147-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-122-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-019-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-019-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42043-141-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-294-13","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-294-88","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-152-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-152-15","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-163-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG CAPSULE [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-163-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-545-88","type":"NDC"}],"standard_charges":[{"gross_charge":154.75,"discounted_cash":129.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979-155-14","type":"NDC"}],"standard_charges":[{"gross_charge":156.75,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-441-01","type":"NDC"}],"standard_charges":[{"gross_charge":156.75,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CEPHALEXIN 250 MG CAPSULE [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-018-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 250 MG CAPSULE [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-293-88","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.5,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 250 MG CAPSULE [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-220-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 250 MG CAPSULE [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-151-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION [127551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0697","type":"HCPCS"},{"code":"63323-353-45","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEPHALEXIN 250 MG CAPSULE [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-151-15","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":15.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 250 MG CAPSULE [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-152-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 250 MG CAPSULE [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-152-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4177-73","type":"NDC"}],"standard_charges":[{"gross_charge":156.75,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-441-02","type":"NDC"}],"standard_charges":[{"gross_charge":210.5,"discounted_cash":176.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION [127551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0697","type":"HCPCS"},{"code":"25021-119-20","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION [127551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0697","type":"HCPCS"},{"code":"0143-9977-22","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":47.5,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"},{"gross_charge":61.0,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG/KG"}]},{"description":"CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0409-7337-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"64679-701-01","type":"NDC"}],"standard_charges":[{"gross_charge":99.25,"discounted_cash":83.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505-0751-0","type":"NDC"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":304.0,"discounted_cash":255.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0409-7338-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0781-3207-95","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505-0751-4","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0143-9858-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505-0751-1","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0409-7338-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0409-7337-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":95.25,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG/KG"}]},{"description":"CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"64679-701-02","type":"NDC"}],"standard_charges":[{"gross_charge":99.25,"discounted_cash":83.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505-0750-4","type":"NDC"}],"standard_charges":[{"gross_charge":100.25,"discounted_cash":84.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0781-3206-95","type":"NDC"}],"standard_charges":[{"gross_charge":100.25,"discounted_cash":84.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0409-7335-03","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFTRIAXONE 2 GRAM IN 100 ML 0.9 % SODIUM CHLORIDE (PREMIX) [177090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"7700-7056-02","type":"NDC"}],"standard_charges":[{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0781-3209-95","type":"NDC"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505-0753-4","type":"NDC"}],"standard_charges":[{"gross_charge":374.5,"discounted_cash":314.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"63323-347-20","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0143-9856-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567-702-25","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021-107-68","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0143-9856-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0409-7335-13","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE [177568]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"7700-7056-20","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":79.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK [9493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0264-3155-11","type":"NDC"}],"standard_charges":[{"gross_charge":225.5,"discounted_cash":189.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK [9493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"0338-5003-41","type":"NDC"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021-107-20","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-699-60","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-400-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":68.5,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-400-02","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET [9496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64679-922-02","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET [9496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-216-20","type":"NDC"}],"standard_charges":[{"gross_charge":37.75,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET [9496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-059-20","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET [9496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-059-60","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET [9496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-700-60","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":22.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":54.25,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET [9496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-401-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET [9496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-401-02","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-699-20","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-058-60","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFTRIAXONE IV SYRINGE 40 MG/ML FROM PREMIX (NEO/PED) [400054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"99999-0014-01","type":"NDC"}],"standard_charges":[{"gross_charge":274.5,"discounted_cash":230.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64679-921-02","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-302-60","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":59.5,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-215-20","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-215-60","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":77.0,"discounted_cash":64.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CIPROFLOXACIN 500 MG/5 ML ORAL SUSPENSION [22988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50419-773-01","type":"NDC"}],"standard_charges":[{"gross_charge":751.5,"discounted_cash":631.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION [92855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0169-7205-01","type":"NDC"}],"standard_charges":[{"gross_charge":212791374.0,"discounted_cash":178744754.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MCG/KG"},{"gross_charge":124128301.5,"discounted_cash":104267773.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MCG/KG"},{"gross_charge":159593530.5,"discounted_cash":134058565.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MCG/KG"}]},{"description":"COCAINE (BULK) 100 % CRYSTALS [22776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-1520-53","type":"NDC"}],"standard_charges":[{"gross_charge":2055.5,"discounted_cash":1726.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"COCAINE (BULK) 100 % CRYSTALS [22776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-1520-55","type":"NDC"}],"standard_charges":[{"gross_charge":7015.0,"discounted_cash":5892.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"COCAINE 4 % NASAL SOLUTION [178616]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64950-362-04","type":"NDC"}],"standard_charges":[{"gross_charge":1052.75,"discounted_cash":884.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"COCAINE 4 % NASAL SOLUTION [178616]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1961-74","type":"NDC"}],"standard_charges":[{"gross_charge":947.5,"discounted_cash":795.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"COCAINE 4 % NASAL SOLUTION [178616]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81665-301-02","type":"NDC"}],"standard_charges":[{"gross_charge":1542.5,"discounted_cash":1295.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-087-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-087-12","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1550-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1550-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1550-40","type":"NDC"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CODEINE SULFATE 15 MG TABLET [1801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0243-24","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"CODEINE SULFATE 30 MG TABLET [1802]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0244-24","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"CODEINE SULFATE 30 MG TABLET [1802]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1698-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.75,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"CODEINE SULFATE 60 MG TABLET [1803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0245-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"COLCHICINE 0.6 MG TABLET [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":116.75,"discounted_cash":98.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION [92854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0169-7212-11","type":"NDC"}],"standard_charges":[{"gross_charge":85116549.75,"discounted_cash":71497901.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MCG/KG"},{"gross_charge":49651320.75,"discounted_cash":41707109.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MCG/KG"},{"gross_charge":63837412.25,"discounted_cash":53623426.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MCG/KG"}]},{"description":"CLOZAPINE 25 MG TABLET [9648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4359-93","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 25 MG TABLET [9648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-844-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 25 MG TABLET [9648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-404-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 25 MG TABLET [9648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-404-11","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"COAGULATION FACTOR IX (RECOMB) 3,000 UNIT INTRAVENOUS SOLUTION [134736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58394-637-03","type":"NDC"}],"standard_charges":[{"gross_charge":6270.0,"discounted_cash":5266.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 INT'L UNITS"}]},{"description":"COAGULATION FACTOR IX (RECOMB) 500 UNIT INTRAVENOUS SOLUTION [134733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58394-634-03","type":"NDC"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":877.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 INT'L UNITS"}]},{"description":"COAGULATION FACTOR IX 1,500 (+/-) UNIT INTRAVENOUS SOLUTION [97683]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68516-3603-2","type":"NDC"}],"standard_charges":[{"gross_charge":2550.0,"discounted_cash":2142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 INT'L UNITS"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION [92853]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0169-7201-01","type":"NDC"}],"standard_charges":[{"gross_charge":42558275.0,"discounted_cash":35748951.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MCG/KG"},{"gross_charge":24825660.5,"discounted_cash":20853554.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MCG/KG"},{"gross_charge":31918706.25,"discounted_cash":26811713.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MCG/KG"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION [92854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0169-7202-01","type":"NDC"}],"standard_charges":[{"gross_charge":85116549.75,"discounted_cash":71497901.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MCG/KG"},{"gross_charge":49651320.75,"discounted_cash":41707109.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MCG/KG"},{"gross_charge":63837412.25,"discounted_cash":53623426.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MCG/KG"}]},{"description":"COLCHICINE 0.6 MG TABLET [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-119-07","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":116.75,"discounted_cash":98.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION [9681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0770","type":"HCPCS"},{"code":"63323-393-06","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION [9681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0770","type":"HCPCS"},{"code":"39822-0615-1","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION [9681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0770","type":"HCPCS"},{"code":"39822-0615-2","type":"NDC"}],"standard_charges":[{"gross_charge":182.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 0.9 MG SOLUTION FOR INJECTION [101010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0775","type":"HCPCS"},{"code":"66887-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":9399.75,"discounted_cash":7895.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.58 MG"},{"gross_charge":14585.75,"discounted_cash":12252.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"}]},{"description":"COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM - WOUND CARE [181300]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50484-010-90","type":"NDC"}],"standard_charges":[{"gross_charge":3302.25,"discounted_cash":2773.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 G"}]},{"description":"COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM - WOUND CARE [181300]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50484-010-30","type":"NDC"}],"standard_charges":[{"gross_charge":1364.0,"discounted_cash":1145.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID [131925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"574030216","type":"NDC"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":584.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.18 ORAL [134964]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"3877926008","type":"NDC"}],"standard_charges":[{"gross_charge":662.25,"discounted_cash":556.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL [168831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"574030316","type":"NDC"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":584.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL [168831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"3877907438","type":"NDC"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":616.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"COMPOUNDING VEHICLE SYRUP NO.23 [179460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3877907448","type":"NDC"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":616.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"CONIVAPTAN 20 MG/100 ML IN 5 % DEXTROSE IV [96988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"66220-160-10","type":"NDC"}],"standard_charges":[{"gross_charge":3452.5,"discounted_cash":2900.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":3452.5,"discounted_cash":2900.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"CONJUGATED ESTROGENS 0.3 MG TABLET [9973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0046-1100-81","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.45 MG"},{"gross_charge":119.5,"discounted_cash":100.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.625 MG"},{"gross_charge":172.0,"discounted_cash":144.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"},{"gross_charge":239.0,"discounted_cash":200.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"COLESEVELAM 625 MG TABLET [28372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-190-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1875 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"COLESEVELAM 625 MG TABLET [28372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-506-51","type":"NDC"}],"standard_charges":[{"gross_charge":53.5,"discounted_cash":44.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":80.25,"discounted_cash":67.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1875 MG"},{"gross_charge":26.75,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"COLCHICINE 0.6 MG TABLET [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-165-02","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLCHICINE 0.6 MG TABLET [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0254-2008-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLCHICINE 0.6 MG TABLET [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-389-11","type":"NDC"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLCHICINE 0.6 MG TABLET [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-389-21","type":"NDC"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLCHICINE 0.6 MG TABLET [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1086-93","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLCHICINE 0.6 MG TABLET [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292-054-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLCHICINE 0.6 MG TABLET [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292-054-03","type":"NDC"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":150.75,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLCHICINE 0.6 MG TABLET [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-710-09","type":"NDC"}],"standard_charges":[{"gross_charge":45.75,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":91.25,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLESEVELAM 625 MG TABLET [28372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65597-701-18","type":"NDC"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1875 MG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"COLESEVELAM 625 MG TABLET [28372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51660-996-28","type":"NDC"}],"standard_charges":[{"gross_charge":50.75,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1875 MG"},{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CLOZAPINE 25 MG TABLET [9648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4359-19","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOPIDOGREL 75 MG TABLET [22142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-196-90","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLOPIDOGREL 75 MG TABLET [22142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-218-10","type":"NDC"}],"standard_charges":[{"gross_charge":141.25,"discounted_cash":118.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLORAZEPATE DIPOTASSIUM 15 MG TABLET [1758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0070-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET [1759]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4042-1","type":"NDC"}],"standard_charges":[{"gross_charge":37.25,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":13.25,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG TABLET [1760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0040-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.5,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":14.75,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"},{"gross_charge":24.25,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM [1767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7822-31","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.35 G"}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM [1767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7822-36","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.17 G"}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM [1767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-434-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM [1767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2002-2","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":62.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM [1767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-181-17","type":"NDC"}],"standard_charges":[{"gross_charge":134.5,"discounted_cash":112.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM [1767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-181-35","type":"NDC"}],"standard_charges":[{"gross_charge":189.5,"discounted_cash":159.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM [1767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1272-22","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL SOLUTION [1768]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1260-3","type":"NDC"}],"standard_charges":[{"gross_charge":307.25,"discounted_cash":258.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL SOLUTION [1768]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-800-30","type":"NDC"}],"standard_charges":[{"gross_charge":307.25,"discounted_cash":258.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE [9644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4146-22","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CLOPIDOGREL 75 MG TABLET [22142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-894-81","type":"NDC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLOPIDOGREL 75 MG TABLET [22142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-894-13","type":"NDC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLOPIDOGREL 75 MG TABLET [22142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6294-61","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLOPIDOGREL 75 MG TABLET [22142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0253-2","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLONIDINE HCL 0.1 MG TABLET [1755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-113-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLONIDINE HCL 0.1 MG TABLET [1755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657-647-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLONIDINE SUSPENSION 20 MCG/ML [185442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-7163-10","type":"NDC"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CLOPIDOGREL 300 MG TABLET [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-671-06","type":"NDC"}],"standard_charges":[{"gross_charge":151.25,"discounted_cash":127.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":302.5,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOPIDOGREL 300 MG TABLET [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-671-31","type":"NDC"}],"standard_charges":[{"gross_charge":151.25,"discounted_cash":127.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":302.5,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOPIDOGREL 300 MG TABLET [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-752-25","type":"NDC"}],"standard_charges":[{"gross_charge":144.75,"discounted_cash":121.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":289.25,"discounted_cash":242.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE [9644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4146-23","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CLOPIDOGREL 300 MG TABLET [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-752-95","type":"NDC"}],"standard_charges":[{"gross_charge":144.75,"discounted_cash":121.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":289.25,"discounted_cash":242.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOPIDOGREL 300 MG TABLET [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-184-11","type":"NDC"}],"standard_charges":[{"gross_charge":130.25,"discounted_cash":109.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":260.5,"discounted_cash":218.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOPIDOGREL 300 MG TABLET [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-184-12","type":"NDC"}],"standard_charges":[{"gross_charge":130.25,"discounted_cash":109.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":260.5,"discounted_cash":218.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOPIDOGREL 300 MG TABLET [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6467-10","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":132.75,"discounted_cash":111.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOPIDOGREL 300 MG TABLET [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-752-18","type":"NDC"}],"standard_charges":[{"gross_charge":144.75,"discounted_cash":121.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":289.25,"discounted_cash":242.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOPIDOGREL 300 MG TABLET [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-752-19","type":"NDC"}],"standard_charges":[{"gross_charge":144.75,"discounted_cash":121.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":289.25,"discounted_cash":242.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOPIDOGREL 75 MG TABLET [22142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63653-1171-1","type":"NDC"}],"standard_charges":[{"gross_charge":52.25,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE [9644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8146-22","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE [9644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0107-77","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CLOZAPINE 100 MG TABLET [9647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-273-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":28.0,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 100 MG TABLET [9647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60429-990-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 25 MG TABLET [9648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0126-06","type":"NDC"}],"standard_charges":[{"gross_charge":130.5,"discounted_cash":109.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":261.0,"discounted_cash":219.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":65.25,"discounted_cash":54.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 25 MG TABLET [9648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-921-20","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":30.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":71.5,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":18.0,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 25 MG TABLET [9648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4359-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":69.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 100 MG TABLET [9647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7772-93","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % LOTION [29436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1308-3","type":"NDC"}],"standard_charges":[{"gross_charge":688.75,"discounted_cash":578.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM [29424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0258-15","type":"NDC"}],"standard_charges":[{"gross_charge":136.75,"discounted_cash":114.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM [29424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4048-1","type":"NDC"}],"standard_charges":[{"gross_charge":167.25,"discounted_cash":140.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOVE OIL (BULK) [1770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"395194988","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.7 ML"}]},{"description":"CLOZAPINE 100 MG TABLET [9647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0127-06","type":"NDC"}],"standard_charges":[{"gross_charge":84.5,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":42.25,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 100 MG TABLET [9647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0860-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE [9644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0107-70","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CLOZAPINE 100 MG TABLET [9647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-922-20","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 100 MG TABLET [9647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7772-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 100 MG TABLET [9647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7772-19","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":46.5,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CONJUGATED ESTROGENS 0.625 MG TABLET [9974]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0046-1102-81","type":"NDC"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.45 MG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.625 MG"},{"gross_charge":82.75,"discounted_cash":69.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"},{"gross_charge":114.75,"discounted_cash":96.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-332-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3422-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-558-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-558-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 5 MG TABLET [35184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0771-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 5 MG TABLET [35184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-006-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 5 MG TABLET [35184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-190-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-846-07","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET [2008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8068107100","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":14.5,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":7.25,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0751-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5658-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2.0,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":4.0,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-644-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-644-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-531-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 5 MG TABLET [35184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-190-15","type":"NDC"}],"standard_charges":[{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOPHOSPHAMIDE 25 MG CAPSULE [126404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"54879-021-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":46.25,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CYCLOPHOSPHAMIDE 25 MG CAPSULE [126404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"62332-618-31","type":"NDC"}],"standard_charges":[{"gross_charge":60.75,"discounted_cash":51.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":121.5,"discounted_cash":102.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CYCLOPHOSPHAMIDE 50 MG CAPSULE [126405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"0054-0383-25","type":"NDC"}],"standard_charges":[{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":116.25,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CYCLOPHOSPHAMIDE 50 MG CAPSULE [126405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"54879-022-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":32.5,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CYCLOPHOSPHAMIDE 50 MG CAPSULE [126405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"62332-619-31","type":"NDC"}],"standard_charges":[{"gross_charge":55.75,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10019-955-01","type":"NDC"}],"standard_charges":[{"gross_charge":1569.25,"discounted_cash":1318.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10019-943-01","type":"NDC"}],"standard_charges":[{"gross_charge":792.75,"discounted_cash":665.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10019-943-25","type":"NDC"}],"standard_charges":[{"gross_charge":792.75,"discounted_cash":665.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3233-94","type":"NDC"}],"standard_charges":[{"gross_charge":1471.0,"discounted_cash":1235.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70121-1238-1","type":"NDC"}],"standard_charges":[{"gross_charge":580.75,"discounted_cash":487.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16714-859-01","type":"NDC"}],"standard_charges":[{"gross_charge":1478.0,"discounted_cash":1241.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-9163-30","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-6202-1","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-214-30","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CYCLOSPORINE 100 MG CAPSULE [9706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"0078-0241-15","type":"NDC"}],"standard_charges":[{"gross_charge":145.25,"discounted_cash":122.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOSPORINE 100 MG CAPSULE [9706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"60505-0134-0","type":"NDC"}],"standard_charges":[{"gross_charge":119.5,"discounted_cash":100.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOSPORINE 25 MG CAPSULE [9707]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"0078-0240-15","type":"NDC"}],"standard_charges":[{"gross_charge":145.5,"discounted_cash":122.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":72.75,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CYCLOPHOSPHAMIDE 25 MG CAPSULE [126404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"0054-0382-25","type":"NDC"}],"standard_charges":[{"gross_charge":63.25,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":126.5,"discounted_cash":106.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION [186199]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-218-03","type":"NDC"}],"standard_charges":[{"gross_charge":1870.25,"discounted_cash":1571.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"CYCLOBENZAPRINE 5 MG TABLET [35184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-845-07","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 5 MG TABLET [35184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-399-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 5 MG TABLET [35184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-330-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOBENZAPRINE 5 MG TABLET [35184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-413-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":16.75,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CYCLOPENTOLATE 0.5 % EYE DROPS [9699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0395-15","type":"NDC"}],"standard_charges":[{"gross_charge":499.5,"discounted_cash":419.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CYCLOPENTOLATE 0.5 % EYE DROPS [9699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-096-15","type":"NDC"}],"standard_charges":[{"gross_charge":316.25,"discounted_cash":265.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CYCLOPENTOLATE 1 % EYE DROPS [2025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-735-01","type":"NDC"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CYCLOPENTOLATE 1 % EYE DROPS [2025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-396-01","type":"NDC"}],"standard_charges":[{"gross_charge":113.5,"discounted_cash":95.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CYCLOPENTOLATE 1 % EYE DROPS [2025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-100-02","type":"NDC"}],"standard_charges":[{"gross_charge":99.75,"discounted_cash":83.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS [9701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0359-02","type":"NDC"}],"standard_charges":[{"gross_charge":241.75,"discounted_cash":203.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS [9701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0359-05","type":"NDC"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10019-956-01","type":"NDC"}],"standard_charges":[{"gross_charge":1712.75,"discounted_cash":1438.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10019-956-16","type":"NDC"}],"standard_charges":[{"gross_charge":1712.75,"discounted_cash":1438.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-131-20","type":"NDC"}],"standard_charges":[{"gross_charge":1542.25,"discounted_cash":1295.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION [186199]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-218-05","type":"NDC"}],"standard_charges":[{"gross_charge":3672.25,"discounted_cash":3084.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET [2008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026885211","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"COVID VACC 2024-2025 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE [199546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"91320","type":"HCPCS"},{"code":"0069-2432-01","type":"NDC"}],"standard_charges":[{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"COVID VACC 2024-2025 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE [199546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"91320","type":"HCPCS"},{"code":"0069-2432-10","type":"NDC"}],"standard_charges":[{"gross_charge":164.25,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [183983]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0791","type":"HCPCS"},{"code":"0078-0883-61","type":"NDC"}],"standard_charges":[{"gross_charge":7270.75,"discounted_cash":6107.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":28028.0,"discounted_cash":23543.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"CROMOLYN 5.2 MG/SPRAY (4 %) NASAL SPRAY [24325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57782-397-26","type":"NDC"}],"standard_charges":[{"gross_charge":87.25,"discounted_cash":73.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26 ML"}]},{"description":"CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION [29313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0840","type":"HCPCS"},{"code":"50633-110-12","type":"NDC"}],"standard_charges":[{"gross_charge":56873.25,"discounted_cash":47773.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 G"}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [127057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4092-01","type":"NDC"}],"standard_charges":[{"gross_charge":77.75,"discounted_cash":65.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":207.0,"discounted_cash":173.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [127057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4092-11","type":"NDC"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":173.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [127057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0103-1","type":"NDC"}],"standard_charges":[{"gross_charge":171.25,"discounted_cash":143.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION [127057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0103-4","type":"NDC"}],"standard_charges":[{"gross_charge":171.25,"discounted_cash":143.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET [2009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7431201380","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET [2009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5164591401","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET [2009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3786491401","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0834","type":"HCPCS"},{"code":"0548-5900-00","type":"NDC"}],"standard_charges":[{"gross_charge":524.5,"discounted_cash":440.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":1048.75,"discounted_cash":880.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":1573.25,"discounted_cash":1321.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG"},{"gross_charge":524.5,"discounted_cash":440.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0834","type":"HCPCS"},{"code":"0781-3440-95","type":"NDC"}],"standard_charges":[{"gross_charge":394.75,"discounted_cash":331.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":789.25,"discounted_cash":662.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":1184.0,"discounted_cash":994.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG"}]},{"description":"CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0046-0872-21","type":"NDC"}],"standard_charges":[{"gross_charge":1681.25,"discounted_cash":1412.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"CONJUGATED ESTROGENS 1.25 MG TABLET [2938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0046-1104-81","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.45 MG"},{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.625 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"},{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1410","type":"HCPCS"},{"code":"0046-0749-05","type":"NDC"}],"standard_charges":[{"gross_charge":1614.75,"discounted_cash":1356.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET [2009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026885515","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"COPANLISIB 60 MG INTRAVENOUS SOLUTION [177071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9057","type":"HCPCS"},{"code":"50419-385-01","type":"NDC"}],"standard_charges":[{"gross_charge":9573.25,"discounted_cash":8041.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"COPPER 380 SQUARE MM INTRAUTERINE DEVICE [134757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7300","type":"HCPCS"},{"code":"59365-5128-1","type":"NDC"}],"standard_charges":[{"gross_charge":4152.75,"discounted_cash":3488.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"CORTISONE 25 MG TABLET [1935]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-173-30","type":"NDC"}],"standard_charges":[{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0834","type":"HCPCS"},{"code":"0781-3440-71","type":"NDC"}],"standard_charges":[{"gross_charge":394.75,"discounted_cash":331.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":789.25,"discounted_cash":662.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":1184.0,"discounted_cash":994.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"0143-9621-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70069-005-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70069-005-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":30.25,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"0517-0031-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"0517-0032-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323-044-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET [2008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"5026885215","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":10.5,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"0143-9621-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323-044-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":56.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":11.25,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET [2009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7431252805","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET [2009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733393810","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET [2009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7733393825","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET [2009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1000670022","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"0517-0031-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":59.25,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":12.0,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"0517-0032-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":36.75,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"63323-237-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CLONIDINE HCL 0.1 MG TABLET [1755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-113-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":7.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CITALOPRAM 10 MG/5 ML ORAL SOLUTION [28228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"7700-4579-05","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":66.25,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 20 MG TABLET [21062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-4020-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":76.75,"discounted_cash":64.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":153.5,"discounted_cash":128.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 20 MG TABLET [21062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-343-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 20 MG TABLET [21062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-343-30","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":35.5,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 20 MG TABLET [21062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-508-13","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 20 MG TABLET [21062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-006-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 20 MG TABLET [21062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 20 MG TABLET [21062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6232-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 10 MG/5 ML ORAL SOLUTION [28228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0062-58","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 10 MG TABLET [30264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6084-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":65.75,"discounted_cash":55.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"0703-5748-11","type":"NDC"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":274.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323-103-51","type":"NDC"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":140.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323-103-64","type":"NDC"}],"standard_charges":[{"gross_charge":667.5,"discounted_cash":560.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323-103-65","type":"NDC"}],"standard_charges":[{"gross_charge":333.75,"discounted_cash":280.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"44567-509-01","type":"NDC"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"44567-510-01","type":"NDC"}],"standard_charges":[{"gross_charge":243.25,"discounted_cash":204.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"16729-288-11","type":"NDC"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"16729-288-38","type":"NDC"}],"standard_charges":[{"gross_charge":292.5,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"70860-206-51","type":"NDC"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":245.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [88376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"0143-9505-01","type":"NDC"}],"standard_charges":[{"gross_charge":248.75,"discounted_cash":208.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION FOR DESENSITIZATION [182001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"0703-5747-11","type":"NDC"}],"standard_charges":[{"gross_charge":163.5,"discounted_cash":137.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CISPLATIN 50 MG INTRAVENOUS POWDER FOR SOLUTION [182463]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"44567-530-01","type":"NDC"}],"standard_charges":[{"gross_charge":1824.0,"discounted_cash":1532.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CITALOPRAM 10 MG TABLET [30264]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-009-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":69.75,"discounted_cash":58.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 20 MG TABLET [21062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6085-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.25,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.5,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CLEVIDIPINE 0.5 MG/ML INTRAVENOUS EMULSION WRAPPER [408734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9248","type":"HCPCS"},{"code":"10122-610-01","type":"NDC"}],"standard_charges":[{"gross_charge":434.75,"discounted_cash":365.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CLEVIDIPINE 0.5 MG/ML INTRAVENOUS EMULSION WRAPPER [408734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9248","type":"HCPCS"},{"code":"10122-610-10","type":"NDC"}],"standard_charges":[{"gross_charge":434.75,"discounted_cash":365.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CLEVIDIPINE 0.5 MG/ML INTRAVENOUS EMULSION WRAPPER [408734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9248","type":"HCPCS"},{"code":"10122-611-01","type":"NDC"}],"standard_charges":[{"gross_charge":757.25,"discounted_cash":636.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CLEVIDIPINE 0.5 MG/ML INTRAVENOUS EMULSION WRAPPER [408734]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9248","type":"HCPCS"},{"code":"10122-611-10","type":"NDC"}],"standard_charges":[{"gross_charge":757.25,"discounted_cash":636.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CLINDAMYCIN 1 % TOPICAL GEL [9623]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-900-94","type":"NDC"}],"standard_charges":[{"gross_charge":162.25,"discounted_cash":136.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"CLINDAMYCIN 1 % TOPICAL GEL [9623]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-900-96","type":"NDC"}],"standard_charges":[{"gross_charge":324.25,"discounted_cash":272.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0009-0775-26","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0009-0870-26","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0009-0902-18","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":29.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"63323-282-02","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"63323-282-04","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"63323-282-06","type":"NDC"}],"standard_charges":[{"gross_charge":39.75,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"25021-115-04","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG/KG"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0009-0602-04","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0009-0602-25","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"0009-0901-25","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0009-0775-20","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"67457-815-00","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"67457-815-04","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CLINDAMYCIN 2 % VAGINAL CREAM [9624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0277-40","type":"NDC"}],"standard_charges":[{"gross_charge":535.75,"discounted_cash":450.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 G"}]},{"description":"CLINDAMYCIN 300 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0781-3288-09","type":"NDC"}],"standard_charges":[{"gross_charge":120.75,"discounted_cash":101.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLINDAMYCIN 300 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0338-3410-24","type":"NDC"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLINDAMYCIN 300 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0338-3410-50","type":"NDC"}],"standard_charges":[{"gross_charge":111.5,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLARITHROMYCIN 500 MG TABLET [9617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-651-95","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CLARITHROMYCIN 500 MG TABLET [9617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-651-25","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":41.5,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CITALOPRAM 20 MG TABLET [21062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-744-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CITALOPRAM 20 MG TABLET [21062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-744-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION [9615]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"63323-140-10","type":"NDC"}],"standard_charges":[{"gross_charge":1587.0,"discounted_cash":1333.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION [9615]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"0143-9871-01","type":"NDC"}],"standard_charges":[{"gross_charge":1159.5,"discounted_cash":973.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":1503.75,"discounted_cash":1263.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-6022-46","type":"NDC"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":516.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-6022-52","type":"NDC"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CLARITHROMYCIN 250 MG TABLET [9616]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1961-60","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":81.5,"discounted_cash":68.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CLARITHROMYCIN 250 MG TABLET [9616]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-225-60","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":81.5,"discounted_cash":68.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CLARITHROMYCIN 250 MG TABLET [9616]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1931-06","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":81.5,"discounted_cash":68.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION [12886]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-6023-46","type":"NDC"}],"standard_charges":[{"gross_charge":781.25,"discounted_cash":656.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION [12886]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-6023-52","type":"NDC"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":406.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CLARITHROMYCIN 500 MG TABLET [9617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1962-60","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CLARITHROMYCIN 500 MG TABLET [9617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-226-60","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":40.75,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-151-10","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":1046.0,"discounted_cash":878.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG/ML"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1103-11","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3150-75","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":187.75,"discounted_cash":157.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3150-95","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":78.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":187.75,"discounted_cash":157.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":121.75,"discounted_cash":102.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3152-70","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":132.75,"discounted_cash":111.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":86.25,"discounted_cash":72.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3152-95","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":132.75,"discounted_cash":111.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":86.25,"discounted_cash":72.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-4378-24","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":196.0,"discounted_cash":164.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":127.25,"discounted_cash":106.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-4380-79","type":"NDC"}],"standard_charges":[{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-417-10","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":74.75,"discounted_cash":62.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-2056-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-2056-03","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-4380-10","type":"NDC"}],"standard_charges":[{"gross_charge":69.25,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":138.5,"discounted_cash":116.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CIPROFLOXACIN 6 % (6 MG/0.1 ML) INTRATYMPANIC SUSPENSION [169044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7342","type":"HCPCS"},{"code":"69251-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":1216.75,"discounted_cash":1022.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CIPROFLOXACIN 750 MG TABLET [25120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-128-50","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 750 MG TABLET [25120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-071-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.25,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":34.5,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 750 MG TABLET [25120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-413-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN 750 MG TABLET [25120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-653-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":37.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0781-3289-09","type":"NDC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":129.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-161-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-2045-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-2045-03","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-151-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288-713-20","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288-713-21","type":"NDC"}],"standard_charges":[{"gross_charge":28.75,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":38.25,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":24.75,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1103-01","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":90.5,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":58.75,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-418-20","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":89.75,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":58.25,"discounted_cash":48.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3153-80","type":"NDC"}],"standard_charges":[{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-161-10","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":75.25,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1208-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1208-11","type":"NDC"}],"standard_charges":[{"gross_charge":58.5,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [119149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-670-10","type":"NDC"}],"standard_charges":[{"gross_charge":51.75,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG/KG"},{"gross_charge":103.5,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":67.25,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-4382-20","type":"NDC"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":98.5,"discounted_cash":82.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3153-95","type":"NDC"}],"standard_charges":[{"gross_charge":70.75,"discounted_cash":59.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":94.5,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":61.25,"discounted_cash":51.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION [16169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-4382-91","type":"NDC"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG/KG"},{"gross_charge":98.5,"discounted_cash":82.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG/KG"},{"gross_charge":64.0,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0338-3612-24","type":"NDC"}],"standard_charges":[{"gross_charge":140.75,"discounted_cash":118.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0338-3616-24","type":"NDC"}],"standard_charges":[{"gross_charge":140.75,"discounted_cash":118.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLONAZEPAM 1 MG TABLET [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-882-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG TABLET [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-882-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":3.25,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.25,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG TABLET [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-750-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG TABLET [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-407-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG TABLET [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3212-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG TABLET [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-555-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG TABLET [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-555-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG DISINTEGRATING TABLET [35628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-367-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG TABLET [9637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-544-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG TABLET [9637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-544-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":19.25,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG TABLET [9637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888-152-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG TABLET [9637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7227-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG DISINTEGRATING TABLET [35628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0097-96","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG TABLET [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-174-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907-023-48","type":"NDC"}],"standard_charges":[{"gross_charge":180.25,"discounted_cash":151.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907-023-11","type":"NDC"}],"standard_charges":[{"gross_charge":180.25,"discounted_cash":151.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0032-34","type":"NDC"}],"standard_charges":[{"gross_charge":601.25,"discounted_cash":505.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0872-99","type":"NDC"}],"standard_charges":[{"gross_charge":228.75,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3509-04","type":"NDC"}],"standard_charges":[{"gross_charge":228.75,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0872-16","type":"NDC"}],"standard_charges":[{"gross_charge":228.75,"discounted_cash":192.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [27506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-611-04","type":"NDC"}],"standard_charges":[{"gross_charge":540.5,"discounted_cash":454.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE HCL 0.1 MG TABLET [1755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2127-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":8.75,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLONIDINE HCL 0.1 MG TABLET [1755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-299-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLONIDINE HCL 0.1 MG TABLET [1755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-299-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLONIDINE HCL 0.1 MG TABLET [1755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-060-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":6.5,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLONIDINE HCL 0.1 MG TABLET [1755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-054-31","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":5.75,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-453-04","type":"NDC"}],"standard_charges":[{"gross_charge":180.25,"discounted_cash":151.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-453-01","type":"NDC"}],"standard_charges":[{"gross_charge":180.25,"discounted_cash":151.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0871-16","type":"NDC"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3508-54","type":"NDC"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONAZEPAM 1 MG TABLET [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-174-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":2.5,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":9.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG TABLET [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-723-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":6.0,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":11.75,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 2 MG DISINTEGRATING TABLET [35629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0098-96","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":1.75,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":3.5,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":7.0,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 2 MG TABLET [9639]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0004-0098-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":16.5,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":32.75,"discounted_cash":27.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION [19333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"0143-9724-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"}]},{"description":"CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION [19333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"39822-2000-1","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":21.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0031-34","type":"NDC"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":299.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0871-99","type":"NDC"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [27505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3508-04","type":"NDC"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONAZEPAM 0.5 MG TABLET [9637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-406-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLOBAZAM 10 MG TABLET [112703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67386-314-01","type":"NDC"}],"standard_charges":[{"gross_charge":209.5,"discounted_cash":175.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":413.75,"discounted_cash":347.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":107.25,"discounted_cash":90.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CLOBAZAM 10 MG TABLET [112703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1305-1","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":286.75,"discounted_cash":240.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":75.5,"discounted_cash":63.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CLOBAZAM 20 MG TABLET [112704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67386-315-01","type":"NDC"}],"standard_charges":[{"gross_charge":159.25,"discounted_cash":133.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":313.25,"discounted_cash":263.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":82.25,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM [9630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0163-15","type":"NDC"}],"standard_charges":[{"gross_charge":527.25,"discounted_cash":442.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM [9630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1258-1","type":"NDC"}],"standard_charges":[{"gross_charge":527.25,"discounted_cash":442.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM [9630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-267-15","type":"NDC"}],"standard_charges":[{"gross_charge":527.25,"discounted_cash":442.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM [9630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0400-60","type":"NDC"}],"standard_charges":[{"gross_charge":1643.25,"discounted_cash":1380.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM [9630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-730-01","type":"NDC"}],"standard_charges":[{"gross_charge":522.5,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM [9630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52565-051-15","type":"NDC"}],"standard_charges":[{"gross_charge":527.25,"discounted_cash":442.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM [9630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1532-5","type":"NDC"}],"standard_charges":[{"gross_charge":527.25,"discounted_cash":442.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM [9630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-076-60","type":"NDC"}],"standard_charges":[{"gross_charge":1643.25,"discounted_cash":1380.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT [9631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0162-15","type":"NDC"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":536.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT [9631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1259-1","type":"NDC"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":536.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT [9631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-268-15","type":"NDC"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":536.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT [9631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-782-01","type":"NDC"}],"standard_charges":[{"gross_charge":631.75,"discounted_cash":530.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE [1740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292-018-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0338-3616-50","type":"NDC"}],"standard_charges":[{"gross_charge":140.75,"discounted_cash":118.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [127315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0016-1","type":"NDC"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [127315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-511-10","type":"NDC"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0781-3290-09","type":"NDC"}],"standard_charges":[{"gross_charge":176.5,"discounted_cash":148.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0338-3814-24","type":"NDC"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0338-3814-50","type":"NDC"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0338-4114-24","type":"NDC"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0338-4114-50","type":"NDC"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE [1740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-0225-02","type":"NDC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":101.75,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE [1740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5708-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT [9631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52565-039-15","type":"NDC"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":536.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE [1740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3328-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE [1740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-692-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE [1740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-059-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":9.25,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE [1740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-243-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":8.5,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE [1740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5959-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE [1740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292-018-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":15.75,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"0338-3612-50","type":"NDC"}],"standard_charges":[{"gross_charge":140.75,"discounted_cash":118.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT [9631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-077-15","type":"NDC"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":536.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOMIPRAMINE 25 MG CAPSULE [9635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2027-01","type":"NDC"}],"standard_charges":[{"gross_charge":455.75,"discounted_cash":382.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":228.0,"discounted_cash":191.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLONAZEPAM 0.5 MG DISINTEGRATING TABLET [35627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0096-96","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG TABLET [9637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0832-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG TABLET [9637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-263-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":11.0,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG TABLET [9637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-136-00","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG TABLET [9637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-752-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":5.25,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":10.25,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":20.25,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.25 MG DISINTEGRATING TABLET [35626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0095-96","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLOMIPRAMINE 25 MG CAPSULE [9635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4011-5","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":2.75,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLOMIPRAMINE 25 MG CAPSULE [9635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4011-6","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":4.25,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":8.25,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLOMIPRAMINE 25 MG CAPSULE [9635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-342-01","type":"NDC"}],"standard_charges":[{"gross_charge":455.75,"discounted_cash":382.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":228.0,"discounted_cash":191.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLOMIPRAMINE 25 MG CAPSULE [9635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-683-09","type":"NDC"}],"standard_charges":[{"gross_charge":455.75,"discounted_cash":382.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":228.0,"discounted_cash":191.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLONAZEPAM 0.125 MG DISINTEGRATING TABLET [35625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0094-96","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":17.75,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":35.25,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":70.25,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":140.5,"discounted_cash":118.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"Hc Myd88 Gene Analysis P.Leu265 (L265P) Variant","code_information":[{"code":"03001235","type":"CDM"},{"code":"300","type":"RC"},{"code":"81305","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":619.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Private Room Charge","code_information":[{"code":"11000000","type":"CDM"},{"code":"110","type":"RC"}],"standard_charges":[{"gross_charge":2060.64,"discounted_cash":1730.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gyn Private Room Charge","code_information":[{"code":"11100000","type":"CDM"},{"code":"111","type":"RC"}],"standard_charges":[{"gross_charge":1850.76,"discounted_cash":1554.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ob Private Room Charge","code_information":[{"code":"11200000","type":"CDM"},{"code":"112","type":"RC"}],"standard_charges":[{"gross_charge":1850.76,"discounted_cash":1554.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Peds Private Room Charge","code_information":[{"code":"11300000","type":"CDM"},{"code":"113","type":"RC"}],"standard_charges":[{"gross_charge":1979.02,"discounted_cash":1662.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rehab Room Charge","code_information":[{"code":"11800000","type":"CDM"},{"code":"118","type":"RC"}],"standard_charges":[{"gross_charge":2512.2,"discounted_cash":2110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Semi-Private Room Charge","code_information":[{"code":"12000000","type":"CDM"},{"code":"120","type":"RC"}],"standard_charges":[{"gross_charge":2060.64,"discounted_cash":1730.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Peds Semi-Private Room Charge","code_information":[{"code":"12300000","type":"CDM"},{"code":"123","type":"RC"}],"standard_charges":[{"gross_charge":1979.02,"discounted_cash":1662.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rehab Semi-Private Room Charge","code_information":[{"code":"12800000","type":"CDM"},{"code":"128","type":"RC"}],"standard_charges":[{"gross_charge":2512.2,"discounted_cash":2110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Neo-Natal Level 1","code_information":[{"code":"17100000","type":"CDM"},{"code":"171","type":"RC"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":1156.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surrogacy Neo-Natal Level 1","code_information":[{"code":"17100001","type":"CDM"},{"code":"171","type":"RC"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":1632.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Neo-Natal Level 2","code_information":[{"code":"17200000","type":"CDM"},{"code":"172","type":"RC"}],"standard_charges":[{"gross_charge":3105.0,"discounted_cash":2608.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Icu Room Charge","code_information":[{"code":"20000000","type":"CDM"},{"code":"200","type":"RC"}],"standard_charges":[{"gross_charge":5328.0,"discounted_cash":4475.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Imc Private Room Charge","code_information":[{"code":"20600000","type":"CDM"},{"code":"206","type":"RC"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":2653.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cv/Sicu Room Charge","code_information":[{"code":"21000000","type":"CDM"},{"code":"210","type":"RC"}],"standard_charges":[{"gross_charge":5438.0,"discounted_cash":4567.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nurse Transport Per Hour","code_information":[{"code":"23000000","type":"CDM"},{"code":"230","type":"RC"}],"standard_charges":[{"gross_charge":401.74,"discounted_cash":337.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Hydra Initial =< 1Hr","code_information":[{"code":"26000000","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":700.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Hydration Ea Add'l Hr","code_information":[{"code":"26000001","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":307.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther/Proph/Diag Inj Sc/Im","code_information":[{"code":"26000002","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Appl On-Body Injector For Timed Subq Injection","code_information":[{"code":"26000003","type":"CDM"},{"code":"260","type":"RC"},{"code":"96377","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_10490","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":699.3,"discounted_cash":587.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_10559","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":555.44,"discounted_cash":466.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_11442","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_15985","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_16093","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_16094","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":329.8,"discounted_cash":277.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_20710","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":106.7,"discounted_cash":89.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_21591","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":192.01,"discounted_cash":161.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_21655","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":449.55,"discounted_cash":377.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_23778","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":3609.31,"discounted_cash":3031.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_27814","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":264.48,"discounted_cash":222.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_28206","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":232.9,"discounted_cash":195.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_33229","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":3838.04,"discounted_cash":3223.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_33230","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":256.3,"discounted_cash":215.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_33231","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":584.3,"discounted_cash":490.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_33232","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":399.95,"discounted_cash":335.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_33233","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":862.46,"discounted_cash":724.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_46916","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":113.73,"discounted_cash":95.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_47631","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":3532.48,"discounted_cash":2967.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_47638","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":309.13,"discounted_cash":259.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_47639","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":478.52,"discounted_cash":401.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_47640","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":509.09,"discounted_cash":427.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_47669","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":515.48,"discounted_cash":433.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_49298","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":369.3,"discounted_cash":310.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_49300","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":143.56,"discounted_cash":120.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_49657","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":124.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_49658","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_49814","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":607.73,"discounted_cash":510.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_50072","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":982.35,"discounted_cash":825.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_53971","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":265.78,"discounted_cash":223.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_6198","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":1103.91,"discounted_cash":927.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_6549","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":407.79,"discounted_cash":342.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_86598","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":482.85,"discounted_cash":405.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_86599","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":492.51,"discounted_cash":413.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_86600","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":376.05,"discounted_cash":315.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_86606","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":103.07,"discounted_cash":86.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_86724","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":5547.65,"discounted_cash":4660.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_86725","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":799.2,"discounted_cash":671.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_9734","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":172.39,"discounted_cash":144.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_9760","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":152.12,"discounted_cash":127.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_9866","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":622.71,"discounted_cash":523.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_9975","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":173.82,"discounted_cash":146.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27000000_9996","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":323.18,"discounted_cash":271.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Low Flow Oxygen","code_information":[{"code":"27000001","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Low Flow Oxygen","code_information":[{"code":"27000001_270","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":120.42,"discounted_cash":101.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc High Flow Oxygen","code_information":[{"code":"27000002","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc High Flow Oxygen","code_information":[{"code":"27000002_270","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":240.46,"discounted_cash":201.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bipap/Cpap Circuit Change","code_information":[{"code":"27000003","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bipap/Cpap Circuit Change","code_information":[{"code":"27000003_270","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":97.17,"discounted_cash":81.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mech Vent Circuit Change","code_information":[{"code":"27000004","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":81.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mech Vent Circuit Change","code_information":[{"code":"27000004_270","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":95.68,"discounted_cash":80.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Arterial Blood Gas Kit","code_information":[{"code":"27000005","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Arterial Blood Gas Kit","code_information":[{"code":"27000005_270","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Artificial Airway Change","code_information":[{"code":"27000006","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Artificial Airway Change","code_information":[{"code":"27000006_270","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":76.59,"discounted_cash":64.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fiber Optic Stylet","code_information":[{"code":"27000007","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cricothyrotomy Tray","code_information":[{"code":"27000008","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":278.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Retrograde Intubation Tray","code_information":[{"code":"27000009","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":208.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Endotracheal Tube","code_information":[{"code":"27000010","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intubation Stylet","code_information":[{"code":"27000011","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc End Tidal Co2 Detector","code_information":[{"code":"27000012","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27070427_93662","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":2622.0,"discounted_cash":2202.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27070428_93663","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":2622.0,"discounted_cash":2202.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27100000_33223","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":432.91,"discounted_cash":363.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27100000_34826","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":409.32,"discounted_cash":343.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27100000_90911","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":226.93,"discounted_cash":190.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27100000_91542","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":1880.32,"discounted_cash":1579.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10001","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.66,"discounted_cash":129.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10004","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":869.6,"discounted_cash":730.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_100094","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_100146","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10021","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":342.15,"discounted_cash":287.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10025","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":428.1,"discounted_cash":359.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10035","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":356.81,"discounted_cash":299.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_100935","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2408.96,"discounted_cash":2023.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_101210","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1468.54,"discounted_cash":1233.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10529","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":366.3,"discounted_cash":307.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10547","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1232.51,"discounted_cash":1035.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10563","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8737.55,"discounted_cash":7339.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10570","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":818.06,"discounted_cash":687.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10585","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":144.97,"discounted_cash":121.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10586","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":150.86,"discounted_cash":126.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10773","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":506.99,"discounted_cash":425.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10786","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1075.59,"discounted_cash":903.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10788","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":325.92,"discounted_cash":273.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10790","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":246.77,"discounted_cash":207.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10824","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":130.37,"discounted_cash":109.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10830","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":394.68,"discounted_cash":331.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10836","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":649.35,"discounted_cash":545.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10837","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":114.07,"discounted_cash":95.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10839","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":489.51,"discounted_cash":411.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10840","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":489.51,"discounted_cash":411.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10841","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":489.51,"discounted_cash":411.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10844","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":681.82,"discounted_cash":572.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10848","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":681.82,"discounted_cash":572.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_10851","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11194","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.89,"discounted_cash":513.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11209","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11352","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":489.51,"discounted_cash":411.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11419","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":476.36,"discounted_cash":400.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11421","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":353.95,"discounted_cash":297.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11471","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":104.76,"discounted_cash":88.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11498","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":344.11,"discounted_cash":289.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11503","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":216.8,"discounted_cash":182.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11517","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":868.29,"discounted_cash":729.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11518","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1586.87,"discounted_cash":1332.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11519","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1964.7,"discounted_cash":1650.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11548","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.24,"discounted_cash":159.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11562","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.24,"discounted_cash":159.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11563","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.24,"discounted_cash":159.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11567","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":702.63,"discounted_cash":590.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11569","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":874.13,"discounted_cash":734.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11611","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11624","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":481.61,"discounted_cash":404.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11628","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":255.98,"discounted_cash":215.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11637","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.2,"discounted_cash":130.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11653","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":126.42,"discounted_cash":106.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11654","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":113.99,"discounted_cash":95.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11656","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":147.84,"discounted_cash":124.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11684","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":312.34,"discounted_cash":262.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11685","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":237.9,"discounted_cash":199.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11686","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1425.24,"discounted_cash":1197.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11687","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1325.34,"discounted_cash":1113.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11706","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":747.67,"discounted_cash":628.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11707","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":158.26,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11708","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":143.56,"discounted_cash":120.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11709","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":115.08,"discounted_cash":96.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11710","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":115.24,"discounted_cash":96.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11727","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11731","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11732","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11745","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":135.8,"discounted_cash":114.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11753","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":342.32,"discounted_cash":287.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11760","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":199.36,"discounted_cash":167.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11817","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":123.42,"discounted_cash":103.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11818","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":122.48,"discounted_cash":102.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11825","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":139.36,"discounted_cash":117.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11837","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":520.86,"discounted_cash":437.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11841","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":819.18,"discounted_cash":688.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11852","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":182.58,"discounted_cash":153.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11859","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":195.8,"discounted_cash":164.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11886","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":135.8,"discounted_cash":114.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11891","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7560.26,"discounted_cash":6350.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11892","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3462.5,"discounted_cash":2908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11921","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2773.83,"discounted_cash":2330.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11924","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3075.46,"discounted_cash":2583.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11934","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":87.43,"discounted_cash":73.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11936","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.54,"discounted_cash":157.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11946","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3644.21,"discounted_cash":3061.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11950","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5103.95,"discounted_cash":4287.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11966","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":709.62,"discounted_cash":596.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11979","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":346.15,"discounted_cash":290.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11987","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.34,"discounted_cash":494.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11988","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":781.85,"discounted_cash":656.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11989","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":563.3,"discounted_cash":473.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11995","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":422.91,"discounted_cash":355.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":392.52,"discounted_cash":329.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_11998","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1034.03,"discounted_cash":868.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12024","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":394.7,"discounted_cash":331.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12037","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":311.04,"discounted_cash":261.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12038","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.36,"discounted_cash":227.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12039","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":226.74,"discounted_cash":190.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12043","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.95,"discounted_cash":188.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12049","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6213.78,"discounted_cash":5219.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12056","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":182.62,"discounted_cash":153.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12065","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5991.78,"discounted_cash":5033.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12066","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":299.74,"discounted_cash":251.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12077","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":200.6,"discounted_cash":168.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12078","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":200.6,"discounted_cash":168.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12095","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":294.88,"discounted_cash":247.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12115","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1981.35,"discounted_cash":1664.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12116","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":563.29,"discounted_cash":473.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12121","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":123.11,"discounted_cash":103.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12128","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":953.18,"discounted_cash":800.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12130","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1660.14,"discounted_cash":1394.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12146","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":104.76,"discounted_cash":88.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12152","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":732.6,"discounted_cash":615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12154","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.23,"discounted_cash":646.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12156","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":839.16,"discounted_cash":704.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12161","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":127.06,"discounted_cash":106.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12173","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1616.6,"discounted_cash":1357.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12175","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1503.99,"discounted_cash":1263.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12178","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":699.3,"discounted_cash":587.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12191","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.47,"discounted_cash":104.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12192","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":132.5,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12194","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":139.01,"discounted_cash":116.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12198","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":490.34,"discounted_cash":411.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12199","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":213.4,"discounted_cash":179.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12200","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":142.46,"discounted_cash":119.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12201","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":143.31,"discounted_cash":120.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12204","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1878.03,"discounted_cash":1577.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12210","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":262.75,"discounted_cash":220.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12211","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":370.28,"discounted_cash":311.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12213","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":292.31,"discounted_cash":245.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12214","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":944.45,"discounted_cash":793.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12319","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12320","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":142.59,"discounted_cash":119.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12353","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":126.46,"discounted_cash":106.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12373","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":137.81,"discounted_cash":115.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12375","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.21,"discounted_cash":129.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12376","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.67,"discounted_cash":91.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12377","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":137.71,"discounted_cash":115.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12378","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":160.66,"discounted_cash":134.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12379","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":1958.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12387","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":214.18,"discounted_cash":179.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12392","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1061.03,"discounted_cash":891.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12397","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":357.99,"discounted_cash":300.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12406","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.23,"discounted_cash":211.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12412","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12422","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":183.14,"discounted_cash":153.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12423","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":361.11,"discounted_cash":303.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12425","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1081.51,"discounted_cash":908.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12429","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":899.1,"discounted_cash":755.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12431","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":110.77,"discounted_cash":93.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12433","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":826.95,"discounted_cash":694.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12434","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1561.77,"discounted_cash":1311.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12437","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":121.11,"discounted_cash":101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12438","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":117.42,"discounted_cash":98.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12439","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":126.1,"discounted_cash":105.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12441","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.14,"discounted_cash":107.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12442","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.4,"discounted_cash":91.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12447","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.33,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12448","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":127.37,"discounted_cash":106.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12449","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.12,"discounted_cash":90.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12450","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.68,"discounted_cash":91.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12451","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.97,"discounted_cash":161.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12452","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":109.01,"discounted_cash":91.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12453","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":127.63,"discounted_cash":107.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12456","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":933.51,"discounted_cash":784.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12457","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1034.3,"discounted_cash":868.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12458","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1275.39,"discounted_cash":1071.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12460","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":308.5,"discounted_cash":259.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12462","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1024.31,"discounted_cash":860.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":303.54,"discounted_cash":254.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12465","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":143.56,"discounted_cash":120.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12466","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.71,"discounted_cash":171.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12469","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":476.52,"discounted_cash":400.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12489","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":133.24,"discounted_cash":111.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12490","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":112.95,"discounted_cash":94.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12508","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":143.56,"discounted_cash":120.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":482.3,"discounted_cash":405.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12514","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1301.65,"discounted_cash":1093.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12515","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":479.07,"discounted_cash":402.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12518","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1043.39,"discounted_cash":876.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_12591","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.04,"discounted_cash":107.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_14063","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.17,"discounted_cash":90.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_14167","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.44,"discounted_cash":469.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_14359","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.65,"discounted_cash":293.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_15102","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":327.24,"discounted_cash":274.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_15165","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":179.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_15356","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":144.52,"discounted_cash":121.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_15497","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":225.04,"discounted_cash":189.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_15592","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":344.66,"discounted_cash":289.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_15651","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":137.53,"discounted_cash":115.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_15765","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.07,"discounted_cash":118.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_15997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":184.11,"discounted_cash":154.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_15998","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.48,"discounted_cash":157.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_16110","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.8,"discounted_cash":277.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_16113","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":649.35,"discounted_cash":545.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_16262","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":243.88,"discounted_cash":204.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_16263","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":249.41,"discounted_cash":209.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_16342","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":177.78,"discounted_cash":149.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_16508","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":209.2,"discounted_cash":175.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_16535","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":166.9,"discounted_cash":140.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_16602","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.66,"discounted_cash":145.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_16616","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":600.88,"discounted_cash":504.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_18982","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":648.86,"discounted_cash":545.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_18983","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":693.3,"discounted_cash":582.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_19265","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":795.87,"discounted_cash":668.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_19279","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":243.59,"discounted_cash":204.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_19380","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":138.88,"discounted_cash":116.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_19548","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":582.64,"discounted_cash":489.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_20426","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":341.54,"discounted_cash":286.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_20587","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":181.34,"discounted_cash":152.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_20626","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":168.4,"discounted_cash":141.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_20756","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.15,"discounted_cash":157.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_20778","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":246.74,"discounted_cash":207.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_20824","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":254.1,"discounted_cash":213.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_20830","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":392.76,"discounted_cash":329.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_21317","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.5,"discounted_cash":278.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_21332","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.61,"discounted_cash":104.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_21346","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":82.54,"discounted_cash":69.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_21396","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":184.44,"discounted_cash":154.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_21627","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.52,"discounted_cash":257.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_21658","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":162.96,"discounted_cash":136.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_21672","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":168.65,"discounted_cash":141.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_21788","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":554.77,"discounted_cash":466.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_22499","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":975.76,"discounted_cash":819.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_22691","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":107.4,"discounted_cash":90.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_22701","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":269.11,"discounted_cash":226.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_22837","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":245.17,"discounted_cash":205.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_22960","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":408.8,"discounted_cash":343.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_22961","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":233.27,"discounted_cash":195.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_22991","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.55,"discounted_cash":91.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23240","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":679.59,"discounted_cash":570.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23277","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":295.89,"discounted_cash":248.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23306","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":807.53,"discounted_cash":678.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23419","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1516.48,"discounted_cash":1273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23556","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.64,"discounted_cash":91.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23557","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":122.22,"discounted_cash":102.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23655","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":1118.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23708","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5060.79,"discounted_cash":4251.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23731","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1030.64,"discounted_cash":865.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23808","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1010.66,"discounted_cash":848.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_23966","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":582.42,"discounted_cash":489.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24230","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":637.33,"discounted_cash":535.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24239","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24240","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":230.09,"discounted_cash":193.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24241","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":384.87,"discounted_cash":323.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24255","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":792.98,"discounted_cash":666.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24256","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3171.65,"discounted_cash":2664.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24351","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1026.95,"discounted_cash":862.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24509","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":201.88,"discounted_cash":169.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24843","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":414.98,"discounted_cash":348.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24844","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":114.76,"discounted_cash":96.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24845","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":596.18,"discounted_cash":500.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24846","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":587.46,"discounted_cash":493.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24855","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":475.19,"discounted_cash":399.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24856","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":144.59,"discounted_cash":121.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24866","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24872","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":902.8,"discounted_cash":758.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24884","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":793.63,"discounted_cash":666.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24885","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":756.64,"discounted_cash":635.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24925","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.6,"discounted_cash":228.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24995","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10.11,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24996","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10.11,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10.11,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_24999","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10.11,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_25012","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2056.94,"discounted_cash":1727.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_25132","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":699.3,"discounted_cash":587.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_25135","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10.11,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_25136","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10.11,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_25184","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":125.38,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_25340","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":199.3,"discounted_cash":167.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_25910","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":574.46,"discounted_cash":482.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_26885","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":234.74,"discounted_cash":197.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_26886","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":225.04,"discounted_cash":189.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_26988","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":340.79,"discounted_cash":286.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":287.63,"discounted_cash":241.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27223","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":750.92,"discounted_cash":630.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27243","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":135.22,"discounted_cash":113.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27291","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":162.74,"discounted_cash":136.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27292","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":750.92,"discounted_cash":630.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27308","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":178.39,"discounted_cash":149.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27420","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27518","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":261.18,"discounted_cash":219.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27535","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":227.14,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27556","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":168.2,"discounted_cash":141.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27558","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":202.85,"discounted_cash":170.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27735","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.95,"discounted_cash":188.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27751","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":168.31,"discounted_cash":141.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27754","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":209.89,"discounted_cash":176.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27764","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.89,"discounted_cash":513.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27775","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":260.88,"discounted_cash":219.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27776","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.2,"discounted_cash":293.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27777","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.93,"discounted_cash":177.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27785","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":194.7,"discounted_cash":163.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27787","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":476.11,"discounted_cash":399.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27813","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":234.09,"discounted_cash":196.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_27985","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":346.92,"discounted_cash":291.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28123","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":993.78,"discounted_cash":834.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28164","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":336.12,"discounted_cash":282.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28165","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":307.71,"discounted_cash":258.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28166","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.44,"discounted_cash":170.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28167","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.06,"discounted_cash":188.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28174","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":885.5,"discounted_cash":743.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28185","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":373.11,"discounted_cash":313.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28230","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":283.31,"discounted_cash":237.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28273","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1193.14,"discounted_cash":1002.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28283","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":707.62,"discounted_cash":594.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28286","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":277.03,"discounted_cash":232.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28298","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":341.81,"discounted_cash":287.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28306","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":217.55,"discounted_cash":182.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28308","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":217.55,"discounted_cash":182.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28310","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":649.35,"discounted_cash":545.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28311","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":649.35,"discounted_cash":545.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28329","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":122.08,"discounted_cash":102.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28331","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":319.71,"discounted_cash":268.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28334","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":126.1,"discounted_cash":105.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28335","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.89,"discounted_cash":108.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28379","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":506.69,"discounted_cash":425.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28394","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":852.15,"discounted_cash":715.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28401","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":237.78,"discounted_cash":199.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28465","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1136.36,"discounted_cash":954.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28470","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":211.02,"discounted_cash":177.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28471","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":616.05,"discounted_cash":517.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28474","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":542.68,"discounted_cash":455.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28480","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28481","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":282.52,"discounted_cash":237.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28485","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.89,"discounted_cash":108.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28495","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":366.3,"discounted_cash":307.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28496","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.39,"discounted_cash":366.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28497","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":481.08,"discounted_cash":404.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28498","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":544.64,"discounted_cash":457.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28500","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":375.98,"discounted_cash":315.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":166.84,"discounted_cash":140.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28503","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":855.81,"discounted_cash":718.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28563","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.89,"discounted_cash":513.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28576","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":499.5,"discounted_cash":419.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28587","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":382.95,"discounted_cash":321.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28603","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":244.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28605","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":303.54,"discounted_cash":254.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28608","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":812.44,"discounted_cash":682.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28622","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":199.36,"discounted_cash":167.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28634","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":104.41,"discounted_cash":87.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28675","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.91,"discounted_cash":176.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28678","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":394.85,"discounted_cash":331.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28679","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":276.17,"discounted_cash":231.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28704","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":489.51,"discounted_cash":411.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28705","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":489.51,"discounted_cash":411.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28725","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":771.56,"discounted_cash":648.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28753","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2400.93,"discounted_cash":2016.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28772","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.5,"discounted_cash":1258.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28782","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.06,"discounted_cash":125.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28783","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":226.71,"discounted_cash":190.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28784","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":267.72,"discounted_cash":224.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28791","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":269.15,"discounted_cash":226.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28800","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1597.88,"discounted_cash":1342.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28969","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.04,"discounted_cash":160.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_28987","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":215.11,"discounted_cash":180.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_29257","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":377.62,"discounted_cash":317.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_29304","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":151.49,"discounted_cash":127.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_29405","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":174.41,"discounted_cash":146.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_30272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.79,"discounted_cash":157.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_30642","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":402.1,"discounted_cash":337.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_30656","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":582.75,"discounted_cash":489.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_30663","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":340.45,"discounted_cash":285.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_30665","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":342.94,"discounted_cash":288.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_30667","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":336.22,"discounted_cash":282.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_30668","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.89,"discounted_cash":513.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_30669","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.52,"discounted_cash":257.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_30764","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5060.79,"discounted_cash":4251.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31076","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":221.16,"discounted_cash":185.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31182","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":909.07,"discounted_cash":763.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31226","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":836.52,"discounted_cash":702.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31270","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":491.18,"discounted_cash":412.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31282","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":659.34,"discounted_cash":553.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31404","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":197.77,"discounted_cash":166.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8.85,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31536","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":378.59,"discounted_cash":318.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31541","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":199.94,"discounted_cash":167.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31542","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":213.28,"discounted_cash":179.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31543","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":213.1,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31545","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":497.1,"discounted_cash":417.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31546","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":409.92,"discounted_cash":344.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31550","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":217.46,"discounted_cash":182.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31552","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":186.77,"discounted_cash":156.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31555","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":253.26,"discounted_cash":212.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31562","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":138.58,"discounted_cash":116.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31947","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":990.18,"discounted_cash":831.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31958","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2881.04,"discounted_cash":2420.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_31959","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":249.9,"discounted_cash":209.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32032","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":497.27,"discounted_cash":417.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32088","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":217.55,"discounted_cash":182.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32223","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1344.38,"discounted_cash":1129.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32243","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":994.29,"discounted_cash":835.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32248","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2497.5,"discounted_cash":2097.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32256","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":192.41,"discounted_cash":161.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32284","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":244.44,"discounted_cash":205.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32288","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":130.37,"discounted_cash":109.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32366","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":179.64,"discounted_cash":150.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32467","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":310.96,"discounted_cash":261.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32674","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2098.24,"discounted_cash":1762.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32694","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2574.09,"discounted_cash":2162.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32809","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":451.72,"discounted_cash":379.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32821","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":195.39,"discounted_cash":164.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_32832","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":130.37,"discounted_cash":109.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_33112","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":338.59,"discounted_cash":284.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_33217","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1279.02,"discounted_cash":1074.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_33224","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":342.54,"discounted_cash":287.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_33355","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":313.13,"discounted_cash":263.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_33751","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":731.96,"discounted_cash":614.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_34036","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":735.86,"discounted_cash":618.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_34037","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":735.86,"discounted_cash":618.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_34067","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":152.3,"discounted_cash":127.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_34068","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":255.11,"discounted_cash":214.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_34595","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":399.6,"discounted_cash":335.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_34634","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2261.07,"discounted_cash":1899.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_34730","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":749.08,"discounted_cash":629.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35069","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1222.96,"discounted_cash":1027.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35078","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":206.63,"discounted_cash":173.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35217","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1099.49,"discounted_cash":923.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35218","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":633.1,"discounted_cash":531.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35226","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":402.1,"discounted_cash":337.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35227","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1223.78,"discounted_cash":1027.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35369","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3438.93,"discounted_cash":2888.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35372","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":415.96,"discounted_cash":349.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35377","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1732.4,"discounted_cash":1455.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35409","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2432.17,"discounted_cash":2043.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35416","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.24,"discounted_cash":40.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35425","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1098.0,"discounted_cash":922.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35460","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1132.2,"discounted_cash":951.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35461","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1137.75,"discounted_cash":955.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35479","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":181.26,"discounted_cash":152.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35480","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35515","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":113.3,"discounted_cash":95.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35622","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":419.47,"discounted_cash":352.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35623","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":413.21,"discounted_cash":347.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35624","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35702","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1054.54,"discounted_cash":885.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35709","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":310.4,"discounted_cash":260.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35710","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":491.18,"discounted_cash":412.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35720","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.64,"discounted_cash":91.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35751","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.64,"discounted_cash":91.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35915","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.64,"discounted_cash":91.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35916","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":687.65,"discounted_cash":577.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35919","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.64,"discounted_cash":91.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35929","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2181.5,"discounted_cash":1832.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_35948","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":982.35,"discounted_cash":825.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36091","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1265.4,"discounted_cash":1062.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36092","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1265.4,"discounted_cash":1062.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36212","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":130.95,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36330","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":337.09,"discounted_cash":283.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36333","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":914.76,"discounted_cash":768.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36334","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":860.31,"discounted_cash":722.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36446","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.26,"discounted_cash":129.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36552","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1315.35,"discounted_cash":1104.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36556","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2574.09,"discounted_cash":2162.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36579","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":949.88,"discounted_cash":797.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36594","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1278.99,"discounted_cash":1074.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36633","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":505.15,"discounted_cash":424.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36636","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":422.3,"discounted_cash":354.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36670","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4155.0,"discounted_cash":3490.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_36862","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":324.37,"discounted_cash":272.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_37956","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":404.43,"discounted_cash":339.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_38739","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.2,"discounted_cash":104.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_39839","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":733.32,"discounted_cash":615.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_41864","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1101.4,"discounted_cash":925.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_42437","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1321.11,"discounted_cash":1109.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_42812","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1341.99,"discounted_cash":1127.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_42921","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":645.12,"discounted_cash":541.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_42993","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":872.46,"discounted_cash":732.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_42994","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1035.7,"discounted_cash":869.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_43503","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":414.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_43504","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":494.36,"discounted_cash":415.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_43505","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":482.05,"discounted_cash":404.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_43544","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":579.19,"discounted_cash":486.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_43708","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2547.45,"discounted_cash":2139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_44169","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":424.66,"discounted_cash":356.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_44841","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":147.44,"discounted_cash":123.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_44923","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":982.35,"discounted_cash":825.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_44981","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":980.98,"discounted_cash":824.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_45002","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1810.17,"discounted_cash":1520.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_45026","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4709.0,"discounted_cash":3955.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_45027","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":1118.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_45029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":299.8,"discounted_cash":251.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_45077","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":655.41,"discounted_cash":550.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_45082","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.61,"discounted_cash":59.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_45236","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":982.35,"discounted_cash":825.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_45293","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":343.75,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_46888","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":263.84,"discounted_cash":221.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_46916","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":130.28,"discounted_cash":109.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_46927","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1059.05,"discounted_cash":889.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_46928","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":397.16,"discounted_cash":333.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_46945","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":865.8,"discounted_cash":727.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47169","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2497.5,"discounted_cash":2097.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47237","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":362.8,"discounted_cash":304.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47597","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":204.3,"discounted_cash":171.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47627","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":946.57,"discounted_cash":795.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47628","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":706.14,"discounted_cash":593.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47782","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":115.96,"discounted_cash":97.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47783","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":122.86,"discounted_cash":103.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47784","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":100.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47804","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":419.23,"discounted_cash":352.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47807","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2183.55,"discounted_cash":1834.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47809","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":926.57,"discounted_cash":778.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47810","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1118.37,"discounted_cash":939.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47811","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":899.1,"discounted_cash":755.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47812","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":932.4,"discounted_cash":783.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47813","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":907.22,"discounted_cash":762.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47814","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":768.88,"discounted_cash":645.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47815","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":899.1,"discounted_cash":755.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47816","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.23,"discounted_cash":646.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47817","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":699.3,"discounted_cash":587.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47819","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":503.5,"discounted_cash":422.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47821","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":524.48,"discounted_cash":440.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47823","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.55,"discounted_cash":381.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47825","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":122.22,"discounted_cash":102.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47827","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.23,"discounted_cash":646.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47828","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":122.08,"discounted_cash":102.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47835","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":597.46,"discounted_cash":501.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47837","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":211.85,"discounted_cash":177.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47849","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":914.9,"discounted_cash":768.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_47862","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":832.5,"discounted_cash":699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48114","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.8,"discounted_cash":277.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48338","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":102.17,"discounted_cash":85.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48339","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":660.84,"discounted_cash":555.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48340","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2773.83,"discounted_cash":2330.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48341","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2891.88,"discounted_cash":2429.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48347","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1188.81,"discounted_cash":998.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48409","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":292.88,"discounted_cash":246.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48430","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":150.31,"discounted_cash":126.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48436","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5401.5,"discounted_cash":4537.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48437","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5401.5,"discounted_cash":4537.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48509","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":379.62,"discounted_cash":318.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48526","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":379.62,"discounted_cash":318.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48556","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":153.04,"discounted_cash":128.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48753","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":106.57,"discounted_cash":89.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48896","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1690.14,"discounted_cash":1419.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48979","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1428.57,"discounted_cash":1200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_48984","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":130.37,"discounted_cash":109.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49007","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":263.84,"discounted_cash":221.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49024","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":122.07,"discounted_cash":102.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49129","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":447.97,"discounted_cash":376.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49193","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":130.37,"discounted_cash":109.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49200","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":914.9,"discounted_cash":768.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49342","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":982.35,"discounted_cash":825.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49379","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":381.4,"discounted_cash":320.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49384","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":136.94,"discounted_cash":115.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49386","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":175.28,"discounted_cash":147.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49394","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":419.58,"discounted_cash":352.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49419","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.5,"discounted_cash":278.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49427","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":649.35,"discounted_cash":545.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49440","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":262.4,"discounted_cash":220.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49489","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":832.5,"discounted_cash":699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49492","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1731.6,"discounted_cash":1454.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_49608","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.45,"discounted_cash":461.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50079","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1480.55,"discounted_cash":1243.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50125","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2862.96,"discounted_cash":2404.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50213","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.5,"discounted_cash":1258.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50236","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3544.18,"discounted_cash":2977.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50319","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2773.83,"discounted_cash":2330.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1998.0,"discounted_cash":1678.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50480","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":125.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50482","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.25,"discounted_cash":349.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50502","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1855.59,"discounted_cash":1558.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50503","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2534.96,"discounted_cash":2129.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50543","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":197.82,"discounted_cash":166.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50544","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":197.82,"discounted_cash":166.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50623","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":278.28,"discounted_cash":233.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50624","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":278.28,"discounted_cash":233.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50646","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1853.15,"discounted_cash":1556.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50647","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":804.2,"discounted_cash":675.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50648","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":804.2,"discounted_cash":675.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50702","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":218.83,"discounted_cash":183.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50831","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2053.32,"discounted_cash":1724.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50841","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":240.56,"discounted_cash":202.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50892","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5143.89,"discounted_cash":4320.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50904","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":87.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50905","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.6,"discounted_cash":228.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50953","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":832.5,"discounted_cash":699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_50978","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":915.75,"discounted_cash":769.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51019","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":804.2,"discounted_cash":675.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51112","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.6,"discounted_cash":228.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51115","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1265.4,"discounted_cash":1062.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51148","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":181.88,"discounted_cash":152.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51155","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3429.26,"discounted_cash":2880.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51156","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2010.49,"discounted_cash":1688.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51160","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":341.18,"discounted_cash":286.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51269","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":524.48,"discounted_cash":440.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51278","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":927.67,"discounted_cash":779.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51306","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4570.5,"discounted_cash":3839.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51329","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.26,"discounted_cash":104.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51381","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.08,"discounted_cash":349.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51396","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.5,"discounted_cash":1258.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51455","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":849.15,"discounted_cash":713.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51456","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":849.15,"discounted_cash":713.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51468","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1631.7,"discounted_cash":1370.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51484","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1748.25,"discounted_cash":1468.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51486","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3429.26,"discounted_cash":2880.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51530","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1282.05,"discounted_cash":1076.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51531","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":142.83,"discounted_cash":119.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51535","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":49250.0,"discounted_cash":41370.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51585","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":359.64,"discounted_cash":302.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51588","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1165.5,"discounted_cash":979.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51626","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2223.24,"discounted_cash":1867.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51664","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":357.94,"discounted_cash":300.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51668","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1349.78,"discounted_cash":1133.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51762","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":112.66,"discounted_cash":94.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_51794","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":150.54,"discounted_cash":126.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52095","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1451.05,"discounted_cash":1218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52111","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":915.75,"discounted_cash":769.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52124","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1178.49,"discounted_cash":989.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52157","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":495.5,"discounted_cash":416.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52158","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":282.46,"discounted_cash":237.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52160","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":495.5,"discounted_cash":416.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52161","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.77,"discounted_cash":125.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52162","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1718.28,"discounted_cash":1443.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52168","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2912.52,"discounted_cash":2446.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52269","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":1039.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52270","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1180.45,"discounted_cash":991.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52397","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1774.47,"discounted_cash":1490.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52399","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1101.1,"discounted_cash":924.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52408","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":961.54,"discounted_cash":807.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52538","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":121.65,"discounted_cash":102.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52727","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":133.46,"discounted_cash":112.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52735","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":196.52,"discounted_cash":165.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52760","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":350.42,"discounted_cash":294.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52770","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":182.17,"discounted_cash":153.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52771","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":189.98,"discounted_cash":159.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52806","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4423.69,"discounted_cash":3715.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52807","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4138.38,"discounted_cash":3476.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52808","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4423.69,"discounted_cash":3715.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52849","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":131.63,"discounted_cash":110.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52854","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":178.48,"discounted_cash":149.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_52922","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3710.88,"discounted_cash":3117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53123","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5552.03,"discounted_cash":4663.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53126","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5401.5,"discounted_cash":4537.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53159","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1714.95,"discounted_cash":1440.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53260","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":180.51,"discounted_cash":151.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53261","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":142.78,"discounted_cash":119.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53262","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":142.43,"discounted_cash":119.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53263","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53333","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":504.12,"discounted_cash":423.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53421","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.8,"discounted_cash":277.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5347","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":505.73,"discounted_cash":424.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5352","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":599.5,"discounted_cash":503.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53525","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":332.86,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5353","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":158.93,"discounted_cash":133.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53542","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.44,"discounted_cash":469.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53568","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1138.86,"discounted_cash":956.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53570","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4188.24,"discounted_cash":3518.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53571","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":747.59,"discounted_cash":627.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5361","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":663.15,"discounted_cash":557.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53628","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":341.81,"discounted_cash":287.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5370","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":582.75,"discounted_cash":489.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5371","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":340.54,"discounted_cash":286.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53790","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1020.49,"discounted_cash":857.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53791","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1081.41,"discounted_cash":908.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53794","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":302.59,"discounted_cash":254.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53820","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1132.87,"discounted_cash":951.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53879","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":716.77,"discounted_cash":602.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5388","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":373.88,"discounted_cash":314.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_53939","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":339.09,"discounted_cash":284.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54038","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":126.72,"discounted_cash":106.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54083","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.44,"discounted_cash":469.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54084","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.44,"discounted_cash":469.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54140","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1764.9,"discounted_cash":1482.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54233","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2884.92,"discounted_cash":2423.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54248","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.5,"discounted_cash":1258.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54249","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4113.45,"discounted_cash":3455.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54254","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":350.55,"discounted_cash":294.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54257","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.5,"discounted_cash":1258.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54258","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.5,"discounted_cash":1258.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54267","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.5,"discounted_cash":1258.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54330","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":233.4,"discounted_cash":196.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":255.94,"discounted_cash":214.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54472","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":698.82,"discounted_cash":587.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54473","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":820.88,"discounted_cash":689.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54474","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.79,"discounted_cash":513.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54475","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":594.52,"discounted_cash":499.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54477","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54478","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":524.17,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54480","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":594.52,"discounted_cash":499.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54481","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":169.75,"discounted_cash":142.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54484","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":303.54,"discounted_cash":254.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54489","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":821.24,"discounted_cash":689.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54491","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1895.49,"discounted_cash":1592.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54492","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":699.3,"discounted_cash":587.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54493","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":699.3,"discounted_cash":587.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54494","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":699.3,"discounted_cash":587.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54592","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":12212.03,"discounted_cash":10258.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54638","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":1118.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54657","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54730","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54742","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1621.71,"discounted_cash":1362.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54743","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4423.69,"discounted_cash":3715.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54826","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.5,"discounted_cash":1258.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_54829","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5548","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1060.14,"discounted_cash":890.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5553","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":168.37,"discounted_cash":141.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5565","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":385.41,"discounted_cash":323.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5595","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":145.36,"discounted_cash":122.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5637","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":709.62,"discounted_cash":596.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5641","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":104.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5645","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":249.98,"discounted_cash":209.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5647","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1214.98,"discounted_cash":1020.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5653","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1019.28,"discounted_cash":856.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5654","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":344.75,"discounted_cash":289.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5655","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":341.18,"discounted_cash":286.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5715","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":171.83,"discounted_cash":144.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5756","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.63,"discounted_cash":129.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5757","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":151.36,"discounted_cash":127.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5758","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.78,"discounted_cash":125.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5761","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":525.36,"discounted_cash":441.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5762","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.84,"discounted_cash":125.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5763","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":215.55,"discounted_cash":181.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5892","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.5,"discounted_cash":187.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5900","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.72,"discounted_cash":381.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5901","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":799.65,"discounted_cash":671.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5914","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":135.53,"discounted_cash":113.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5916","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":582.38,"discounted_cash":489.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_59178","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3067.8,"discounted_cash":2576.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_59189","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1225.47,"discounted_cash":1029.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5921","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":121.64,"discounted_cash":102.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5932","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":396.54,"discounted_cash":333.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5938","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2877.85,"discounted_cash":2417.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_59719","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2912.52,"discounted_cash":2446.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_59735","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":140.15,"discounted_cash":117.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_59799","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5003.54,"discounted_cash":4202.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5980","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2230.1,"discounted_cash":1873.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5981","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1397.16,"discounted_cash":1173.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5993","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5994","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":336.84,"discounted_cash":282.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_59943","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":404.4,"discounted_cash":339.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5996","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.33,"discounted_cash":157.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":152.68,"discounted_cash":128.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5998","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":133.92,"discounted_cash":112.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_5999","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":142.14,"discounted_cash":119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6002","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.83,"discounted_cash":161.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6005","type":"CDM"},{"code":"272","type":"RC"},{"code":"A7048","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.92,"discounted_cash":181.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6019","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":529.63,"discounted_cash":444.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":162.61,"discounted_cash":136.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6030","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.79,"discounted_cash":130.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6056","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":117.88,"discounted_cash":99.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6057","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":355.47,"discounted_cash":298.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6072","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":130.99,"discounted_cash":110.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6085","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":140.07,"discounted_cash":117.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6086","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":260.41,"discounted_cash":218.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6087","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":412.16,"discounted_cash":346.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6099","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":466.2,"discounted_cash":391.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6101","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1698.57,"discounted_cash":1426.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6106","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.69,"discounted_cash":119.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6107","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2470.86,"discounted_cash":2075.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6108","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":902.43,"discounted_cash":758.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6112","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":339.57,"discounted_cash":285.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6114","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1125.17,"discounted_cash":945.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6122","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1691.72,"discounted_cash":1421.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6123","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1486.62,"discounted_cash":1248.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6126","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1860.58,"discounted_cash":1562.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6138","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":348.39,"discounted_cash":292.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6163","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1132.06,"discounted_cash":950.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6167","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1065.6,"discounted_cash":895.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6191","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":142.64,"discounted_cash":119.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6194","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":687.75,"discounted_cash":577.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6217","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":274.85,"discounted_cash":230.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6227","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1396.7,"discounted_cash":1173.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6261","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":416.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63664","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":859.14,"discounted_cash":721.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63748","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":227.29,"discounted_cash":190.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63774","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.06,"discounted_cash":189.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63775","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.51,"discounted_cash":289.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63786","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1318.93,"discounted_cash":1107.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63918","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":946.52,"discounted_cash":795.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63919","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1078.92,"discounted_cash":906.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63921","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":743.76,"discounted_cash":624.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63932","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.04,"discounted_cash":144.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63941","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":627.07,"discounted_cash":526.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63942","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":274.8,"discounted_cash":230.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_63996","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":361.93,"discounted_cash":304.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64014","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2912.52,"discounted_cash":2446.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64015","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2869.85,"discounted_cash":2410.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64016","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":636.03,"discounted_cash":534.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64019","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":450.08,"discounted_cash":378.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64021","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.5,"discounted_cash":1258.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64022","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2497.5,"discounted_cash":2097.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64023","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2664.0,"discounted_cash":2237.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64024","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":636.03,"discounted_cash":534.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64025","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":342.99,"discounted_cash":288.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64026","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.94,"discounted_cash":125.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64027","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.2,"discounted_cash":130.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64056","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1581.38,"discounted_cash":1328.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64106","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":953.4,"discounted_cash":800.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64120","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":982.35,"discounted_cash":825.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64133","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2164.5,"discounted_cash":1818.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64134","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":186.24,"discounted_cash":156.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64183","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":133.86,"discounted_cash":112.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64202","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":173.59,"discounted_cash":145.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64207","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":173.59,"discounted_cash":145.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64213","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.87,"discounted_cash":130.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64218","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.46,"discounted_cash":130.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64221","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":208.2,"discounted_cash":174.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64223","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.07,"discounted_cash":129.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64225","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.56,"discounted_cash":144.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64226","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":220.25,"discounted_cash":185.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64232","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.3,"discounted_cash":144.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64233","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":185.46,"discounted_cash":155.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64237","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.74,"discounted_cash":145.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64283","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":76.55,"discounted_cash":64.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64357","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.2,"discounted_cash":130.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64408","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1697.9,"discounted_cash":1426.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64488","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.39,"discounted_cash":27.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64515","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":405.67,"discounted_cash":340.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64516","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":409.51,"discounted_cash":343.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64517","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.62,"discounted_cash":257.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64578","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":116.52,"discounted_cash":97.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64583","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1660.84,"discounted_cash":1395.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64690","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":462.87,"discounted_cash":388.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64695","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64703","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.4,"discounted_cash":157.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64743","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":199.63,"discounted_cash":167.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64745","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.12,"discounted_cash":159.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64746","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.12,"discounted_cash":159.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64749","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.12,"discounted_cash":159.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64750","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.12,"discounted_cash":159.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64754","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.12,"discounted_cash":159.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64757","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.12,"discounted_cash":159.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64759","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.12,"discounted_cash":159.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64917","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":171.36,"discounted_cash":143.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64923","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":130.37,"discounted_cash":109.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64951","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":244.44,"discounted_cash":205.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64952","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":384.62,"discounted_cash":323.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_64957","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":116.4,"discounted_cash":97.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65010","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":134.44,"discounted_cash":112.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65020","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.4,"discounted_cash":157.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65021","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":171.11,"discounted_cash":143.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65043","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":158.89,"discounted_cash":133.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65077","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":305.55,"discounted_cash":256.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65079","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":346.29,"discounted_cash":290.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65080","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":332.86,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65082","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65085","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":402.1,"discounted_cash":337.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65089","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1660.84,"discounted_cash":1395.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65096","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1853.15,"discounted_cash":1556.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65109","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":158.88,"discounted_cash":133.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65287","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":636.03,"discounted_cash":534.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6529","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":585.21,"discounted_cash":491.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6534","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":596.81,"discounted_cash":501.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6537","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2831.63,"discounted_cash":2378.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_65385","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":1398.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6568","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.1,"discounted_cash":21.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6569","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":134.63,"discounted_cash":113.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6570","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.18,"discounted_cash":125.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6573","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.62,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6574","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.49,"discounted_cash":188.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6575","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":277.28,"discounted_cash":232.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6583","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":322.63,"discounted_cash":271.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6584","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":524.27,"discounted_cash":440.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6585","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":530.8,"discounted_cash":445.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6588","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":943.98,"discounted_cash":792.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6589","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":584.61,"discounted_cash":491.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6592","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":947.62,"discounted_cash":796.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6599","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":823.15,"discounted_cash":691.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6600","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":916.12,"discounted_cash":769.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6602","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1117.84,"discounted_cash":938.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6605","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1678.36,"discounted_cash":1409.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6606","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":786.4,"discounted_cash":660.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6607","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1336.92,"discounted_cash":1123.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6611","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":469.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6613","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1904.13,"discounted_cash":1599.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_6616","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":278.24,"discounted_cash":233.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66342","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1165.5,"discounted_cash":979.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66343","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1165.5,"discounted_cash":979.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66344","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1165.5,"discounted_cash":979.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66345","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1165.5,"discounted_cash":979.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66346","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1165.5,"discounted_cash":979.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66347","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1165.5,"discounted_cash":979.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66348","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1165.5,"discounted_cash":979.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66804","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.89,"discounted_cash":513.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66821","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.89,"discounted_cash":513.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66822","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.89,"discounted_cash":513.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66823","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.89,"discounted_cash":513.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66874","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":198.85,"discounted_cash":167.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66875","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":198.85,"discounted_cash":167.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_66986","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_67131","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.44,"discounted_cash":469.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_67926","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2912.52,"discounted_cash":2446.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_67977","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":162.96,"discounted_cash":136.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_68317","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_68657","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1223.78,"discounted_cash":1027.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_68673","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.5,"discounted_cash":1258.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_69336","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.8,"discounted_cash":277.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_69363","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":384.62,"discounted_cash":323.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_69388","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.44,"discounted_cash":469.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_69403","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":582.75,"discounted_cash":489.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_69406","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":582.75,"discounted_cash":489.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_69413","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":649.35,"discounted_cash":545.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_69415","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_69416","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_69423","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":982.35,"discounted_cash":825.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_69438","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.44,"discounted_cash":469.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_70143","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":576.92,"discounted_cash":484.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_71929","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.8,"discounted_cash":277.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_71932","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_71933","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.8,"discounted_cash":277.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_73363","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":499.5,"discounted_cash":419.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_73578","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4348.21,"discounted_cash":3652.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_78810","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":131.19,"discounted_cash":110.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_78865","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6660.0,"discounted_cash":5594.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79039","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79060","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.78,"discounted_cash":322.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79061","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":809.19,"discounted_cash":679.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79089","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":367.53,"discounted_cash":308.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79092","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.17,"discounted_cash":22.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79223","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":639.91,"discounted_cash":537.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79224","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":600.3,"discounted_cash":504.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79225","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":583.15,"discounted_cash":489.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79246","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":491.18,"discounted_cash":412.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79355","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":22.31,"discounted_cash":18.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79372","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":874.31,"discounted_cash":734.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79373","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":286.06,"discounted_cash":240.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79380","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":88.72,"discounted_cash":74.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79381","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":79.48,"discounted_cash":66.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79633","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1253.51,"discounted_cash":1052.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79637","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2773.83,"discounted_cash":2330.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79638","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":245.82,"discounted_cash":206.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79662","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":635.9,"discounted_cash":534.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79663","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":583.15,"discounted_cash":489.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79779","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1118.88,"discounted_cash":939.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79860","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":317.77,"discounted_cash":266.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79909","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2822.16,"discounted_cash":2370.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79938","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":916.73,"discounted_cash":770.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79955","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":242.78,"discounted_cash":203.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79989","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":982.62,"discounted_cash":825.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79994","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":596.01,"discounted_cash":500.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_79999","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":635.9,"discounted_cash":534.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80000","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":635.9,"discounted_cash":534.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80009","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2267.53,"discounted_cash":1904.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80042","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7659.0,"discounted_cash":6433.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80079","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":759.81,"discounted_cash":638.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80082","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1109.5,"discounted_cash":931.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80106","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1737.16,"discounted_cash":1459.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80111","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1737.16,"discounted_cash":1459.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80234","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1774.47,"discounted_cash":1490.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80235","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1774.47,"discounted_cash":1490.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80257","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":336.4,"discounted_cash":282.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80327","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":174.6,"discounted_cash":146.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80329","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":685.98,"discounted_cash":576.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80353","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1748.25,"discounted_cash":1468.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80462","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":648.31,"discounted_cash":544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80463","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":605.45,"discounted_cash":508.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":356.49,"discounted_cash":299.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80577","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":345.1,"discounted_cash":289.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80605","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":381.14,"discounted_cash":320.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80641","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":859.14,"discounted_cash":721.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80661","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.46,"discounted_cash":130.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80662","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.46,"discounted_cash":130.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80768","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":859.14,"discounted_cash":721.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80880","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":399.05,"discounted_cash":335.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80925","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":596.03,"discounted_cash":500.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_80993","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":359.3,"discounted_cash":301.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81002","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":16.22,"discounted_cash":13.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81034","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1145.71,"discounted_cash":962.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81036","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":397.5,"discounted_cash":333.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81037","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":400.8,"discounted_cash":336.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81038","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":284.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81135","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":643.77,"discounted_cash":540.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81191","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.35,"discounted_cash":350.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81298","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":207.03,"discounted_cash":173.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81363","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.87,"discounted_cash":750.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81490","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":679.32,"discounted_cash":570.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81640","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1394.6,"discounted_cash":1171.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81641","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1641.16,"discounted_cash":1378.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81643","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1509.92,"discounted_cash":1268.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81645","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1226.57,"discounted_cash":1030.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81646","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1318.18,"discounted_cash":1107.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81737","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":422.04,"discounted_cash":354.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81743","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":373.39,"discounted_cash":313.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81767","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1342.92,"discounted_cash":1128.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81788","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2224.44,"discounted_cash":1868.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81806","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":111.33,"discounted_cash":93.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81807","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1686.84,"discounted_cash":1416.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_81885","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":745.22,"discounted_cash":625.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82012","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.04,"discounted_cash":107.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82016","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":352.48,"discounted_cash":296.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82018","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":332.86,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82109","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":116.4,"discounted_cash":97.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82154","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":18668.21,"discounted_cash":15681.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82246","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":982.35,"discounted_cash":825.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82367","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":728.6,"discounted_cash":612.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82368","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":735.93,"discounted_cash":618.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82381","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":176.58,"discounted_cash":148.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82392","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4218.79,"discounted_cash":3543.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82433","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1242.46,"discounted_cash":1043.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82434","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1232.12,"discounted_cash":1034.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82435","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1215.96,"discounted_cash":1021.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82481","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2773.83,"discounted_cash":2330.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82566","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2417.98,"discounted_cash":2031.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82620","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82621","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82622","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82623","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82624","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82625","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82626","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82627","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82628","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82631","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82633","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82634","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82635","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82645","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82647","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82648","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82649","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82651","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":684.87,"discounted_cash":575.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82652","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82653","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82654","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82655","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":789.21,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82796","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2274.39,"discounted_cash":1910.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82797","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3781.05,"discounted_cash":3176.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82835","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":759.24,"discounted_cash":637.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82883","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":275.33,"discounted_cash":231.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82962","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10638.0,"discounted_cash":8935.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_82963","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.44,"discounted_cash":469.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83015","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":180.47,"discounted_cash":151.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83017","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":323.2,"discounted_cash":271.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83048","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":476.52,"discounted_cash":400.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83050","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":476.52,"discounted_cash":400.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83052","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":843.96,"discounted_cash":708.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83205","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":269.93,"discounted_cash":226.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83208","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":787.09,"discounted_cash":661.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83238","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.1,"discounted_cash":77.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83246","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":324.91,"discounted_cash":272.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83312","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":961.54,"discounted_cash":807.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2164.5,"discounted_cash":1818.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83467","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":120.5,"discounted_cash":101.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83630","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":106.7,"discounted_cash":89.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83631","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":106.7,"discounted_cash":89.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83632","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":268.88,"discounted_cash":225.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83682","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":961.54,"discounted_cash":807.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83699","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.89,"discounted_cash":513.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83705","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":342.99,"discounted_cash":288.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83864","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2085.51,"discounted_cash":1751.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83882","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.11,"discounted_cash":160.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83883","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6308.63,"discounted_cash":5299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83884","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":867.23,"discounted_cash":728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83885","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83886","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83912","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1688.31,"discounted_cash":1418.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_83913","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1688.31,"discounted_cash":1418.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_84310","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":244.71,"discounted_cash":205.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_84890","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1935.56,"discounted_cash":1625.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_84891","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":208.66,"discounted_cash":175.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_84892","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":939.98,"discounted_cash":789.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_84896","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1748.25,"discounted_cash":1468.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_84897","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":382.95,"discounted_cash":321.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_84914","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1207.56,"discounted_cash":1014.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_84929","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4294.14,"discounted_cash":3607.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85033","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":795.37,"discounted_cash":668.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85255","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":667.86,"discounted_cash":561.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85256","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1874.72,"discounted_cash":1574.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85257","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1517.48,"discounted_cash":1274.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85258","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1394.6,"discounted_cash":1171.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85263","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1511.12,"discounted_cash":1269.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85264","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1318.18,"discounted_cash":1107.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85266","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":145.96,"discounted_cash":122.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85269","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1615.62,"discounted_cash":1357.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85313","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":482.85,"discounted_cash":405.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85315","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4085.75,"discounted_cash":3432.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85498","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":865.57,"discounted_cash":727.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85827","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2049.03,"discounted_cash":1721.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85862","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":952.38,"discounted_cash":800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85863","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":959.04,"discounted_cash":805.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85886","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":332.86,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85943","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":156.75,"discounted_cash":131.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85966","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.81,"discounted_cash":130.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85967","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.81,"discounted_cash":130.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_85968","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.81,"discounted_cash":130.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_86347","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.64,"discounted_cash":130.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_86523","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":115.82,"discounted_cash":97.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_86524","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":532.8,"discounted_cash":447.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_86526","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":462.87,"discounted_cash":388.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_86652","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":382.95,"discounted_cash":321.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_86716","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1352.06,"discounted_cash":1135.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_86765","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1543.91,"discounted_cash":1296.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_86767","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":119.42,"discounted_cash":100.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_86801","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1516.48,"discounted_cash":1273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87047","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":118.6,"discounted_cash":99.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87056","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":865.9,"discounted_cash":727.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87191","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":518.36,"discounted_cash":435.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87320","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1470.75,"discounted_cash":1235.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87324","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1050.23,"discounted_cash":882.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87327","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":952.75,"discounted_cash":800.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87340","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":1118.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87891","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2905.73,"discounted_cash":2440.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87921","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":338.31,"discounted_cash":284.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87941","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1945.05,"discounted_cash":1633.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87942","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":188.65,"discounted_cash":158.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87943","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1753.62,"discounted_cash":1473.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87944","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2216.09,"discounted_cash":1861.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87948","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3174.97,"discounted_cash":2666.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87949","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3349.6,"discounted_cash":2813.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87951","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3239.79,"discounted_cash":2721.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_87952","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":17.68,"discounted_cash":14.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88046","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":338.41,"discounted_cash":284.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88117","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2884.78,"discounted_cash":2423.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88163","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7576.86,"discounted_cash":6364.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88230","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":29254.5,"discounted_cash":24573.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88361","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3429.26,"discounted_cash":2880.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88362","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3429.26,"discounted_cash":2880.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88365","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":148.22,"discounted_cash":124.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88405","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3052.72,"discounted_cash":2564.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88483","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":342.68,"discounted_cash":287.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88484","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":343.66,"discounted_cash":288.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88636","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":231.08,"discounted_cash":194.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_88949","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":182.36,"discounted_cash":153.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89078","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3831.83,"discounted_cash":3218.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89079","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":174.6,"discounted_cash":146.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89089","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5772.0,"discounted_cash":4848.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89153","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":408.59,"discounted_cash":343.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89165","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":842.15,"discounted_cash":707.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89249","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1791.54,"discounted_cash":1504.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89263","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1076.35,"discounted_cash":904.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89352","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1935.56,"discounted_cash":1625.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89490","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":982.35,"discounted_cash":825.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89531","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1225.58,"discounted_cash":1029.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89533","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":709.65,"discounted_cash":596.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89552","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1621.71,"discounted_cash":1362.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89556","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":23.1,"discounted_cash":19.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89557","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":346.17,"discounted_cash":290.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89603","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1674.99,"discounted_cash":1406.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89635","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":445.51,"discounted_cash":374.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89715","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3192.31,"discounted_cash":2681.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89716","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.89,"discounted_cash":514.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89726","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":365.06,"discounted_cash":306.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89731","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1513.87,"discounted_cash":1271.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89737","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":488.51,"discounted_cash":410.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89738","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1910.59,"discounted_cash":1604.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89808","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":646.94,"discounted_cash":543.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89809","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":410.26,"discounted_cash":344.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89810","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":472.86,"discounted_cash":397.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89906","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":378.07,"discounted_cash":317.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89907","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":362.35,"discounted_cash":304.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89908","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":382.27,"discounted_cash":321.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89909","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":352.64,"discounted_cash":296.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89910","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":504.94,"discounted_cash":424.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_89976","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90041","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":815.49,"discounted_cash":685.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90054","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":803.2,"discounted_cash":674.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90055","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1478.52,"discounted_cash":1241.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90081","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":863.14,"discounted_cash":725.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90290","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":239.01,"discounted_cash":200.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90291","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":239.01,"discounted_cash":200.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90292","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1606.72,"discounted_cash":1349.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90311","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90312","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90313","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90314","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90316","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90317","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90318","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90319","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90320","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90321","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90322","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":252.2,"discounted_cash":211.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90440","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2927.16,"discounted_cash":2458.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90451","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8715.65,"discounted_cash":7321.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90820","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2191.84,"discounted_cash":1841.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90878","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":111.53,"discounted_cash":93.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90879","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":117.35,"discounted_cash":98.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90884","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":194.38,"discounted_cash":163.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90893","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1497.57,"discounted_cash":1257.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90919","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_90988","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":119.5,"discounted_cash":100.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91014","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1173.83,"discounted_cash":986.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91015","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":370.3,"discounted_cash":311.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91075","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1182.15,"discounted_cash":993.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91076","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1182.15,"discounted_cash":993.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91077","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1182.15,"discounted_cash":993.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91141","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1275.39,"discounted_cash":1071.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91236","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":826.94,"discounted_cash":694.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91252","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1311.72,"discounted_cash":1101.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91356","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91361","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":681.98,"discounted_cash":572.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91540","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":839.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91624","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":188.18,"discounted_cash":158.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91719","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7659.0,"discounted_cash":6433.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91794","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5686.34,"discounted_cash":4776.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91795","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1117.55,"discounted_cash":938.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_91969","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92360","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5547.65,"discounted_cash":4660.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92361","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4.73,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92364","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":387.7,"discounted_cash":325.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92371","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1130.14,"discounted_cash":949.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92474","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":343.95,"discounted_cash":288.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92475","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":577.42,"discounted_cash":485.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92502","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1311.19,"discounted_cash":1101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92506","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":844.86,"discounted_cash":709.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92675","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":339.52,"discounted_cash":285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92676","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":165.44,"discounted_cash":138.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_92861","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1396.1,"discounted_cash":1172.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_93152","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":735.93,"discounted_cash":618.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_93178","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1631.7,"discounted_cash":1370.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_93311","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1032.3,"discounted_cash":867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_93312","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":235.4,"discounted_cash":197.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_93318","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6102.78,"discounted_cash":5126.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9353","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2056.94,"discounted_cash":1727.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_93544","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":109.48,"discounted_cash":91.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_93854","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":673.64,"discounted_cash":565.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_93855","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":574.43,"discounted_cash":482.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_93856","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2912.52,"discounted_cash":2446.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_93867","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":313.88,"discounted_cash":263.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9398","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3101.54,"discounted_cash":2605.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94057","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94168","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":712.62,"discounted_cash":598.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94172","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":879.12,"discounted_cash":738.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94180","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":410.26,"discounted_cash":344.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94182","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.6,"discounted_cash":257.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94184","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":847.98,"discounted_cash":712.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94317","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":278.28,"discounted_cash":233.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94353","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.78,"discounted_cash":188.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94367","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94380","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1346.15,"discounted_cash":1130.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94381","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1101.4,"discounted_cash":925.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94382","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1101.4,"discounted_cash":925.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94396","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1035.63,"discounted_cash":869.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94703","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1024.81,"discounted_cash":860.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94704","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1031.47,"discounted_cash":866.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94705","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":437.06,"discounted_cash":367.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94706","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":576.92,"discounted_cash":484.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94708","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":108.56,"discounted_cash":91.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_94714","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":159.12,"discounted_cash":133.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_95193","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":162.18,"discounted_cash":136.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_95196","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":33490.0,"discounted_cash":28131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_95198","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":33490.0,"discounted_cash":28131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_95199","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":33490.0,"discounted_cash":28131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_95200","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":33490.0,"discounted_cash":28131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_95202","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4155.0,"discounted_cash":3490.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_95454","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1471.69,"discounted_cash":1236.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_95480","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":516.15,"discounted_cash":433.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_95505","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1107.23,"discounted_cash":930.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_96070","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1312.73,"discounted_cash":1102.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_96071","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3494.88,"discounted_cash":2935.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_96108","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3033.15,"discounted_cash":2547.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_96166","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2809.08,"discounted_cash":2359.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_96194","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":392.01,"discounted_cash":329.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_96340","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5346.1,"discounted_cash":4490.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_96341","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5346.1,"discounted_cash":4490.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_96494","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":127.83,"discounted_cash":107.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_96638","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_96661","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97086","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5905.2,"discounted_cash":4960.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97103","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97207","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":143.29,"discounted_cash":120.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9722","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.42,"discounted_cash":104.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9723","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":246.79,"discounted_cash":207.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9732","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":305.55,"discounted_cash":256.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9738","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":325.55,"discounted_cash":273.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97387","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1207.78,"discounted_cash":1014.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97388","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1207.78,"discounted_cash":1014.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97389","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1207.78,"discounted_cash":1014.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9739","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2158.97,"discounted_cash":1813.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97390","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1207.78,"discounted_cash":1014.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97391","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9745","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":343.1,"discounted_cash":288.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97511","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4124.53,"discounted_cash":3464.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4401.53,"discounted_cash":3697.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9755","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":949.41,"discounted_cash":797.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9756","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1433.72,"discounted_cash":1204.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97577","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":468.6,"discounted_cash":393.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97597","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1048.95,"discounted_cash":881.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97598","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1048.95,"discounted_cash":881.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97635","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":131.62,"discounted_cash":110.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9786","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":270.74,"discounted_cash":227.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97873","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5401.5,"discounted_cash":4537.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_97874","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":249.1,"discounted_cash":209.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9800","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":195.48,"discounted_cash":164.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9801","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3831.83,"discounted_cash":3218.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9802","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":347.73,"discounted_cash":292.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98026","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1265.4,"discounted_cash":1062.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98027","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":552.45,"discounted_cash":464.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98028","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":398.27,"discounted_cash":334.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":863.14,"discounted_cash":725.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98030","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1358.64,"discounted_cash":1141.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9811","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":183.06,"discounted_cash":153.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98169","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":126.68,"discounted_cash":106.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98170","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":480.42,"discounted_cash":403.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9822","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":125.97,"discounted_cash":105.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9823","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":180.62,"discounted_cash":151.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98290","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2197.8,"discounted_cash":1846.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9831","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":603.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9832","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":312.71,"discounted_cash":262.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9833","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":452.23,"discounted_cash":379.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9834","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1293.61,"discounted_cash":1086.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9835","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":264.37,"discounted_cash":222.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9843","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.87,"discounted_cash":130.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9846","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":415.18,"discounted_cash":348.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9847","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":175.93,"discounted_cash":147.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9848","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1171.13,"discounted_cash":983.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98484","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":1118.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98489","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":961.54,"discounted_cash":807.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9849","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":267.08,"discounted_cash":224.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9850","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":278.96,"discounted_cash":234.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9851","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":833.87,"discounted_cash":700.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98513","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9853","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":244.1,"discounted_cash":205.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98559","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":816.33,"discounted_cash":685.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98566","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1809.18,"discounted_cash":1519.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98567","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1863.81,"discounted_cash":1565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9858","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":301.58,"discounted_cash":253.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9859","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":442.89,"discounted_cash":372.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9860","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":241.34,"discounted_cash":202.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9864","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.04,"discounted_cash":107.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9865","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":375.64,"discounted_cash":315.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9867","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98693","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1032.3,"discounted_cash":867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98707","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1265.4,"discounted_cash":1062.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98709","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1605.06,"discounted_cash":1348.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9871","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.73,"discounted_cash":145.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9872","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":341.4,"discounted_cash":286.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98727","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1428.93,"discounted_cash":1200.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9875","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":272.3,"discounted_cash":228.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9876","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":287.22,"discounted_cash":241.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98772","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":572.43,"discounted_cash":480.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9885","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.89,"discounted_cash":514.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_98988","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_99225","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":442.59,"discounted_cash":371.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9931","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2773.83,"discounted_cash":2330.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_99326","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3955.56,"discounted_cash":3322.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_99331","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":786.71,"discounted_cash":660.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_99358","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2359.91,"discounted_cash":1982.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_99380","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.5,"discounted_cash":293.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_99601","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1770.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_99611","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1479.82,"discounted_cash":1243.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9976","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1040.63,"discounted_cash":874.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9980","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2909.78,"discounted_cash":2444.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9982","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2365.97,"discounted_cash":1987.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9983","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6631.14,"discounted_cash":5570.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9990","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.52,"discounted_cash":257.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_99903","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2830.5,"discounted_cash":2377.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_99904","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2830.5,"discounted_cash":2377.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9991","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.52,"discounted_cash":257.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200000_9992","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.52,"discounted_cash":257.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200001_10587","type":"CDM"},{"code":"272","type":"RC"},{"code":"B4087","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.44,"discounted_cash":133.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200001_21399","type":"CDM"},{"code":"272","type":"RC"},{"code":"B4087","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.33,"discounted_cash":825.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200001_30162","type":"CDM"},{"code":"272","type":"RC"},{"code":"B4087","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.46,"discounted_cash":833.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200001_30338","type":"CDM"},{"code":"272","type":"RC"},{"code":"B4087","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.2,"discounted_cash":478.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200001_86715","type":"CDM"},{"code":"272","type":"RC"},{"code":"B4087","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.26,"discounted_cash":1203.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200001_93597","type":"CDM"},{"code":"272","type":"RC"},{"code":"B4087","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.02,"discounted_cash":1213.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_11736","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.87,"discounted_cash":511.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_11748","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.41,"discounted_cash":583.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_11749","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.72,"discounted_cash":539.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_11750","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.59,"discounted_cash":543.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_11868","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.04,"discounted_cash":541.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_11869","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.57,"discounted_cash":552.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_21164","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4337.5,"discounted_cash":3643.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_23590","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.89,"discounted_cash":366.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_23707","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3726.45,"discounted_cash":3130.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_24322","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.07,"discounted_cash":811.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_24323","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.25,"discounted_cash":825.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_24333","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.18,"discounted_cash":711.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_24344","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.49,"discounted_cash":543.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_24352","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.7,"discounted_cash":541.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_24882","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":971.07,"discounted_cash":815.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_26797","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.98,"discounted_cash":770.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27073","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.57,"discounted_cash":596.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27074","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.33,"discounted_cash":765.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27084","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27086","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.95,"discounted_cash":747.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27087","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.95,"discounted_cash":747.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27159","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.53,"discounted_cash":559.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27160","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.7,"discounted_cash":541.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27161","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.53,"discounted_cash":538.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27163","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.64,"discounted_cash":547.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27209","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.2,"discounted_cash":594.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_27212","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.86,"discounted_cash":524.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29104","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.25,"discounted_cash":253.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29105","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.5,"discounted_cash":250.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29106","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.83,"discounted_cash":306.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29107","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.11,"discounted_cash":250.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29108","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.04,"discounted_cash":252.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29109","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.4,"discounted_cash":248.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29122","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.44,"discounted_cash":578.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29123","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.42,"discounted_cash":570.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29124","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.86,"discounted_cash":524.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29125","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.77,"discounted_cash":596.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29126","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.7,"discounted_cash":541.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29127","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.32,"discounted_cash":580.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29128","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.3,"discounted_cash":576.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29129","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.86,"discounted_cash":524.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29130","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.53,"discounted_cash":559.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29132","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.53,"discounted_cash":559.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29133","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.2,"discounted_cash":594.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29134","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.86,"discounted_cash":524.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29193","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29195","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.4,"discounted_cash":751.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29197","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.98,"discounted_cash":770.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29199","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.4,"discounted_cash":751.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29200","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.52,"discounted_cash":781.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29201","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":924.5,"discounted_cash":776.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29202","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.91,"discounted_cash":784.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29203","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.45,"discounted_cash":816.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29204","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29205","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":856.7,"discounted_cash":719.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29206","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.62,"discounted_cash":775.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29207","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.46,"discounted_cash":766.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29208","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29209","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.52,"discounted_cash":780.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29210","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.62,"discounted_cash":687.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29310","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.56,"discounted_cash":274.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29311","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.21,"discounted_cash":277.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29314","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.78,"discounted_cash":389.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29332","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29336","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.98,"discounted_cash":770.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29436","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.86,"discounted_cash":524.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29439","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.95,"discounted_cash":862.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29442","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.28,"discounted_cash":841.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29444","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.6,"discounted_cash":821.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29445","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.98,"discounted_cash":770.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29446","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29462","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.47,"discounted_cash":674.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29463","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.52,"discounted_cash":780.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29527","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.42,"discounted_cash":847.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29528","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":899.76,"discounted_cash":755.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29542","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.95,"discounted_cash":862.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29601","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.6,"discounted_cash":325.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29618","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.45,"discounted_cash":763.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29619","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.3,"discounted_cash":968.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29620","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.69,"discounted_cash":760.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29622","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29623","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.98,"discounted_cash":770.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29624","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.44,"discounted_cash":669.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_29626","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.44,"discounted_cash":669.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30245","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.64,"discounted_cash":276.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30246","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.4,"discounted_cash":266.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30247","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.76,"discounted_cash":315.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30249","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30250","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.25,"discounted_cash":263.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30251","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.09,"discounted_cash":277.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30252","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":252.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30253","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.75,"discounted_cash":247.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30255","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.4,"discounted_cash":751.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30256","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30257","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.4,"discounted_cash":751.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30258","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.6,"discounted_cash":325.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30279","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.42,"discounted_cash":570.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30280","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.47,"discounted_cash":568.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30281","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.5,"discounted_cash":632.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30282","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.64,"discounted_cash":547.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30285","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.11,"discounted_cash":550.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30286","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.2,"discounted_cash":594.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30288","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.86,"discounted_cash":524.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30319","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.56,"discounted_cash":575.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30320","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.86,"discounted_cash":524.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30321","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.59,"discounted_cash":568.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30333","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30335","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30354","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.53,"discounted_cash":559.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30355","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.31,"discounted_cash":703.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30356","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.07,"discounted_cash":742.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30357","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.31,"discounted_cash":703.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30358","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.26,"discounted_cash":888.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30359","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.02,"discounted_cash":585.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30360","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.79,"discounted_cash":821.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30362","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.31,"discounted_cash":703.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30363","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.02,"discounted_cash":585.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30364","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.02,"discounted_cash":585.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30365","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.02,"discounted_cash":585.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30366","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.38,"discounted_cash":753.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30367","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.39,"discounted_cash":836.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30368","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.38,"discounted_cash":753.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30369","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.38,"discounted_cash":753.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30469","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.27,"discounted_cash":320.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30519","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":935.18,"discounted_cash":785.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_30632","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4186.0,"discounted_cash":3516.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_32411","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.37,"discounted_cash":1285.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_36016","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.02,"discounted_cash":285.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_40121","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.4,"discounted_cash":751.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_47913","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_47914","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_47917","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3611.76,"discounted_cash":3033.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_47919","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_50110","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_50112","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":244.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54755","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4914.0,"discounted_cash":4127.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54757","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4736.88,"discounted_cash":3978.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54759","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4713.8,"discounted_cash":3959.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54761","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4837.5,"discounted_cash":4063.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54763","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4776.3,"discounted_cash":4012.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54765","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4885.31,"discounted_cash":4103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54766","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4713.8,"discounted_cash":3959.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54769","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4813.9,"discounted_cash":4043.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54773","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4567.03,"discounted_cash":3836.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54777","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4741.88,"discounted_cash":3983.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54779","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4713.8,"discounted_cash":3959.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54781","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5154.75,"discounted_cash":4329.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54789","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6025.72,"discounted_cash":5061.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54798","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7035.7,"discounted_cash":5909.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54877","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.5,"discounted_cash":5683.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54880","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_54881","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_63577","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.82,"discounted_cash":260.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_63578","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":279.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_63626","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.95,"discounted_cash":862.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_63629","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.07,"discounted_cash":742.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_64099","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.98,"discounted_cash":770.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_64100","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_64101","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_64102","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.55,"discounted_cash":789.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79269","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.78,"discounted_cash":319.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79273","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79276","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.78,"discounted_cash":319.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79278","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.42,"discounted_cash":310.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79279","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.56,"discounted_cash":311.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79285","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.8,"discounted_cash":334.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79286","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79292","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79293","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.42,"discounted_cash":310.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79297","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.8,"discounted_cash":334.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27200002_79298","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79303","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79304","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79306","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79316","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79327","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.8,"discounted_cash":334.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79329","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.99,"discounted_cash":328.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79330","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.78,"discounted_cash":319.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79346","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79347","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.8,"discounted_cash":334.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79391","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.45,"discounted_cash":324.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79392","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.8,"discounted_cash":334.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79393","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.12,"discounted_cash":320.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79402","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.1,"discounted_cash":315.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79405","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.78,"discounted_cash":319.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_79418","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.8,"discounted_cash":334.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_80041","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":9556.5,"discounted_cash":8027.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_80042","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10039.5,"discounted_cash":8433.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_82419","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3328.0,"discounted_cash":2795.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_82422","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3496.0,"discounted_cash":2936.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_82426","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3496.0,"discounted_cash":2936.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_82430","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3496.0,"discounted_cash":2936.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_83992","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1088.58,"discounted_cash":914.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_83993","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1513.26,"discounted_cash":1271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_83994","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1572.74,"discounted_cash":1321.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_83995","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1548.18,"discounted_cash":1300.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_83996","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.53,"discounted_cash":1305.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_83997","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.95,"discounted_cash":1315.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_83998","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1540.56,"discounted_cash":1294.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_85748","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.18,"discounted_cash":1058.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_8696","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88410","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.73,"discounted_cash":292.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88411","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.65,"discounted_cash":270.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88412","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.6,"discounted_cash":309.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88415","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.73,"discounted_cash":292.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88416","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.3,"discounted_cash":283.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88417","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.3,"discounted_cash":283.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88418","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88420","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.09,"discounted_cash":306.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88421","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.54,"discounted_cash":281.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88422","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.65,"discounted_cash":270.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88424","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.58,"discounted_cash":276.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88425","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.5,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88426","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.21,"discounted_cash":275.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88427","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.58,"discounted_cash":281.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88428","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.04,"discounted_cash":278.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88429","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88430","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.73,"discounted_cash":292.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88431","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.2,"discounted_cash":284.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88432","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.56,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88433","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.3,"discounted_cash":283.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88435","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.91,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88436","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.43,"discounted_cash":277.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88437","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.3,"discounted_cash":274.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88438","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.08,"discounted_cash":279.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88439","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.91,"discounted_cash":268.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88441","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.65,"discounted_cash":270.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88442","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.82,"discounted_cash":280.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88443","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.58,"discounted_cash":291.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88444","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.56,"discounted_cash":288.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88445","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88446","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.52,"discounted_cash":267.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88447","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.86,"discounted_cash":271.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88448","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.29,"discounted_cash":284.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88449","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.05,"discounted_cash":273.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88450","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.22,"discounted_cash":280.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88451","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.49,"discounted_cash":289.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88452","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.87,"discounted_cash":274.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88453","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88454","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88455","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.8,"discounted_cash":304.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88456","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.6,"discounted_cash":288.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88457","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.77,"discounted_cash":275.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88458","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.91,"discounted_cash":270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88459","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.8,"discounted_cash":291.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88460","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.83,"discounted_cash":279.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88461","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88462","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88463","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.4,"discounted_cash":274.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88464","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.04,"discounted_cash":278.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88465","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.87,"discounted_cash":274.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88466","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_88469","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.6,"discounted_cash":325.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_89153","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.2,"discounted_cash":450.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_89739","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.3,"discounted_cash":1020.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_90441","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":611.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_90442","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.82,"discounted_cash":408.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_90449","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.38,"discounted_cash":449.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_90450","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_90990","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6107.56,"discounted_cash":5130.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_91188","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2513.3,"discounted_cash":2111.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_91719","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10039.5,"discounted_cash":8433.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_93908","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.93,"discounted_cash":278.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_94198","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_94200","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.35,"discounted_cash":256.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_94201","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_94203","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_94208","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_94209","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_94211","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_95194","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.25,"discounted_cash":825.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_95992","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1669.91,"discounted_cash":1402.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_97592","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_97593","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_97983","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_98515","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.98,"discounted_cash":565.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_98516","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.98,"discounted_cash":565.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_98518","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_98526","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5749.38,"discounted_cash":4829.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_98528","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.49,"discounted_cash":128.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_98529","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_9985","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3935.54,"discounted_cash":3305.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200002_99902","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27200002_C1725_272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.72,"discounted_cash":292.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_11976","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1141.18,"discounted_cash":958.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_11977","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1126.22,"discounted_cash":946.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_24849","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.36,"discounted_cash":788.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_24850","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.43,"discounted_cash":779.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_24851","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.22,"discounted_cash":838.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_24852","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":898.69,"discounted_cash":754.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_24854","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.36,"discounted_cash":781.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_24874","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.39,"discounted_cash":763.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_29222","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":3157.32,"discounted_cash":2652.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_29223","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":3134.35,"discounted_cash":2632.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_30274","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.9,"discounted_cash":167.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_31741","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1038.17,"discounted_cash":872.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_33868","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.56,"discounted_cash":296.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_35551","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.74,"discounted_cash":726.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_48909","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.88,"discounted_cash":347.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_48910","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.41,"discounted_cash":385.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_54234","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.02,"discounted_cash":197.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_5550","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1013.72,"discounted_cash":851.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_5680","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1018.63,"discounted_cash":855.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_6173","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":5851.72,"discounted_cash":4915.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_6174","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":5659.19,"discounted_cash":4753.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_81524","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.18,"discounted_cash":950.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_81525","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.91,"discounted_cash":940.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_81526","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.14,"discounted_cash":835.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_85528","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":7136.82,"discounted_cash":5994.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200003_85529","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_10553","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1048.25,"discounted_cash":880.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_12516","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2371.42,"discounted_cash":1991.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_20403","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1176.64,"discounted_cash":988.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_20714","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.55,"discounted_cash":501.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_20963","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.58,"discounted_cash":513.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_20964","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.91,"discounted_cash":524.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_23220","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":505.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_24242","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2293.86,"discounted_cash":1926.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_24334","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.8,"discounted_cash":316.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_24336","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.85,"discounted_cash":303.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_24337","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.94,"discounted_cash":254.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_24349","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.77,"discounted_cash":361.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_24350","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.98,"discounted_cash":364.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_24353","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.34,"discounted_cash":282.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_29239","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.72,"discounted_cash":363.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_29522","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.3,"discounted_cash":293.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_30151","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.96,"discounted_cash":456.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_30557","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_30569","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.14,"discounted_cash":301.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_31534","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.48,"discounted_cash":133.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_34230","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.35,"discounted_cash":451.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_36205","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.05,"discounted_cash":241.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_43499","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.5,"discounted_cash":364.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_43500","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.39,"discounted_cash":342.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_43501","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.5,"discounted_cash":364.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_48359","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.17,"discounted_cash":672.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_49312","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":863.03,"discounted_cash":724.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_49815","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.34,"discounted_cash":337.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_50056","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.14,"discounted_cash":417.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_51476","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.78,"discounted_cash":365.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_51663","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.73,"discounted_cash":394.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_53276","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.44,"discounted_cash":748.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_6003","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":3969.95,"discounted_cash":3334.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_6147","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1042.25,"discounted_cash":875.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_64104","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.66,"discounted_cash":15.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_80472","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.39,"discounted_cash":306.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200005_83915","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.87,"discounted_cash":419.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_30337","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":2744.98,"discounted_cash":2305.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_30418","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1228.51,"discounted_cash":1031.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_31366","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1978.74,"discounted_cash":1662.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_33989","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.41,"discounted_cash":576.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_35299","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1047.42,"discounted_cash":879.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_51586","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":3659.48,"discounted_cash":3073.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_51587","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":6991.45,"discounted_cash":5872.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_80101","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.17,"discounted_cash":432.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_80102","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.69,"discounted_cash":425.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_80461","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":3344.62,"discounted_cash":2809.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_81642","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1235.69,"discounted_cash":1037.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_85176","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.05,"discounted_cash":190.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_85204","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.06,"discounted_cash":1090.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_87179","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.66,"discounted_cash":664.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_87223","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1082.04,"discounted_cash":908.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_87236","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.25,"discounted_cash":458.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200006_97595","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.74,"discounted_cash":374.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27200006_C1730_272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":2181.5,"discounted_cash":1832.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200008_47641","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":5993.13,"discounted_cash":5034.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200009_47646","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":3059.66,"discounted_cash":2570.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200009_47667","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200009_80458","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":10737.74,"discounted_cash":9019.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200009_80459","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200009_89248","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":7336.28,"discounted_cash":6162.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200009_93904","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":7231.76,"discounted_cash":6074.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200009_94373","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":8171.28,"discounted_cash":6863.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_18759","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2338.6,"discounted_cash":1964.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_20974","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.07,"discounted_cash":346.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_27282","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.66,"discounted_cash":372.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_27294","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.45,"discounted_cash":487.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_29048","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.77,"discounted_cash":826.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_29544","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.16,"discounted_cash":616.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_30453","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.19,"discounted_cash":758.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_30558","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_34763","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1136.21,"discounted_cash":954.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_34764","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1155.69,"discounted_cash":970.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_35301","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.49,"discounted_cash":606.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_35689","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1512.65,"discounted_cash":1270.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_37821","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.85,"discounted_cash":214.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_37824","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.9,"discounted_cash":214.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_45201","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.84,"discounted_cash":447.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_45202","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.36,"discounted_cash":448.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_45204","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.96,"discounted_cash":434.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_45205","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.64,"discounted_cash":385.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_45206","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.1,"discounted_cash":391.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_45207","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.88,"discounted_cash":386.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_47195","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1032.15,"discounted_cash":867.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_47664","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.7,"discounted_cash":227.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_47665","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.04,"discounted_cash":278.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_48197","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.81,"discounted_cash":549.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_48198","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.1,"discounted_cash":449.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_50334","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.21,"discounted_cash":498.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_52088","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_53341","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.1,"discounted_cash":501.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_6229","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.03,"discounted_cash":230.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_78895","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.84,"discounted_cash":427.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_78902","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.52,"discounted_cash":136.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_80877","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.3,"discounted_cash":174.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_80878","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.13,"discounted_cash":173.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200010_C1751_272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.31,"discounted_cash":470.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200011_51543","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":4000.77,"discounted_cash":3360.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200011_64072","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200011_79646","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":7176.04,"discounted_cash":6027.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200011_85232","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":5665.04,"discounted_cash":4758.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200011_89353","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200011_89382","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200011_89383","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200011_98292","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":3124.55,"discounted_cash":2624.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200011_98293","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_12104","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.03,"discounted_cash":436.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_27298","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2591.54,"discounted_cash":2176.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_29339","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2643.85,"discounted_cash":2220.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_32335","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.69,"discounted_cash":460.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_52693","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2141.3,"discounted_cash":1798.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_6128","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.06,"discounted_cash":333.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_6129","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.11,"discounted_cash":329.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_6130","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.56,"discounted_cash":316.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_78941","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15540.0,"discounted_cash":13053.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_78942","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8520.0,"discounted_cash":7156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_79448","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8715.45,"discounted_cash":7320.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_79960","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.56,"discounted_cash":791.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_79962","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_79963","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7199.83,"discounted_cash":6047.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_79964","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7094.68,"discounted_cash":5959.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_79965","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_85501","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":30360.0,"discounted_cash":25502.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_86416","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9277.58,"discounted_cash":7793.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_86420","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9980.25,"discounted_cash":8383.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_89293","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_89294","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200013_93862","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.89,"discounted_cash":377.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200014_32263","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.48,"discounted_cash":358.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200014_53974","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.18,"discounted_cash":16.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200014_5601","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":278.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_10076","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.23,"discounted_cash":121.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_10099","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.66,"discounted_cash":174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_10118","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.41,"discounted_cash":151.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_11840","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":611.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_11870","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.13,"discounted_cash":101.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_11884","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.36,"discounted_cash":576.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_11980","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.27,"discounted_cash":119.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_12014","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.59,"discounted_cash":167.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_12015","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.13,"discounted_cash":151.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_12074","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.62,"discounted_cash":215.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_12079","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.8,"discounted_cash":219.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_20985","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.05,"discounted_cash":132.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_20990","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.13,"discounted_cash":354.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_23233","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_24320","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1293.14,"discounted_cash":1086.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_24328","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":128.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_24341","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.04,"discounted_cash":307.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_24342","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.34,"discounted_cash":161.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_24579","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.59,"discounted_cash":173.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_24842","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.05,"discounted_cash":404.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_25316","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.45,"discounted_cash":427.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27081","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.31,"discounted_cash":158.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27169","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.48,"discounted_cash":358.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27171","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27191","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.8,"discounted_cash":351.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27198","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.2,"discounted_cash":430.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27218","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.84,"discounted_cash":324.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27284","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.31,"discounted_cash":190.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27285","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.2,"discounted_cash":316.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27295","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.64,"discounted_cash":340.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27303","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.54,"discounted_cash":315.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_27306","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.16,"discounted_cash":356.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29072","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.39,"discounted_cash":332.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29103","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.52,"discounted_cash":334.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29110","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29113","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.8,"discounted_cash":291.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29114","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29211","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.15,"discounted_cash":134.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29212","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.4,"discounted_cash":145.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29213","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.84,"discounted_cash":167.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29214","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.72,"discounted_cash":363.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29215","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.94,"discounted_cash":392.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29235","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.83,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29238","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.05,"discounted_cash":277.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29248","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.57,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29253","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.9,"discounted_cash":168.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29309","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.23,"discounted_cash":367.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29318","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.82,"discounted_cash":156.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29461","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.04,"discounted_cash":478.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29514","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.51,"discounted_cash":18.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_29914","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.11,"discounted_cash":882.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_30156","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.94,"discounted_cash":124.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_30170","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.61,"discounted_cash":209.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_30171","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":252.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_30172","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.95,"discounted_cash":356.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_30173","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.18,"discounted_cash":328.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_30486","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.28,"discounted_cash":576.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_30487","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.76,"discounted_cash":586.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_30619","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.19,"discounted_cash":360.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_30790","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.32,"discounted_cash":149.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_31077","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.72,"discounted_cash":319.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_31254","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1217.94,"discounted_cash":1023.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_31275","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.72,"discounted_cash":319.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_32093","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":611.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_32094","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.26,"discounted_cash":767.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_32262","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.5,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_32472","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.05,"discounted_cash":367.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_32498","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.4,"discounted_cash":317.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_33391","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.34,"discounted_cash":440.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_33753","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.78,"discounted_cash":411.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_34227","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.84,"discounted_cash":169.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_36023","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.84,"discounted_cash":277.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_42005","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.89,"discounted_cash":786.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_43001","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.61,"discounted_cash":316.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_45011","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.62,"discounted_cash":811.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_47084","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.49,"discounted_cash":369.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_47650","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.2,"discounted_cash":653.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_47651","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.58,"discounted_cash":702.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_48310","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.21,"discounted_cash":331.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_48547","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.97,"discounted_cash":181.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_49242","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.81,"discounted_cash":469.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_49243","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.23,"discounted_cash":482.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_49315","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.08,"discounted_cash":482.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_50242","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.48,"discounted_cash":361.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_50243","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.88,"discounted_cash":360.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_51688","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.93,"discounted_cash":361.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_51807","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.04,"discounted_cash":478.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_52823","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.56,"discounted_cash":366.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_53043","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.48,"discounted_cash":358.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_53873","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":866.03,"discounted_cash":727.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_53973","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.25,"discounted_cash":458.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_54501","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3327.21,"discounted_cash":2794.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_5523","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.21,"discounted_cash":148.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_5524","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.68,"discounted_cash":170.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_5546","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.89,"discounted_cash":252.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_5672","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.35,"discounted_cash":149.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_6223","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.34,"discounted_cash":21.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_63772","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.95,"discounted_cash":1475.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_6517","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.85,"discounted_cash":329.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_6540","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.74,"discounted_cash":906.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_79088","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.42,"discounted_cash":585.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_79813","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.39,"discounted_cash":478.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_79814","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.99,"discounted_cash":477.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_79815","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.2,"discounted_cash":587.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_80038","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.25,"discounted_cash":458.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_80767","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.77,"discounted_cash":506.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_80851","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.36,"discounted_cash":560.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_81077","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.59,"discounted_cash":559.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_81139","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.58,"discounted_cash":1530.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_81523","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.22,"discounted_cash":564.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_82149","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.68,"discounted_cash":331.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_82789","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.55,"discounted_cash":730.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_82790","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":789.92,"discounted_cash":663.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_82791","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.63,"discounted_cash":900.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_82874","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.8,"discounted_cash":149.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_84515","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":741.14,"discounted_cash":622.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_84516","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.51,"discounted_cash":674.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_84517","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.92,"discounted_cash":787.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_84518","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.76,"discounted_cash":793.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_84900","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.38,"discounted_cash":739.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_85741","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.25,"discounted_cash":546.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_86525","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.44,"discounted_cash":427.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_87799","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_88118","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.82,"discounted_cash":1075.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_89080","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.12,"discounted_cash":565.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_89081","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.55,"discounted_cash":1204.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_89634","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.18,"discounted_cash":210.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_89975","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.04,"discounted_cash":893.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_90073","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.62,"discounted_cash":1204.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_90237","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.88,"discounted_cash":211.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_91237","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":971.44,"discounted_cash":816.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_93905","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.5,"discounted_cash":655.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_98598","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.05,"discounted_cash":972.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_98599","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.05,"discounted_cash":972.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200016_C1769_272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.61,"discounted_cash":621.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200017_11848","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1535.4,"discounted_cash":1289.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200017_20535","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.11,"discounted_cash":1112.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200017_20696","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.71,"discounted_cash":1139.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200017_30419","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.36,"discounted_cash":1247.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200017_39854","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.71,"discounted_cash":1139.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200017_50943","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.11,"discounted_cash":1112.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200020_53860","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":10594.14,"discounted_cash":8899.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200020_81409","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":10713.9,"discounted_cash":8999.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_11739","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_11740","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.84,"discounted_cash":143.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_11880","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.26,"discounted_cash":361.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_11881","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":117.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_11887","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.05,"discounted_cash":141.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_20997","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.3,"discounted_cash":236.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_21156","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.53,"discounted_cash":184.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_21157","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.96,"discounted_cash":186.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_21158","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_23566","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.87,"discounted_cash":735.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_23570","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.76,"discounted_cash":606.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_26900","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_26903","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.76,"discounted_cash":180.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_26907","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_26910","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_26913","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.75,"discounted_cash":182.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_26918","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.45,"discounted_cash":172.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_26921","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_26923","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.69,"discounted_cash":190.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_26924","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_26926","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27088","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.7,"discounted_cash":201.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27090","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":178.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27091","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.7,"discounted_cash":176.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27092","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.98,"discounted_cash":194.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27093","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.6,"discounted_cash":179.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27094","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27095","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27098","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27099","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27100","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27101","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.7,"discounted_cash":178.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27102","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27105","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.2,"discounted_cash":174.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27106","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.26,"discounted_cash":176.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27107","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.35,"discounted_cash":185.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27108","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.87,"discounted_cash":177.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27109","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.95,"discounted_cash":175.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27111","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.81,"discounted_cash":186.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27157","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.36,"discounted_cash":261.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27167","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.71,"discounted_cash":518.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27200021_27175","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27190","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.89,"discounted_cash":403.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27201","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.25,"discounted_cash":454.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27216","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.87,"discounted_cash":311.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27262","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.9,"discounted_cash":190.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27263","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.26,"discounted_cash":195.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_27264","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29060","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.47,"discounted_cash":362.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29135","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29139","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.8,"discounted_cash":248.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29241","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.2,"discounted_cash":284.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29242","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.67,"discounted_cash":272.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29243","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.68,"discounted_cash":307.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29245","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.72,"discounted_cash":545.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29246","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.94,"discounted_cash":583.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29320","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.98,"discounted_cash":177.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29437","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.69,"discounted_cash":660.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_29438","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.83,"discounted_cash":611.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30169","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.37,"discounted_cash":273.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30271","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.13,"discounted_cash":221.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30405","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.97,"discounted_cash":195.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30460","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.36,"discounted_cash":180.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30461","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30485","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.16,"discounted_cash":523.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30560","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.36,"discounted_cash":533.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30561","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.18,"discounted_cash":520.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30568","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.6,"discounted_cash":471.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30609","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1948.66,"discounted_cash":1636.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_30616","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":532.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_32471","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3583.4,"discounted_cash":3010.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_32756","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.47,"discounted_cash":891.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_35459","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.97,"discounted_cash":195.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_35500","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.64,"discounted_cash":189.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_41592","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.02,"discounted_cash":504.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_43654","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.3,"discounted_cash":116.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_45012","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.14,"discounted_cash":1575.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_47648","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.88,"discounted_cash":166.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_48140","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.24,"discounted_cash":287.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_48141","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.12,"discounted_cash":273.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_48690","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_49818","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3611.76,"discounted_cash":3033.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_50139","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.58,"discounted_cash":177.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_50140","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.7,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_50687","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.44,"discounted_cash":511.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_51863","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.95,"discounted_cash":175.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_51864","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_52638","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3469.78,"discounted_cash":2914.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_53046","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2834.04,"discounted_cash":2380.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_53047","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2929.5,"discounted_cash":2460.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_54814","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.2,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_63931","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1485.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_80670","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_86415","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1685.86,"discounted_cash":1416.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_86726","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.03,"discounted_cash":147.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_8695","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.24,"discounted_cash":658.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_87804","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.86,"discounted_cash":513.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_87805","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.13,"discounted_cash":546.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_87806","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.61,"discounted_cash":536.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_88407","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.94,"discounted_cash":361.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_89083","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.3,"discounted_cash":116.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_89084","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.78,"discounted_cash":119.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_89476","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.95,"discounted_cash":175.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_89510","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.57,"discounted_cash":117.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_90239","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.44,"discounted_cash":742.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_90240","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.71,"discounted_cash":767.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_90241","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.9,"discounted_cash":730.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_90242","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.8,"discounted_cash":749.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_90917","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":8002.5,"discounted_cash":6722.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_91278","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.62,"discounted_cash":118.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_91539","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.48,"discounted_cash":358.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_92807","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.16,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_92835","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":1397.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_93134","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3043.62,"discounted_cash":2556.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_93864","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.0,"discounted_cash":710.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_97087","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.11,"discounted_cash":745.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_97091","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.6,"discounted_cash":154.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_97397","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3277.5,"discounted_cash":2753.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200021_98600","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3168.25,"discounted_cash":2661.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27200021_C1887_272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.66,"discounted_cash":177.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200022_21011","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.45,"discounted_cash":298.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200022_27253","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.72,"discounted_cash":213.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200022_29569","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.85,"discounted_cash":214.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200022_33132","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.02,"discounted_cash":174.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200022_81079","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":1663.35,"discounted_cash":1397.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200022_9754","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.63,"discounted_cash":132.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200022_9879","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200023_20621","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.45,"discounted_cash":2098.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200023_29572","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.8,"discounted_cash":513.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200023_88782","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1148.27,"discounted_cash":964.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_10036","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.75,"discounted_cash":134.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_11441","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.94,"discounted_cash":112.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_11844","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.86,"discounted_cash":466.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_11845","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.96,"discounted_cash":477.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_11846","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.43,"discounted_cash":503.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_11883","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.44,"discounted_cash":422.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_11893","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1518.8,"discounted_cash":1275.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_12401","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4063.46,"discounted_cash":3413.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_12595","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.64,"discounted_cash":187.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_21013","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.23,"discounted_cash":125.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_27213","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.54,"discounted_cash":113.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_27214","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.81,"discounted_cash":115.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_27247","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.08,"discounted_cash":172.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_27248","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.71,"discounted_cash":171.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_27249","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.06,"discounted_cash":172.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_27252","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.37,"discounted_cash":172.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_27255","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.1,"discounted_cash":175.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_27260","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.1,"discounted_cash":218.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_29052","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.42,"discounted_cash":383.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_29226","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.04,"discounted_cash":116.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_29403","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.4,"discounted_cash":489.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_29523","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.1,"discounted_cash":501.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30144","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.4,"discounted_cash":199.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30145","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.23,"discounted_cash":197.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30159","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.15,"discounted_cash":91.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30174","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.93,"discounted_cash":157.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30175","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.82,"discounted_cash":217.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30176","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.13,"discounted_cash":120.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30179","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.26,"discounted_cash":201.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30267","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.1,"discounted_cash":501.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30270","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.72,"discounted_cash":344.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30342","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.4,"discounted_cash":221.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_30559","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.5,"discounted_cash":122.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_32312","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.89,"discounted_cash":197.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_32320","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.89,"discounted_cash":197.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_32495","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.99,"discounted_cash":207.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_32673","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":505.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_33133","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.1,"discounted_cash":218.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_33807","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.14,"discounted_cash":200.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_33865","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_37758","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.21,"discounted_cash":422.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_37759","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.99,"discounted_cash":425.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_37760","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.53,"discounted_cash":422.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_42502","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.41,"discounted_cash":222.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_42503","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.3,"discounted_cash":227.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_44992","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.55,"discounted_cash":420.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_46909","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_48134","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.57,"discounted_cash":122.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_48504","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2622.0,"discounted_cash":2202.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_49636","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_50653","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.9,"discounted_cash":131.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_51900","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.23,"discounted_cash":147.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_52750","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.04,"discounted_cash":215.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_53374","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.3,"discounted_cash":102.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_53441","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.01,"discounted_cash":173.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_5675","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.93,"discounted_cash":389.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_63873","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.45,"discounted_cash":116.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_63955","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_78914","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2758.08,"discounted_cash":2316.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_79849","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2734.32,"discounted_cash":2296.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_81768","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.53,"discounted_cash":267.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_81769","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.12,"discounted_cash":192.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_81770","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.76,"discounted_cash":206.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_82504","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4574.29,"discounted_cash":3842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_84956","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_85317","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2206.29,"discounted_cash":1853.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_85815","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.1,"discounted_cash":304.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_88178","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.61,"discounted_cash":386.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_88179","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.02,"discounted_cash":386.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_89304","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.39,"discounted_cash":431.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_89305","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.78,"discounted_cash":431.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_91187","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.04,"discounted_cash":2860.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_91490","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":3426.08,"discounted_cash":2877.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_91495","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_92349","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.29,"discounted_cash":273.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200024_C1894_272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.72,"discounted_cash":157.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200025_36166","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":5273.54,"discounted_cash":4429.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200025_54849","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":3817.0,"discounted_cash":3206.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200025_96129","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":4586.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200025_96131","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":4892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200025_9998","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":7347.75,"discounted_cash":6172.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200027_11888","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1497.54,"discounted_cash":1257.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200027_23568","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":7963.43,"discounted_cash":6689.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200027_28074","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":7980.09,"discounted_cash":6703.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200027_51998","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":8439.0,"discounted_cash":7088.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200027_53872","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.56,"discounted_cash":673.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200027_63922","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":17353.0,"discounted_cash":14576.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200028_51590","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":8482.48,"discounted_cash":7125.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200029_27126","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":9594.38,"discounted_cash":8059.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200029_31345","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":7977.6,"discounted_cash":6701.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54749","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4699.15,"discounted_cash":3947.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54751","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4799.25,"discounted_cash":4031.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54753","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4914.0,"discounted_cash":4127.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54767","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4812.0,"discounted_cash":4042.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54771","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4763.85,"discounted_cash":4001.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54775","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4684.5,"discounted_cash":3934.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54783","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4998.75,"discounted_cash":4198.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54785","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":5805.8,"discounted_cash":4876.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54787","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":6024.2,"discounted_cash":5060.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54792","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":7148.75,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54794","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":7201.42,"discounted_cash":6049.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200030_54796","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":7127.73,"discounted_cash":5987.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200031_31618","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.17,"discounted_cash":481.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200031_31751","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200031_37784","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.34,"discounted_cash":481.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200031_6226","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1621.16,"discounted_cash":1361.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200031_6621","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.82,"discounted_cash":475.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200032_12023","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1572.68,"discounted_cash":1321.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200032_50081","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1394.47,"discounted_cash":1171.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200032_6262","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.99,"discounted_cash":1182.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200032_6263","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"}],"standard_charges":[{"gross_charge":3585.75,"discounted_cash":3012.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200035_27229","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":3748.14,"discounted_cash":3148.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200035_79862","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":6013.7,"discounted_cash":5051.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200035_79928","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.75,"discounted_cash":2110.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200035_80460","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.13,"discounted_cash":3356.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200035_80532","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":5985.85,"discounted_cash":5028.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200035_81887","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.75,"discounted_cash":2110.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200035_82150","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2392.0,"discounted_cash":2009.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200035_86768","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.75,"discounted_cash":2110.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200035_87333","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":3059.8,"discounted_cash":2570.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200035_93549","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.75,"discounted_cash":2110.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200036_10141","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1755","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.14,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Splint Fingr Lmb Spg Ext Sz B/ D","code_information":[{"code":"27200037","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Kit Ecmo Disposables","code_information":[{"code":"27200038","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":38999.0,"discounted_cash":32759.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27200039_89353","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"\"Hc Ring Pessary With Support 2-1/2\"\", Size 3\"","code_information":[{"code":"27200041","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4564","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"\"Hc Ring Pessary With Support 2-3/4\"\", Size 4\"","code_information":[{"code":"27200042","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4564","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"\"Hc Ring Pessary With Support 3\"\", Size 5\"","code_information":[{"code":"27200043","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4564","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"\"Hc Ring Pessary With Support 3-1/4\"\", Size 6\"","code_information":[{"code":"27200044","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4564","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100094","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":427.02,"discounted_cash":358.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100101","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2279.7,"discounted_cash":1914.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100227","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100228","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":589.95,"discounted_cash":495.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100540","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2287.39,"discounted_cash":1921.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100908","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":196.86,"discounted_cash":165.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100916","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100928","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1354.7,"discounted_cash":1137.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100930","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":646.76,"discounted_cash":543.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100933","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":587.11,"discounted_cash":493.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100943","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":458.85,"discounted_cash":385.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100946","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1660.6,"discounted_cash":1394.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100947","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100951","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":585.58,"discounted_cash":491.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100952","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":553.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100953","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100955","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":303.76,"discounted_cash":255.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100959","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1514.21,"discounted_cash":1271.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100972","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100976","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":548.7,"discounted_cash":460.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_100992","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2592.5,"discounted_cash":2177.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_101056","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1625.64,"discounted_cash":1365.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_101057","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1625.64,"discounted_cash":1365.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_101058","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1625.64,"discounted_cash":1365.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_101059","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1625.64,"discounted_cash":1365.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_101689","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3369.27,"discounted_cash":2830.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_101707","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":295.8,"discounted_cash":248.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_101713","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_101718","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_12375","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1600.95,"discounted_cash":1344.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_12464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":179.45,"discounted_cash":150.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_16109","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":611.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_16512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.94,"discounted_cash":228.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_24255","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":792.98,"discounted_cash":666.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_25812","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1865.99,"discounted_cash":1567.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_28308","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":285.96,"discounted_cash":240.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_29223","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3059.0,"discounted_cash":2569.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_29226","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":159.42,"discounted_cash":133.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_30668","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":802.99,"discounted_cash":674.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_36556","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2287.39,"discounted_cash":1921.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_43524","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":339.5,"discounted_cash":285.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_47237","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":452.61,"discounted_cash":380.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_47943","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":254.62,"discounted_cash":213.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_48525","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.3,"discounted_cash":227.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_48746","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":145.5,"discounted_cash":122.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_48910","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":400.86,"discounted_cash":336.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_49844","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_50062","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_50464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":589.95,"discounted_cash":495.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_51148","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":227.95,"discounted_cash":191.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_53360","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_5361","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_54267","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1966.5,"discounted_cash":1651.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_54730","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":239.7,"discounted_cash":201.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_54829","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1193.01,"discounted_cash":1002.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_63996","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.96,"discounted_cash":396.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_64120","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1227.2,"discounted_cash":1030.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_65279","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_67633","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2592.5,"discounted_cash":2177.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_67639","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":886.16,"discounted_cash":744.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_68199","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_69236","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_74042","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_79989","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":773.79,"discounted_cash":649.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_80353","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2185.0,"discounted_cash":1835.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_80993","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":498.18,"discounted_cash":418.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_81474","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_81743","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1118.72,"discounted_cash":939.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_81801","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":848.64,"discounted_cash":712.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_81802","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":848.64,"discounted_cash":712.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_82016","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":452.61,"discounted_cash":380.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_82856","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1966.5,"discounted_cash":1651.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_82963","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":698.88,"discounted_cash":587.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_83323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2184.0,"discounted_cash":1834.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_84269","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2431.9,"discounted_cash":2042.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_85279","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":956.8,"discounted_cash":803.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_85498","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1288.09,"discounted_cash":1082.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_85861","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_86524","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":731.98,"discounted_cash":614.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_87913","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1118.72,"discounted_cash":939.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_88179","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":453.44,"discounted_cash":380.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89153","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.51,"discounted_cash":462.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89490","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89531","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":953.1,"discounted_cash":800.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89532","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":842.4,"discounted_cash":707.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89533","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1227.2,"discounted_cash":1030.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89557","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":522.65,"discounted_cash":439.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89558","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.2,"discounted_cash":680.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89688","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":848.64,"discounted_cash":712.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89715","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3986.63,"discounted_cash":3348.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89716","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":536.2,"discounted_cash":450.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89725","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1878.91,"discounted_cash":1578.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89737","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.43,"discounted_cash":428.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89739","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":810.2,"discounted_cash":680.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89746","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":443.93,"discounted_cash":372.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89798","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2745.6,"discounted_cash":2306.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89800","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3010.0,"discounted_cash":2528.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89802","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1485.8,"discounted_cash":1248.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89808","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.21,"discounted_cash":157.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_89810","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":590.72,"discounted_cash":496.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_90042","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":546.82,"discounted_cash":459.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_90055","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1893.66,"discounted_cash":1590.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_90884","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":327.42,"discounted_cash":275.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_90988","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.38,"discounted_cash":125.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_90990","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6799.52,"discounted_cash":5711.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_90994","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3593.37,"discounted_cash":3018.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_90996","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1485.8,"discounted_cash":1248.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91014","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1466.4,"discounted_cash":1231.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91016","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.01,"discounted_cash":381.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91017","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":732.41,"discounted_cash":615.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91018","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":539.48,"discounted_cash":453.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91133","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2592.5,"discounted_cash":2177.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91237","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":786.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91539","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91784","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":752.96,"discounted_cash":632.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91785","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91790","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1580.8,"discounted_cash":1327.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91792","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":751.25,"discounted_cash":631.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91794","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1394.83,"discounted_cash":1171.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_91795","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1396.1,"discounted_cash":1172.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_92463","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1227.2,"discounted_cash":1030.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_92474","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":545.54,"discounted_cash":458.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_92475","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":738.72,"discounted_cash":620.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_92502","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":936.98,"discounted_cash":787.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_92506","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1855.64,"discounted_cash":1558.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_92905","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3120.0,"discounted_cash":2620.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93125","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":827.84,"discounted_cash":695.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93126","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":956.8,"discounted_cash":803.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93134","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.72,"discounted_cash":583.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93135","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":698.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93138","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1797.12,"discounted_cash":1509.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93152","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":919.36,"discounted_cash":772.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93153","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1855.36,"discounted_cash":1558.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93158","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93544","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":158.21,"discounted_cash":132.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93599","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1480.96,"discounted_cash":1244.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93857","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5652.63,"discounted_cash":4748.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93859","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93862","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":419.82,"discounted_cash":352.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_93864","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94164","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":811.2,"discounted_cash":681.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94172","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":786.85,"discounted_cash":660.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94173","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1098.24,"discounted_cash":922.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94179","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2059.2,"discounted_cash":1729.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94180","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":525.45,"discounted_cash":441.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94181","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":170.33,"discounted_cash":143.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94182","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1187.67,"discounted_cash":997.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94383","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.06,"discounted_cash":556.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94396","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":992.16,"discounted_cash":833.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94702","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94703","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1353.61,"discounted_cash":1137.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94706","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.91,"discounted_cash":629.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94708","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.86,"discounted_cash":188.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_94805","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":546.25,"discounted_cash":458.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_95445","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":917.7,"discounted_cash":770.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_95454","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4176.68,"discounted_cash":3508.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96257","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96258","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":4892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96279","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":738.53,"discounted_cash":620.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96325","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96336","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2179.54,"discounted_cash":1830.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96340","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7025.2,"discounted_cash":5901.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96341","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7025.2,"discounted_cash":5901.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96446","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2523.68,"discounted_cash":2119.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96557","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4145.81,"discounted_cash":3482.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96638","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":714.5,"discounted_cash":600.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96661","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96729","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1560.09,"discounted_cash":1310.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_96730","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1109.98,"discounted_cash":932.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_97402","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":467.59,"discounted_cash":392.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_97597","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1376.55,"discounted_cash":1156.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_97598","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1376.55,"discounted_cash":1156.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_97869","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1284.78,"discounted_cash":1079.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_97871","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":880.99,"discounted_cash":740.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_97997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98026","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1660.6,"discounted_cash":1394.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98027","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":733.72,"discounted_cash":616.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98028","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":522.65,"discounted_cash":439.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1132.7,"discounted_cash":951.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98030","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":894.98,"discounted_cash":751.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98290","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2884.2,"discounted_cash":2422.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98488","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2523.68,"discounted_cash":2119.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98489","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1261.84,"discounted_cash":1059.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98513","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98518","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98519","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1887.84,"discounted_cash":1585.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98521","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98633","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1073.45,"discounted_cash":901.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98692","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98693","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1354.7,"discounted_cash":1137.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98694","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1354.7,"discounted_cash":1137.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98695","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1900.95,"discounted_cash":1596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98707","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1660.6,"discounted_cash":1394.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98708","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1660.6,"discounted_cash":1394.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98709","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2106.34,"discounted_cash":1769.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98710","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1347.71,"discounted_cash":1132.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98715","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98727","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98772","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":751.2,"discounted_cash":631.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98979","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98984","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_98986","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5405.4,"discounted_cash":4540.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99326","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5096.0,"discounted_cash":4280.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99331","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1032.41,"discounted_cash":867.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99413","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1193.01,"discounted_cash":1002.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99431","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5891.34,"discounted_cash":4948.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99432","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":194.82,"discounted_cash":163.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99437","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99438","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":895.85,"discounted_cash":752.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99439","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99440","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1562.71,"discounted_cash":1312.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99441","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":800.58,"discounted_cash":672.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99599","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1660.6,"discounted_cash":1394.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99601","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99603","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3685.95,"discounted_cash":3096.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99611","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1925.15,"discounted_cash":1617.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99612","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1350.33,"discounted_cash":1134.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99809","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99810","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99811","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1660.6,"discounted_cash":1394.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99812","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":839.04,"discounted_cash":704.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99813","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":655.5,"discounted_cash":550.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99814","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":433.5,"discounted_cash":364.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27299999_99915","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":253.06,"discounted_cash":212.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27400015_85940","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.99,"discounted_cash":168.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27400015_85941","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.04,"discounted_cash":173.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27400015_85942","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.25,"discounted_cash":169.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27400016_12075","type":"CDM"},{"code":"274","type":"RC"},{"code":"L8000","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.6,"discounted_cash":214.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27400016_12076","type":"CDM"},{"code":"274","type":"RC"},{"code":"L8000","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.75,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27400017_16579","type":"CDM"},{"code":"274","type":"RC"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.64,"discounted_cash":302.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27400017_16580","type":"CDM"},{"code":"274","type":"RC"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.34,"discounted_cash":311.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27400020_31737","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.01,"discounted_cash":159.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27400024_6027","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.52,"discounted_cash":446.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27400024_85965","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.6,"discounted_cash":325.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Elbow Ortho W/O Joints Cf","code_information":[{"code":"27400031","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3702","type":"HCPCS"}],"standard_charges":[{"gross_charge":1352.0,"discounted_cash":1135.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Elbow Ortho W/O Joints Cf","code_information":[{"code":"27400031_L3702_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3702","type":"HCPCS"}],"standard_charges":[{"gross_charge":1330.67,"discounted_cash":1117.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc E /W /H Ortho Rigid W/O Jnts Cf","code_information":[{"code":"27400032","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3763","type":"HCPCS"}],"standard_charges":[{"gross_charge":3288.0,"discounted_cash":2761.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc E /W /H Ortho Rigid W/O Jnts Cf","code_information":[{"code":"27400032_L3763_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3763","type":"HCPCS"}],"standard_charges":[{"gross_charge":3209.5,"discounted_cash":2695.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Wrst/Han/Fin Ortho W/Joint(S) Cf","code_information":[{"code":"27400034","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3806","type":"HCPCS"}],"standard_charges":[{"gross_charge":2126.0,"discounted_cash":1785.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Wrist/Hand/Fing Orth Rgd W/O Jnts","code_information":[{"code":"27400035","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1750.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Wrist/Hand/Fing Orth Rgd W/O Jnts","code_information":[{"code":"27400035_L3808_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1726.29,"discounted_cash":1450.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Wrst/Han Orth W/Nontorsion Jnt Cf","code_information":[{"code":"27400036","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3905","type":"HCPCS"}],"standard_charges":[{"gross_charge":4646.0,"discounted_cash":3902.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Wrst/Han Orth W/Nontorsion Jnt Cf","code_information":[{"code":"27400036_L3905_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3905","type":"HCPCS"}],"standard_charges":[{"gross_charge":4646.0,"discounted_cash":3902.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Wrist / Hand Ortho W/O Joints Cf","code_information":[{"code":"27400037","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3906","type":"HCPCS"}],"standard_charges":[{"gross_charge":2063.0,"discounted_cash":1732.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Wrist / Hand Ortho W/O Joints Cf","code_information":[{"code":"27400037_L3906_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3906","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.33,"discounted_cash":1705.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hand / Finger Ortho W/O Joints Cf","code_information":[{"code":"27400038","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3913","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":1065.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hand / Finger Ortho W/O Joints Cf","code_information":[{"code":"27400038_L3913_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3913","type":"HCPCS"}],"standard_charges":[{"gross_charge":1257.0,"discounted_cash":1055.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hand Ortho W/O Joints Cf","code_information":[{"code":"27400039","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3919","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":1065.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hand Ortho W/O Joints Cf","code_information":[{"code":"27400039_L3919_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3919","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":1065.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hand / Finger Ortho W/Joint(S) Cf","code_information":[{"code":"27400040","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3921","type":"HCPCS"}],"standard_charges":[{"gross_charge":1506.0,"discounted_cash":1265.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Finger Ortho W/O Joints Cf","code_information":[{"code":"27400043","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3933","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":840.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Finger Ortho W/O Joints Cf","code_information":[{"code":"27400043_L3933_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3933","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.54,"discounted_cash":825.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc S/E/W/H Orth Cap Dsgn W/O Jnts Cf","code_information":[{"code":"27400044","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3961","type":"HCPCS"}],"standard_charges":[{"gross_charge":7870.0,"discounted_cash":6610.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Who Cock-Up Nonmolde Pre Ots","code_information":[{"code":"27400045","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":261.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Who Cock-Up Nonmolde Pre Ots","code_information":[{"code":"27400045_L3908_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.5,"discounted_cash":254.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hfo Flexion Glove Pre Ots","code_information":[{"code":"27400047","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3912","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hfo Without Joints Pre Ots","code_information":[{"code":"27400049","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3924","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":280.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Comfy Rest Hand Orthosis","code_information":[{"code":"27400050","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":261.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Comfy Rest Hand Orthosis","code_information":[{"code":"27400050_L3807_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hc Shoulder Ortho Cap Design W/O Joint Of","code_information":[{"code":"27400052","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3671","type":"HCPCS"}],"standard_charges":[{"gross_charge":3548.0,"discounted_cash":2980.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Forearm/Arm Cuffs Free Motio","code_information":[{"code":"27400055","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3720","type":"HCPCS"}],"standard_charges":[{"gross_charge":2828.0,"discounted_cash":2375.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Eo Adj Jt Prefab Custom Fit","code_information":[{"code":"27400057","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1969.0,"discounted_cash":1653.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Eo Rigid W/O Joints Pre Ots","code_information":[{"code":"27400058","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3762","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":409.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Ewhfo Rigid W/O Jnts Cf","code_information":[{"code":"27400059","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3765","type":"HCPCS"}],"standard_charges":[{"gross_charge":5049.0,"discounted_cash":4241.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Ewhfo W/Joint(S) Cf","code_information":[{"code":"27400060","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3766","type":"HCPCS"}],"standard_charges":[{"gross_charge":5346.0,"discounted_cash":4490.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Whfo W/O Joints Pre Ots","code_information":[{"code":"27400061","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3809","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.0,"discounted_cash":816.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Whfo W/O Joints Pre Ots","code_information":[{"code":"27400061_L3809_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3809","type":"HCPCS"}],"standard_charges":[{"gross_charge":962.8,"discounted_cash":808.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Metacarp Fx Orthosis Pre Cst","code_information":[{"code":"27400065","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3917","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":349.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Who Nontorsion Jnts Pre Cst","code_information":[{"code":"27400066","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3915","type":"HCPCS"}],"standard_charges":[{"gross_charge":2094.0,"discounted_cash":1758.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Hfo Nontorsion Jnts Pre Cst","code_information":[{"code":"27400067","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3929","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":303.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Hfo Nontorsion Jnts Pre Cst","code_information":[{"code":"27400067_L3929_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3929","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Fo Nontorsion Joint Cf","code_information":[{"code":"27400068","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3935","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":729.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Sewho Cap Design W/Jnt(S) Cf","code_information":[{"code":"27400069","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3971","type":"HCPCS"}],"standard_charges":[{"gross_charge":7413.0,"discounted_cash":6226.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Up Ext Fx Orthos Humeral Nos","code_information":[{"code":"27400072","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3980","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":1090.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Ue Fx Orth Shoul Cap Forearm","code_information":[{"code":"27400073","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3981","type":"HCPCS"}],"standard_charges":[{"gross_charge":3964.0,"discounted_cash":3329.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Upper Ext Fx Orthosis Rad/Ul","code_information":[{"code":"27400074","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3982","type":"HCPCS"}],"standard_charges":[{"gross_charge":1514.0,"discounted_cash":1271.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Upper Ext Fx Orthosis Wrist","code_information":[{"code":"27400075","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3984","type":"HCPCS"}],"standard_charges":[{"gross_charge":1394.0,"discounted_cash":1170.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hfo Nontorsion Jnts Pre Ots","code_information":[{"code":"27400077","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3930","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":295.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Metacarp Fx Orthosis Pre Ots","code_information":[{"code":"27400078","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3918","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":341.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Who Nontorsion Jnts Pre Ots","code_information":[{"code":"27400079","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3916","type":"HCPCS"}],"standard_charges":[{"gross_charge":2041.0,"discounted_cash":1714.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Whfo Nontorsion Joint Prefab","code_information":[{"code":"27400080","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3931","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":605.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eo, Adj Lock Joint Prefab Ot","code_information":[{"code":"27400081","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3761","type":"HCPCS"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cmc Metgrip (Push Metagrip)","code_information":[{"code":"27400082","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":241.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cmc Metgrip (Push Metagrip)","code_information":[{"code":"27400082_L3923_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.5,"discounted_cash":238.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Comfort Cool Thumb Cmc","code_information":[{"code":"27400083","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Comfort Cool Thumb Cmc","code_information":[{"code":"27400083_L3923_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Active Move","code_information":[{"code":"27400084","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":154.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Active Move","code_information":[{"code":"27400084_L3923_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":154.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fo With Joints","code_information":[{"code":"27400085","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3925","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fo With Joints","code_information":[{"code":"27400085_L3925_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3925","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bullseye Brace","code_information":[{"code":"27400086","type":"CDM"},{"code":"274","type":"RC"},{"code":"A4467","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bullseye Brace","code_information":[{"code":"27400086_A4467_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"A4467","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Non-Pneum Walk Boot Pre Cst","code_information":[{"code":"27400096","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":313.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Non-Pneum Walk Boot Pre Cst","code_information":[{"code":"27400096_L4386_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":313.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500002_32493","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":5461.47,"discounted_cash":4587.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500002_33365","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500002_35363","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":9561.39,"discounted_cash":8031.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500002_43381","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":7692.39,"discounted_cash":6461.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27500002_C1785_275","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":7656.56,"discounted_cash":6431.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500003_35367","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":7421.54,"discounted_cash":6234.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500003_43382","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":7001.78,"discounted_cash":5881.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500003_54913","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":29137.5,"discounted_cash":24475.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500004_43655","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":51617.0,"discounted_cash":43358.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500004_79087","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":39287.74,"discounted_cash":33001.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500004_79816","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":41855.95,"discounted_cash":35159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27500004_C1882_275","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":51800.0,"discounted_cash":43512.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500005_100076","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2619","type":"HCPCS"}],"standard_charges":[{"gross_charge":10228.65,"discounted_cash":8592.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500006_37867","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":13959.53,"discounted_cash":11726.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500006_44964","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500006_48045","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":13281.52,"discounted_cash":11156.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500006_50192","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":14959.26,"discounted_cash":12565.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27500006_79001","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":14820.0,"discounted_cash":12448.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_100934","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1345.39,"discounted_cash":1130.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_10579","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":708.89,"discounted_cash":595.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_10790","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.61,"discounted_cash":268.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11648","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4177.23,"discounted_cash":3508.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11772","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11793","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11794","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11795","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11796","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7419.36,"discounted_cash":6232.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11798","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7202.0,"discounted_cash":6049.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11802","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8611.93,"discounted_cash":7234.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11807","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11809","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_11892","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3686.88,"discounted_cash":3096.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_12046","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":490.88,"discounted_cash":412.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_13976","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_21398","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":154.56,"discounted_cash":129.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_24239","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":473.59,"discounted_cash":397.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_24255","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":472.51,"discounted_cash":396.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_26592","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1061.42,"discounted_cash":891.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_26594","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_27817","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":248.88,"discounted_cash":209.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_27822","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":164.22,"discounted_cash":137.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_28436","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":433.5,"discounted_cash":364.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_28437","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_28438","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_28440","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":418.98,"discounted_cash":351.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_28441","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_28442","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_28443","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":429.14,"discounted_cash":360.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_28677","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1867.36,"discounted_cash":1568.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_32277","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1550.7,"discounted_cash":1302.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_32406","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":318.31,"discounted_cash":267.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_32407","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":318.31,"discounted_cash":267.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_33566","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":343.23,"discounted_cash":288.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_34723","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2654.31,"discounted_cash":2229.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_34724","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2379.52,"discounted_cash":1998.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_36756","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6238.64,"discounted_cash":5240.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_43379","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3556.75,"discounted_cash":2987.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_47600","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":6138.71,"discounted_cash":5156.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_48068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1422.23,"discounted_cash":1194.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_49464","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7242.77,"discounted_cash":6083.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_49608","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.45,"discounted_cash":461.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_50062","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":426.48,"discounted_cash":358.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_50100","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":978.31,"discounted_cash":821.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_50384","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1497.6,"discounted_cash":1257.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_50385","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1497.6,"discounted_cash":1257.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_50386","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1497.6,"discounted_cash":1257.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_50387","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1497.6,"discounted_cash":1257.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_50388","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2041.14,"discounted_cash":1714.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_50511","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_50512","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51162","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2177.02,"discounted_cash":1828.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51163","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1950.55,"discounted_cash":1638.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51164","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51166","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3848.0,"discounted_cash":3232.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51167","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4205.95,"discounted_cash":3533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51169","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3193.8,"discounted_cash":2682.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51235","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3669.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51236","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2403.5,"discounted_cash":2018.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51237","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1724.08,"discounted_cash":1448.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51535","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":63250.0,"discounted_cash":53130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51954","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5813.08,"discounted_cash":4882.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_51978","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_52266","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":524.16,"discounted_cash":440.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_52267","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":599.04,"discounted_cash":503.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_53512","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":734.16,"discounted_cash":616.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_5358","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":655.2,"discounted_cash":550.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_53913","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":82355.0,"discounted_cash":69178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_53914","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":83091.67,"discounted_cash":69797.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_54437","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7713.44,"discounted_cash":6479.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_54657","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1664.88,"discounted_cash":1398.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_54827","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2059.2,"discounted_cash":1729.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_54829","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":430.9,"discounted_cash":361.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_6054","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7984.49,"discounted_cash":6706.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_6162","type":"CDM"},{"code":"278","type":"RC"},{"code":"E0465","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.39,"discounted_cash":163.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_6167","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1324.11,"discounted_cash":1112.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_6202","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3987.03,"discounted_cash":3349.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_63774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.04,"discounted_cash":189.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_63775","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.61,"discounted_cash":283.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_64013","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2081.19,"discounted_cash":1748.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_64277","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":873.26,"discounted_cash":733.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_64438","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":764.4,"discounted_cash":642.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_67416","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":595.63,"discounted_cash":500.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_70812","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":458.85,"discounted_cash":385.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_73580","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3057.6,"discounted_cash":2568.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_78998","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_79425","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":747.14,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_79802","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1108.17,"discounted_cash":930.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_79903","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":41990.0,"discounted_cash":35271.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_79904","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":42160.0,"discounted_cash":35414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_79905","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":42268.18,"discounted_cash":35505.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_79906","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":42931.54,"discounted_cash":36062.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_79907","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":42500.0,"discounted_cash":35700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_79908","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_80015","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":184.35,"discounted_cash":154.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_80040","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9798.0,"discounted_cash":8230.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_80236","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":303.06,"discounted_cash":254.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_80256","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":234.44,"discounted_cash":196.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_80885","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":135.8,"discounted_cash":114.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_80999","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18779.44,"discounted_cash":15774.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81003","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7007.64,"discounted_cash":5886.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81165","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15706.24,"discounted_cash":13193.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.71,"discounted_cash":315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81460","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15333.76,"discounted_cash":12880.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81485","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":537.05,"discounted_cash":451.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81568","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1314.8,"discounted_cash":1104.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81729","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":325.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81747","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2579.82,"discounted_cash":2167.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81781","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3527.16,"discounted_cash":2962.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81782","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3589.63,"discounted_cash":3015.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81783","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":771.98,"discounted_cash":648.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_81851","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3351.47,"discounted_cash":2815.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_82045","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16078.72,"discounted_cash":13506.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_82148","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":145.5,"discounted_cash":122.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_82472","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16078.72,"discounted_cash":13506.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_82484","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_82646","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":985.92,"discounted_cash":828.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_82722","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3028.32,"discounted_cash":2543.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_83236","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3166.07,"discounted_cash":2659.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_83700","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":4915.58,"discounted_cash":4129.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_83881","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":220.22,"discounted_cash":184.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_83883","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6308.63,"discounted_cash":5299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_83884","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":849.6,"discounted_cash":713.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_85287","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":10209.8,"discounted_cash":8576.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_85818","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":27170.0,"discounted_cash":22822.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_85861","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3599.37,"discounted_cash":3023.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_86257","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4266.0,"discounted_cash":3583.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_86258","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2912.1,"discounted_cash":2446.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_86515","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1347.15,"discounted_cash":1131.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_86532","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4101.99,"discounted_cash":3445.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_86543","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4251.49,"discounted_cash":3571.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_86723","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_86761","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4058.67,"discounted_cash":3409.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_86820","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3417.24,"discounted_cash":2870.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_86821","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_88229","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":38849.33,"discounted_cash":32633.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_88637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3510.62,"discounted_cash":2948.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_88738","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10798.11,"discounted_cash":9070.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_88876","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":21238.0,"discounted_cash":17839.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_88877","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":21238.0,"discounted_cash":17839.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_88878","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":22721.0,"discounted_cash":19085.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_88882","type":"CDM"},{"code":"278","type":"RC"},{"code":"E0465","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.37,"discounted_cash":178.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_88908","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":74100.0,"discounted_cash":62244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_88911","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":77700.0,"discounted_cash":65268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89085","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":88060.0,"discounted_cash":73970.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89091","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89153","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":536.2,"discounted_cash":450.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89558","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":799.75,"discounted_cash":671.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89637","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10468.94,"discounted_cash":8793.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89715","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4394.76,"discounted_cash":3691.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89720","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":179.11,"discounted_cash":150.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89721","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":362.36,"discounted_cash":304.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89739","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1215.3,"discounted_cash":1020.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89741","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":188.4,"discounted_cash":158.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_89923","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":134.01,"discounted_cash":112.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_90042","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":419.22,"discounted_cash":352.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_90044","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":668.61,"discounted_cash":561.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_90045","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":953.1,"discounted_cash":800.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_90055","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1916.97,"discounted_cash":1610.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_90064","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":677.79,"discounted_cash":569.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_90065","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":953.1,"discounted_cash":800.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_90353","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8436.09,"discounted_cash":7086.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_90451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10719.48,"discounted_cash":9004.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_90990","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6799.52,"discounted_cash":5711.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91186","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":38950.18,"discounted_cash":32718.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91189","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14219.1,"discounted_cash":11944.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91190","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13836.94,"discounted_cash":11623.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91191","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14219.1,"discounted_cash":11944.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91192","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14076.37,"discounted_cash":11824.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91193","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13964.33,"discounted_cash":11730.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91195","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91196","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":33199.27,"discounted_cash":27887.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91631","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":27195.0,"discounted_cash":22843.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91856","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7188.15,"discounted_cash":6038.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_91940","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":86020.0,"discounted_cash":72256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_92374","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7868.64,"discounted_cash":6609.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_92855","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2622.0,"discounted_cash":2202.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_93300","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10661.9,"discounted_cash":8956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_93301","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19891.2,"discounted_cash":16708.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_93315","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7845.65,"discounted_cash":6590.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_93316","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7999.59,"discounted_cash":6719.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_93317","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7999.59,"discounted_cash":6719.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_93318","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7792.17,"discounted_cash":6545.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_93320","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7922.62,"discounted_cash":6655.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_93547","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":88060.0,"discounted_cash":73970.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_93619","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":84175.0,"discounted_cash":70707.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_94265","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":84175.0,"discounted_cash":70707.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_94333","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10575.21,"discounted_cash":8883.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_94334","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10817.92,"discounted_cash":9087.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_94468","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":25060.19,"discounted_cash":21050.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_94500","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_94706","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":738.91,"discounted_cash":620.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_95196","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":44030.0,"discounted_cash":36985.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_95197","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":44030.0,"discounted_cash":36985.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_95198","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":44392.6,"discounted_cash":37289.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_95199","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":44030.0,"discounted_cash":36985.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_95200","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":44030.0,"discounted_cash":36985.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_95470","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":723.63,"discounted_cash":607.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_96270","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_96271","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1212.68,"discounted_cash":1018.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_96272","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17327.1,"discounted_cash":14554.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_97876","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_98559","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":971.7,"discounted_cash":816.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_98715","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_9931","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3582.86,"discounted_cash":3009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_99601","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_99605","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1334.29,"discounted_cash":1120.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_99812","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":839.04,"discounted_cash":704.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_99906","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":44030.0,"discounted_cash":36985.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_99907","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":44030.0,"discounted_cash":36985.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_99909","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":44030.0,"discounted_cash":36985.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_99912","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":44030.0,"discounted_cash":36985.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_99913","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":44030.0,"discounted_cash":36985.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800000_C1777_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":17353.0,"discounted_cash":14576.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800001_10834","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.6,"discounted_cash":995.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800001_89164","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.75,"discounted_cash":962.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_100101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2279.71,"discounted_cash":1914.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_100924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_100973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10715.35,"discounted_cash":9000.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_100988","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_100994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7862.91,"discounted_cash":6604.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10499","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":842.62,"discounted_cash":707.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2930.09,"discounted_cash":2461.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.38,"discounted_cash":784.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":758.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10513","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3745.56,"discounted_cash":3146.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1835.4,"discounted_cash":1541.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1742.87,"discounted_cash":1464.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10850","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.25,"discounted_cash":221.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10880","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2059.12,"discounted_cash":1729.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10882","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1742.32,"discounted_cash":1463.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10986","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1593.24,"discounted_cash":1338.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10987","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5113.53,"discounted_cash":4295.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_10988","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7857.73,"discounted_cash":6600.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11141","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.39,"discounted_cash":646.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1800.12,"discounted_cash":1512.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.44,"discounted_cash":351.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1506.03,"discounted_cash":1265.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11258","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.61,"discounted_cash":804.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11259","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.59,"discounted_cash":1416.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11297","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5624.94,"discounted_cash":4724.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.72,"discounted_cash":1098.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.88,"discounted_cash":514.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1108.6,"discounted_cash":931.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11319","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2496.67,"discounted_cash":2097.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.28,"discounted_cash":358.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.37,"discounted_cash":206.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11726","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.22,"discounted_cash":358.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_11890","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.3,"discounted_cash":437.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_12608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_12710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_12983","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":622.72,"discounted_cash":523.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_12985","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3321.2,"discounted_cash":2789.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_13004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2906.05,"discounted_cash":2441.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_14063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.22,"discounted_cash":116.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_14077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8730.0,"discounted_cash":7333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_14094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":1101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_14261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.17,"discounted_cash":556.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_21025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1280.41,"discounted_cash":1075.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_21031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7384.0,"discounted_cash":6202.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_21059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.29,"discounted_cash":1203.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_21566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5096.0,"discounted_cash":4280.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_21616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2156.6,"discounted_cash":1811.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_21642","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.45,"discounted_cash":711.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_21657","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5550.6,"discounted_cash":4662.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_21680","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.86,"discounted_cash":883.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_22293","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_22850","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3582.86,"discounted_cash":3009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_23177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3029.59,"discounted_cash":2544.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_23178","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4937.33,"discounted_cash":4147.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_23704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_24189","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4156.67,"discounted_cash":3491.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1018.21,"discounted_cash":855.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1018.21,"discounted_cash":855.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1375.79,"discounted_cash":1155.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3762.5,"discounted_cash":3160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3643.5,"discounted_cash":3060.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.82,"discounted_cash":1144.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25719","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3582.86,"discounted_cash":3009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25879","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25886","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.41,"discounted_cash":569.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25895","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.24,"discounted_cash":395.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_25896","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.41,"discounted_cash":569.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.31,"discounted_cash":392.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.23,"discounted_cash":299.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.87,"discounted_cash":660.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.27,"discounted_cash":353.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.72,"discounted_cash":363.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.95,"discounted_cash":551.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26097","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.95,"discounted_cash":551.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26191","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.6,"discounted_cash":384.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26192","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.08,"discounted_cash":399.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26197","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.15,"discounted_cash":394.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26317","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26318","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26319","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.16,"discounted_cash":528.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26399","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.39,"discounted_cash":625.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.05,"discounted_cash":605.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26496","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.4,"discounted_cash":576.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":808.45,"discounted_cash":679.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.14,"discounted_cash":659.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.13,"discounted_cash":253.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26683","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":539.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.54,"discounted_cash":254.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.5,"discounted_cash":550.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26690","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.32,"discounted_cash":421.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26750","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1506.96,"discounted_cash":1265.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_26758","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1078.3,"discounted_cash":905.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_27765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.88,"discounted_cash":1528.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_28007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.23,"discounted_cash":1080.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_28047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_28087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10260.66,"discounted_cash":8618.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_28108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.38,"discounted_cash":259.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_28118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.15,"discounted_cash":394.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_28181","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10661.9,"discounted_cash":8956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_28954","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.35,"discounted_cash":475.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_28988","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.45,"discounted_cash":178.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.5,"discounted_cash":250.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.85,"discounted_cash":167.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30650","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1950.11,"discounted_cash":1638.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30652","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.24,"discounted_cash":149.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30653","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.24,"discounted_cash":149.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30661","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":524.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30701","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.32,"discounted_cash":421.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30702","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.75,"discounted_cash":537.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30717","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.32,"discounted_cash":421.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.32,"discounted_cash":421.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30719","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.32,"discounted_cash":421.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30722","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.43,"discounted_cash":157.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30723","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.3,"discounted_cash":152.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.83,"discounted_cash":153.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.42,"discounted_cash":157.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30726","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.43,"discounted_cash":157.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.84,"discounted_cash":254.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.25,"discounted_cash":253.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30751","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30754","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30772","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.17,"discounted_cash":747.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_30820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3976.7,"discounted_cash":3340.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_31086","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_31191","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.11,"discounted_cash":579.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_31205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_31287","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_31288","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_31323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1280.41,"discounted_cash":1075.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_31324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1259.9,"discounted_cash":1058.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_31325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.95,"discounted_cash":551.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_31373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7021.25,"discounted_cash":5897.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_32030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2009.28,"discounted_cash":1687.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_32074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.66,"discounted_cash":980.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_32089","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.75,"discounted_cash":1865.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_32090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.25,"discounted_cash":1927.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_32091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3547.5,"discounted_cash":2979.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_32092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3585.68,"discounted_cash":3011.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_32292","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3518.62,"discounted_cash":2955.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_32703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5912.5,"discounted_cash":4966.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_32704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_33102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2075.75,"discounted_cash":1743.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_33204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.78,"discounted_cash":353.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_33205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.01,"discounted_cash":348.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_33219","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.69,"discounted_cash":353.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_33220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.69,"discounted_cash":355.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_33221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.04,"discounted_cash":357.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_33222","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3328.88,"discounted_cash":2796.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_33225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.01,"discounted_cash":516.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_33384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.96,"discounted_cash":224.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_33476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5949.9,"discounted_cash":4997.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_34027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_34134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5725.5,"discounted_cash":4809.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_34190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_34568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.61,"discounted_cash":413.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_34595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.67,"discounted_cash":430.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_34838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.34,"discounted_cash":553.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_35071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.01,"discounted_cash":154.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_35075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_35371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.25,"discounted_cash":3028.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_35580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2075.75,"discounted_cash":1743.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_35917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.38,"discounted_cash":906.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_35918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":873.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_35953","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_35955","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":873.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.68,"discounted_cash":352.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36326","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.31,"discounted_cash":343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.68,"discounted_cash":362.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.48,"discounted_cash":358.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3582.86,"discounted_cash":3009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.34,"discounted_cash":346.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3419.42,"discounted_cash":2872.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.83,"discounted_cash":356.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.25,"discounted_cash":3028.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36531","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3561.94,"discounted_cash":2992.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5912.5,"discounted_cash":4966.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5893.8,"discounted_cash":4950.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.3,"discounted_cash":847.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36622","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.24,"discounted_cash":358.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36623","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.4,"discounted_cash":351.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.97,"discounted_cash":352.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36762","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.97,"discounted_cash":351.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36975","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.1,"discounted_cash":1157.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_36980","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2211.56,"discounted_cash":1857.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_37763","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5912.5,"discounted_cash":4966.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_37765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.25,"discounted_cash":1927.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_37766","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6006.0,"discounted_cash":5045.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_37767","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6006.0,"discounted_cash":5045.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_38355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_39466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.18,"discounted_cash":222.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_42789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5725.5,"discounted_cash":4809.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_42929","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5192.14,"discounted_cash":4361.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_42930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5205.0,"discounted_cash":4372.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_43017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_43094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7280.0,"discounted_cash":6115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_43098","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7280.0,"discounted_cash":6115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_43330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_43518","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.58,"discounted_cash":541.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_43700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3764.67,"discounted_cash":3162.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_44697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":698.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_44863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_44870","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_45183","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2184.0,"discounted_cash":1834.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_45292","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.15,"discounted_cash":352.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_45619","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2075.75,"discounted_cash":1743.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_46974","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5725.5,"discounted_cash":4809.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_46976","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5725.5,"discounted_cash":4809.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_46978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_46981","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.25,"discounted_cash":1927.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.35,"discounted_cash":617.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":611.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":611.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2075.75,"discounted_cash":1743.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47233","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3323.76,"discounted_cash":2791.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47235","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.12,"discounted_cash":515.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10260.66,"discounted_cash":8618.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47749","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.01,"discounted_cash":355.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47750","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3334.7,"discounted_cash":2801.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47751","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.32,"discounted_cash":352.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47754","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47845","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5633.83,"discounted_cash":4732.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.38,"discounted_cash":906.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_47943","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.63,"discounted_cash":213.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2926.01,"discounted_cash":2457.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12881.12,"discounted_cash":10820.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2403.65,"discounted_cash":2019.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3494.75,"discounted_cash":2935.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48435","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.96,"discounted_cash":359.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48438","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.48,"discounted_cash":358.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.89,"discounted_cash":353.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48447","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.8,"discounted_cash":519.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.75,"discounted_cash":228.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48519","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.46,"discounted_cash":579.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48521","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48522","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.46,"discounted_cash":579.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.3,"discounted_cash":141.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":757.1,"discounted_cash":635.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48749","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.51,"discounted_cash":501.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.6,"discounted_cash":646.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_48818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7280.0,"discounted_cash":6115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1186.73,"discounted_cash":996.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3536.63,"discounted_cash":2970.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1887.64,"discounted_cash":1585.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49149","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":611.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3513.37,"discounted_cash":2951.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":524.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2686.95,"discounted_cash":2257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49291","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6811.35,"discounted_cash":5721.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49293","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49428","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49484","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5205.0,"discounted_cash":4372.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5896.8,"discounted_cash":4953.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49829","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3582.86,"discounted_cash":3009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_49892","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3331.12,"discounted_cash":2798.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.74,"discounted_cash":1475.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.2,"discounted_cash":308.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50223","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.21,"discounted_cash":2646.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3134.78,"discounted_cash":2633.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.4,"discounted_cash":576.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2622.0,"discounted_cash":2202.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.22,"discounted_cash":147.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.46,"discounted_cash":579.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.46,"discounted_cash":579.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.3,"discounted_cash":355.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.73,"discounted_cash":473.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":30381.0,"discounted_cash":25520.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50852","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5187.0,"discounted_cash":4357.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50860","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.25,"discounted_cash":253.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50872","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_50891","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.28,"discounted_cash":5970.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4000.36,"discounted_cash":3360.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51157","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6421.54,"discounted_cash":5394.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51318","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.47,"discounted_cash":2227.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.21,"discounted_cash":330.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51338","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51343","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6811.35,"discounted_cash":5721.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51346","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51349","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.8,"discounted_cash":291.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51379","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.97,"discounted_cash":787.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2811.12,"discounted_cash":2361.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2713.77,"discounted_cash":2279.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5713.89,"discounted_cash":4799.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51911","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51912","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.85,"discounted_cash":354.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_51913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.52,"discounted_cash":344.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.8,"discounted_cash":429.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.6,"discounted_cash":859.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.4,"discounted_cash":838.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52178","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.15,"discounted_cash":392.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52179","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.45,"discounted_cash":635.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52241","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2133.65,"discounted_cash":1792.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6897.8,"discounted_cash":5794.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.72,"discounted_cash":605.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7280.0,"discounted_cash":6115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2601.65,"discounted_cash":2185.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2652.89,"discounted_cash":2228.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.94,"discounted_cash":326.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52429","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.32,"discounted_cash":327.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1713.57,"discounted_cash":1439.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52438","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3571.3,"discounted_cash":2999.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52490","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52690","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":28824.9,"discounted_cash":24212.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52726","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.92,"discounted_cash":549.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.98,"discounted_cash":328.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_52918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.1,"discounted_cash":324.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.15,"discounted_cash":392.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4626.44,"discounted_cash":3886.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2713.77,"discounted_cash":2279.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2811.12,"discounted_cash":2361.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.31,"discounted_cash":390.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.59,"discounted_cash":392.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.31,"discounted_cash":390.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.31,"discounted_cash":390.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.3,"discounted_cash":355.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.72,"discounted_cash":605.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53149","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.13,"discounted_cash":445.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.68,"discounted_cash":352.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53534","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.27,"discounted_cash":352.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3597.31,"discounted_cash":3021.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53574","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18130.0,"discounted_cash":15229.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53578","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15561.0,"discounted_cash":13071.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.0,"discounted_cash":1659.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_5370","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.21,"discounted_cash":515.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53760","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.72,"discounted_cash":605.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53762","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.3,"discounted_cash":269.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53894","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.1,"discounted_cash":959.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53907","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2288.0,"discounted_cash":1921.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_53920","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.72,"discounted_cash":322.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.2,"discounted_cash":1030.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.38,"discounted_cash":562.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.61,"discounted_cash":413.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54086","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.81,"discounted_cash":522.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.61,"discounted_cash":413.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54089","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.52,"discounted_cash":513.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.81,"discounted_cash":522.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18130.0,"discounted_cash":15229.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.05,"discounted_cash":325.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54573","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15561.0,"discounted_cash":13071.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54701","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5660.52,"discounted_cash":4754.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1312.95,"discounted_cash":1102.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2271.31,"discounted_cash":1907.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.72,"discounted_cash":605.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.05,"discounted_cash":265.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54714","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.98,"discounted_cash":3029.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.11,"discounted_cash":329.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54721","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.89,"discounted_cash":353.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6922.65,"discounted_cash":5815.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.75,"discounted_cash":444.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_54901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.74,"discounted_cash":264.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_55544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_59063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2430.04,"discounted_cash":2041.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_61138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1212.6,"discounted_cash":1018.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_61139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2183.89,"discounted_cash":1834.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_61140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.2,"discounted_cash":306.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_61350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6249","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3582.86,"discounted_cash":3009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6333","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2687.94,"discounted_cash":2257.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_63642","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2162.16,"discounted_cash":1816.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_63707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.08,"discounted_cash":1109.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_63709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2351.08,"discounted_cash":1974.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_63766","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_63770","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1141.96,"discounted_cash":959.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_63771","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1284.78,"discounted_cash":1079.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_63777","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":1101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6390","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2034.02,"discounted_cash":1708.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_63939","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.55,"discounted_cash":464.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_63987","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_64008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_64118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.46,"discounted_cash":1522.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_64123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.23,"discounted_cash":329.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_64138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.28,"discounted_cash":364.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2687.94,"discounted_cash":2257.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_64169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1963.52,"discounted_cash":1649.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2687.94,"discounted_cash":2257.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_64458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1722.29,"discounted_cash":1446.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_64461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3496.0,"discounted_cash":2936.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_64470","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.6,"discounted_cash":1394.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_64500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.14,"discounted_cash":1738.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2431.91,"discounted_cash":2042.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1965.6,"discounted_cash":1651.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65151","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1055.36,"discounted_cash":886.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65164","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1244.88,"discounted_cash":1045.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1844.44,"discounted_cash":1549.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7142.6,"discounted_cash":5999.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.56,"discounted_cash":1082.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1273.16,"discounted_cash":1069.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1281.86,"discounted_cash":1076.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65470","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.56,"discounted_cash":1082.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.5,"discounted_cash":1065.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.76,"discounted_cash":1072.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.56,"discounted_cash":1082.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65485","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65526","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.38,"discounted_cash":1071.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.82,"discounted_cash":1074.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.17,"discounted_cash":1066.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65529","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1262.6,"discounted_cash":1060.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65539","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.61,"discounted_cash":1137.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.61,"discounted_cash":1137.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65541","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1262.82,"discounted_cash":1060.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1266.21,"discounted_cash":1063.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.38,"discounted_cash":1064.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.62,"discounted_cash":1074.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.56,"discounted_cash":1082.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.61,"discounted_cash":1137.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.56,"discounted_cash":1082.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65554","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.56,"discounted_cash":1082.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.56,"discounted_cash":1082.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_65566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.2,"discounted_cash":1030.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6649","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.12,"discounted_cash":1207.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.12,"discounted_cash":1207.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_67237","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4204.2,"discounted_cash":3531.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_67639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.19,"discounted_cash":730.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":805.74,"discounted_cash":676.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_6894","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1331.45,"discounted_cash":1118.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_69955","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7422.2,"discounted_cash":6234.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_69956","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7605.14,"discounted_cash":6388.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2660.49,"discounted_cash":2234.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70241","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6673.75,"discounted_cash":5605.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3582.86,"discounted_cash":3009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70268","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70289","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70337","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.54,"discounted_cash":1830.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2408.96,"discounted_cash":2023.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2753.1,"discounted_cash":2312.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3643.5,"discounted_cash":3060.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3556.09,"discounted_cash":2987.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70487","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70539","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3985.8,"discounted_cash":3348.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4185.09,"discounted_cash":3515.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7261.8,"discounted_cash":6099.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6922.65,"discounted_cash":5815.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70692","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7261.8,"discounted_cash":6099.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70848","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.81,"discounted_cash":418.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70849","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70850","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.48,"discounted_cash":403.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.48,"discounted_cash":403.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70868","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.1,"discounted_cash":530.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70869","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.52,"discounted_cash":513.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70870","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.52,"discounted_cash":513.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70880","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70881","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.71,"discounted_cash":1064.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70971","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.16,"discounted_cash":192.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70972","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.16,"discounted_cash":192.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.16,"discounted_cash":192.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70996","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_70998","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.3,"discounted_cash":269.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.55,"discounted_cash":256.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":917.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":917.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":917.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":917.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71152","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71167","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.15,"discounted_cash":394.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.6,"discounted_cash":384.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71193","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.67,"discounted_cash":418.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.57,"discounted_cash":410.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71335","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71336","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_7134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.5,"discounted_cash":595.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.12,"discounted_cash":447.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71342","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71343","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.12,"discounted_cash":447.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71344","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71345","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71358","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.57,"discounted_cash":532.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71359","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.96,"discounted_cash":526.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.52,"discounted_cash":513.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71389","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.67,"discounted_cash":533.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71390","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71398","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71399","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.52,"discounted_cash":513.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71436","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.5,"discounted_cash":550.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.5,"discounted_cash":550.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.5,"discounted_cash":550.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":757.1,"discounted_cash":635.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71581","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.2,"discounted_cash":681.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.6,"discounted_cash":733.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":873.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71678","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.2,"discounted_cash":1030.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.75,"discounted_cash":1253.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71720","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.0,"discounted_cash":1264.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71743","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71745","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71747","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71748","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3037.15,"discounted_cash":2551.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3037.15,"discounted_cash":2551.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71869","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71904","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.5,"discounted_cash":149.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71960","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3571.3,"discounted_cash":2999.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_71965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72742","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4567.29,"discounted_cash":3836.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72785","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7063.5,"discounted_cash":5933.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72786","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7242.0,"discounted_cash":6083.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72787","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7420.5,"discounted_cash":6233.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7420.5,"discounted_cash":6233.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72989","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.8,"discounted_cash":334.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72990","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.16,"discounted_cash":330.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72991","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.62,"discounted_cash":328.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72992","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.95,"discounted_cash":329.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72993","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.3,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_72994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.8,"discounted_cash":334.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2623.0,"discounted_cash":2203.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73672","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.61,"discounted_cash":1137.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.61,"discounted_cash":1137.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73689","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.46,"discounted_cash":1522.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8710.96,"discounted_cash":7317.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3277.47,"discounted_cash":2753.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73748","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1872.11,"discounted_cash":1572.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1270.93,"discounted_cash":1067.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.2,"discounted_cash":1030.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73869","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.39,"discounted_cash":539.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_73872","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.15,"discounted_cash":394.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_74343","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.05,"discounted_cash":447.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_74348","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.44,"discounted_cash":426.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_7655","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_78864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15561.0,"discounted_cash":13071.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.8,"discounted_cash":114.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2013.7,"discounted_cash":1691.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2075.75,"discounted_cash":1743.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79627","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79777","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.08,"discounted_cash":1109.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79878","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4625.53,"discounted_cash":3885.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15939.0,"discounted_cash":13388.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_79981","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15939.0,"discounted_cash":13388.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80223","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8337.15,"discounted_cash":7003.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.5,"discounted_cash":349.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2380.02,"discounted_cash":1999.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.74,"discounted_cash":345.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80578","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80652","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80786","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.11,"discounted_cash":356.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.39,"discounted_cash":359.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.23,"discounted_cash":357.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_8092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.28,"discounted_cash":463.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_8093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.55,"discounted_cash":1264.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_80994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.5,"discounted_cash":391.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.4,"discounted_cash":359.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81168","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3525.07,"discounted_cash":2961.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.5,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81173","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81348","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4823.0,"discounted_cash":4051.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8730.0,"discounted_cash":7333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":720.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8610.0,"discounted_cash":7232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8610.0,"discounted_cash":7232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81470","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81541","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4823.0,"discounted_cash":4051.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8730.0,"discounted_cash":7333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4338.88,"discounted_cash":3644.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81574","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4338.88,"discounted_cash":3644.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81579","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2346.86,"discounted_cash":1971.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.62,"discounted_cash":386.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81726","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4823.0,"discounted_cash":4051.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81855","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81856","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.46,"discounted_cash":579.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_8186","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.28,"discounted_cash":463.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81883","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2762.44,"discounted_cash":2320.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81884","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2713.77,"discounted_cash":2279.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_81937","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.75,"discounted_cash":1253.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2139.32,"discounted_cash":1797.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.28,"discounted_cash":528.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.05,"discounted_cash":605.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.61,"discounted_cash":353.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82393","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4823.0,"discounted_cash":4051.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1248.0,"discounted_cash":1048.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8730.0,"discounted_cash":7333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7194.61,"discounted_cash":6043.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.48,"discounted_cash":358.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82762","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82857","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4337.5,"discounted_cash":3643.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82865","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.3,"discounted_cash":443.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82911","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_82952","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2122.05,"discounted_cash":1782.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_83032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.47,"discounted_cash":116.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_83314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4327.5,"discounted_cash":3635.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_83319","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2730.16,"discounted_cash":2293.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_83322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8310.0,"discounted_cash":6980.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_83329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8677.5,"discounted_cash":7289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_83692","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.87,"discounted_cash":680.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_84269","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1983.83,"discounted_cash":1666.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_84270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_84425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.84,"discounted_cash":135.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_84903","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3983.6,"discounted_cash":3346.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_84916","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3530.96,"discounted_cash":2966.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_84918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.33,"discounted_cash":143.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_85489","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.64,"discounted_cash":252.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_85578","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_85825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.52,"discounted_cash":351.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_86246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5725.5,"discounted_cash":4809.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_86247","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_86483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15939.0,"discounted_cash":13388.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_86484","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4349.8,"discounted_cash":3653.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_86488","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_86491","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.72,"discounted_cash":1098.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_86492","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.72,"discounted_cash":1098.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_86673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_86950","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1453.4,"discounted_cash":1220.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_8757","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5078.0,"discounted_cash":4265.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_87909","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2133.65,"discounted_cash":1792.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_87910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.62,"discounted_cash":512.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_88100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.45,"discounted_cash":1046.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_88136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_88137","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_88355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.61,"discounted_cash":353.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_88399","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_88477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_88478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.17,"discounted_cash":416.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_88479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.04,"discounted_cash":413.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89153","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.87,"discounted_cash":434.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89154","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.96,"discounted_cash":700.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89155","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.13,"discounted_cash":705.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89157","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5107.25,"discounted_cash":4290.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89158","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6972.42,"discounted_cash":5856.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89159","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2655.23,"discounted_cash":2230.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89161","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2638.05,"discounted_cash":2215.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89162","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2103.75,"discounted_cash":1767.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89163","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2083.33,"discounted_cash":1750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4058.6,"discounted_cash":3409.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.33,"discounted_cash":718.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.2,"discounted_cash":657.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2460.67,"discounted_cash":2066.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89526","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_8953","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3174.59,"discounted_cash":2666.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.53,"discounted_cash":729.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.77,"discounted_cash":764.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.12,"discounted_cash":784.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89538","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.53,"discounted_cash":756.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89539","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.39,"discounted_cash":772.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_8954","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.78,"discounted_cash":920.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89541","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.4,"discounted_cash":158.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.31,"discounted_cash":155.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.54,"discounted_cash":112.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.93,"discounted_cash":419.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.93,"discounted_cash":419.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.26,"discounted_cash":415.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.55,"discounted_cash":409.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.78,"discounted_cash":417.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.01,"discounted_cash":425.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.13,"discounted_cash":493.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89553","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.38,"discounted_cash":125.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89558","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.2,"discounted_cash":680.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89559","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.95,"discounted_cash":702.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.87,"discounted_cash":750.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5502.74,"discounted_cash":4622.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3517.4,"discounted_cash":2954.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.11,"discounted_cash":150.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.78,"discounted_cash":154.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.93,"discounted_cash":419.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89573","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.75,"discounted_cash":416.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89574","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.81,"discounted_cash":978.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89575","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1360.52,"discounted_cash":1142.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3565.92,"discounted_cash":2995.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89578","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3497.38,"discounted_cash":2937.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89659","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9695.0,"discounted_cash":8143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.3,"discounted_cash":675.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2884.2,"discounted_cash":2422.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2118.6,"discounted_cash":1779.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89729","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6916.55,"discounted_cash":5809.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89732","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.56,"discounted_cash":197.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1270.36,"discounted_cash":1067.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1259.26,"discounted_cash":1057.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.84,"discounted_cash":1041.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.92,"discounted_cash":1052.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89740","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89742","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.4,"discounted_cash":158.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89743","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.78,"discounted_cash":154.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89747","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.55,"discounted_cash":156.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.37,"discounted_cash":694.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89797","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.32,"discounted_cash":685.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89798","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2856.48,"discounted_cash":2399.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89799","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2666.0,"discounted_cash":2239.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2985.5,"discounted_cash":2507.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89801","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3059.0,"discounted_cash":2569.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.8,"discounted_cash":1248.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.2,"discounted_cash":594.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.6,"discounted_cash":1394.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.79,"discounted_cash":633.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.34,"discounted_cash":700.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89814","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5616.2,"discounted_cash":4717.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89817","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6646.79,"discounted_cash":5583.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6972.42,"discounted_cash":5856.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6842.17,"discounted_cash":5747.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.58,"discounted_cash":1791.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2115.9,"discounted_cash":1777.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.55,"discounted_cash":156.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.24,"discounted_cash":153.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.12,"discounted_cash":153.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.16,"discounted_cash":430.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89829","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.16,"discounted_cash":430.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.16,"discounted_cash":430.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.23,"discounted_cash":502.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.4,"discounted_cash":506.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.64,"discounted_cash":507.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":298.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_89842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1188.64,"discounted_cash":998.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2945.28,"discounted_cash":2474.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.69,"discounted_cash":712.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.91,"discounted_cash":721.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.92,"discounted_cash":810.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.9,"discounted_cash":818.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.06,"discounted_cash":803.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.74,"discounted_cash":702.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6972.42,"discounted_cash":5856.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.79,"discounted_cash":569.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.69,"discounted_cash":689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90069","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.26,"discounted_cash":158.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3469.78,"discounted_cash":2914.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9176.98,"discounted_cash":7708.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1196.78,"discounted_cash":1005.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1212.68,"discounted_cash":1018.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.22,"discounted_cash":163.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.82,"discounted_cash":163.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.04,"discounted_cash":159.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.82,"discounted_cash":163.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90269","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.49,"discounted_cash":627.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10767.0,"discounted_cash":9044.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90988","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.99,"discounted_cash":477.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90990","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6245.95,"discounted_cash":5246.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90991","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.92,"discounted_cash":674.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90992","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.3,"discounted_cash":681.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90993","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.22,"discounted_cash":668.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3631.98,"discounted_cash":3050.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90995","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1136.2,"discounted_cash":954.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90996","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.8,"discounted_cash":1248.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.07,"discounted_cash":607.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90998","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_90999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":686.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":954.72,"discounted_cash":801.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.98,"discounted_cash":378.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":732.41,"discounted_cash":615.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.56,"discounted_cash":694.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6786.35,"discounted_cash":5700.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6863.88,"discounted_cash":5765.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6972.42,"discounted_cash":5856.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2128.5,"discounted_cash":1787.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.11,"discounted_cash":150.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.11,"discounted_cash":150.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.08,"discounted_cash":156.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.39,"discounted_cash":113.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.49,"discounted_cash":128.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.93,"discounted_cash":419.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.78,"discounted_cash":417.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.7,"discounted_cash":505.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.73,"discounted_cash":504.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":504.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.59,"discounted_cash":501.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.26,"discounted_cash":540.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.5,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.48,"discounted_cash":295.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":298.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1503.28,"discounted_cash":1262.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6676.28,"discounted_cash":5608.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.92,"discounted_cash":973.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8931.09,"discounted_cash":7502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91359","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.44,"discounted_cash":111.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.2,"discounted_cash":111.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.66,"discounted_cash":112.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.97,"discounted_cash":111.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.38,"discounted_cash":115.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.22,"discounted_cash":112.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91368","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.98,"discounted_cash":497.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91369","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.7,"discounted_cash":503.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91370","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.7,"discounted_cash":505.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5307.99,"discounted_cash":4458.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.27,"discounted_cash":155.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.82,"discounted_cash":163.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2138.24,"discounted_cash":1796.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6907.29,"discounted_cash":5802.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91378","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6972.42,"discounted_cash":5856.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91379","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.78,"discounted_cash":502.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1136.2,"discounted_cash":954.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.6,"discounted_cash":1394.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91797","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91798","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91799","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5616.2,"discounted_cash":4717.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91801","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2124.17,"discounted_cash":1784.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.86,"discounted_cash":419.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.04,"discounted_cash":159.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.62,"discounted_cash":161.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.82,"discounted_cash":163.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1883.47,"discounted_cash":1582.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1883.47,"discounted_cash":1582.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.27,"discounted_cash":893.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.32,"discounted_cash":883.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.44,"discounted_cash":861.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91814","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.15,"discounted_cash":878.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.32,"discounted_cash":883.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91817","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.44,"discounted_cash":861.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.2,"discounted_cash":904.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.14,"discounted_cash":185.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.56,"discounted_cash":359.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_91840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8129.26,"discounted_cash":6828.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3410.7,"discounted_cash":2864.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3852.4,"discounted_cash":3236.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92381","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4202.25,"discounted_cash":3529.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92382","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7242.77,"discounted_cash":6083.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7280.0,"discounted_cash":6115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92470","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8730.0,"discounted_cash":7333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3419.52,"discounted_cash":2872.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.79,"discounted_cash":633.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.13,"discounted_cash":705.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5749.38,"discounted_cash":4829.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6646.79,"discounted_cash":5583.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6809.6,"discounted_cash":5720.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2616.58,"discounted_cash":2197.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92484","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.79,"discounted_cash":569.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92488","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92489","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92490","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92491","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.86,"discounted_cash":419.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.95,"discounted_cash":890.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92496","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.4,"discounted_cash":576.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3609.62,"discounted_cash":3032.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.93,"discounted_cash":361.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_92837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2378.75,"discounted_cash":1998.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_93123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.42,"discounted_cash":702.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_93145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2681.0,"discounted_cash":2252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_9330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.99,"discounted_cash":3077.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_93602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2681.0,"discounted_cash":2252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_93605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.82,"discounted_cash":163.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_93608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_93616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_93617","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_93860","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_93861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":298.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2713.77,"discounted_cash":2279.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94175","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94178","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94179","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.15,"discounted_cash":1817.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94185","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94186","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1193.01,"discounted_cash":1002.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1399.49,"discounted_cash":1175.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94383","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.57,"discounted_cash":538.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.42,"discounted_cash":702.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94388","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7083.44,"discounted_cash":5950.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94390","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.39,"discounted_cash":921.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94391","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.39,"discounted_cash":921.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94393","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.96,"discounted_cash":417.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.08,"discounted_cash":422.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.11,"discounted_cash":150.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94772","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2674.44,"discounted_cash":2246.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94849","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94899","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_94928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4058.6,"discounted_cash":3409.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95162","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95163","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.0,"discounted_cash":1676.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95164","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.12,"discounted_cash":963.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2732.78,"discounted_cash":2295.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2681.0,"discounted_cash":2252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95449","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.69,"discounted_cash":1445.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":917.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.0,"discounted_cash":1676.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.43,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.49,"discounted_cash":128.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.16,"discounted_cash":430.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2709.4,"discounted_cash":2275.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5547.36,"discounted_cash":4659.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_95471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.35,"discounted_cash":1115.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.7,"discounted_cash":190.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8845.67,"discounted_cash":7430.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.08,"discounted_cash":1596.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96267","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96268","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.15,"discounted_cash":715.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96486","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.25,"discounted_cash":284.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_96907","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_97868","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.73,"discounted_cash":1207.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5503.68,"discounted_cash":4623.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3085.22,"discounted_cash":2591.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1883.47,"discounted_cash":1582.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98286","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.51,"discounted_cash":516.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98498","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98701","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.24,"discounted_cash":557.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98702","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.24,"discounted_cash":557.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98717","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98720","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_98961","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.42,"discounted_cash":702.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5891.34,"discounted_cash":4948.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99433","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.21,"discounted_cash":904.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.2,"discounted_cash":904.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99436","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.16,"discounted_cash":430.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1209.48,"discounted_cash":1015.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3155.14,"discounted_cash":2650.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.95,"discounted_cash":1596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6930.56,"discounted_cash":5821.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99617","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18907.0,"discounted_cash":15881.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99782","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.69,"discounted_cash":689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99792","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.75,"discounted_cash":735.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17319.33,"discounted_cash":14548.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.93,"discounted_cash":1427.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800002_99815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5749.38,"discounted_cash":4829.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_20627","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":22766.1,"discounted_cash":19123.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_43484","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":39896.36,"discounted_cash":33512.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_48961","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":38865.24,"discounted_cash":32646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_78827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":24821.88,"discounted_cash":20850.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_79816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":41538.5,"discounted_cash":34892.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_81671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":27060.7,"discounted_cash":22730.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_82847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":21600.6,"discounted_cash":18144.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_86090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":30517.78,"discounted_cash":25634.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_86610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":27640.48,"discounted_cash":23218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_86611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":41079.04,"discounted_cash":34506.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_86612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":25588.73,"discounted_cash":21494.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_89671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":42285.64,"discounted_cash":35519.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800004_97093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":41569.5,"discounted_cash":34918.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800005_49998","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":49305.0,"discounted_cash":41416.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800005_80058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":24684.11,"discounted_cash":20734.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800005_82896","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":28601.65,"discounted_cash":24025.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800005_86612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":26102.02,"discounted_cash":21925.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_10564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_21153","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_21154","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_32330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1734.72,"discounted_cash":1457.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_44833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2272.4,"discounted_cash":1908.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_6227","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.53,"discounted_cash":1173.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_6629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.83,"discounted_cash":952.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_6630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1214.06,"discounted_cash":1019.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_81799","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.3,"discounted_cash":663.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_82371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1107.1,"discounted_cash":929.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_82563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":3509.76,"discounted_cash":2948.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_82565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":1397.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800006_91681","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":5412.72,"discounted_cash":4546.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_10040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":3611.76,"discounted_cash":3033.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_10829","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":4477.5,"discounted_cash":3761.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_27300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.6,"discounted_cash":1058.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_27312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.32,"discounted_cash":1157.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_27780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.26,"discounted_cash":621.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_29240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1553.83,"discounted_cash":1305.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_30272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.4,"discounted_cash":857.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_48393","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":6664.11,"discounted_cash":5597.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_48748","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":6676.82,"discounted_cash":5608.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_49028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":6734.0,"discounted_cash":5656.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_49125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":5899.0,"discounted_cash":4955.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_54326","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.85,"discounted_cash":807.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_79802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":2362.47,"discounted_cash":1984.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800007_84930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.85,"discounted_cash":1187.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27800007_C1760_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1195.67,"discounted_cash":1004.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800008_12599","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":4961.22,"discounted_cash":4167.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800008_12600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800008_12601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":4307.07,"discounted_cash":3617.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800008_21065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":20414.55,"discounted_cash":17148.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800008_30774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800008_35000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":23465.4,"discounted_cash":19710.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800008_6883","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":10145.05,"discounted_cash":8521.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800008_89045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1966.5,"discounted_cash":1651.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800009_11353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800009_21042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800009_30776","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":8837.67,"discounted_cash":7423.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800009_30777","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":8246.29,"discounted_cash":6926.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800009_6218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.11,"discounted_cash":378.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800010_6211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":10791.92,"discounted_cash":9065.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800010_81299","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":10676.34,"discounted_cash":8968.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800010_81406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":10609.89,"discounted_cash":8912.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800011_81330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":24482.62,"discounted_cash":20565.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800011_82482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.2,"discounted_cash":768.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800011_82551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":28777.97,"discounted_cash":24173.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800011_83022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":50181.25,"discounted_cash":42152.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_10190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_10577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":4738.76,"discounted_cash":3980.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_10861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":8322.6,"discounted_cash":6990.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_10862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":8369.48,"discounted_cash":7030.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_10863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3967.6,"discounted_cash":3332.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_10865","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":4666.16,"discounted_cash":3919.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_20580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":8954.52,"discounted_cash":7521.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_28412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":27052.55,"discounted_cash":22724.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_34028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":2716.26,"discounted_cash":2281.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_34029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3497.69,"discounted_cash":2938.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_42806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":2367.04,"discounted_cash":1988.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_49840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_49841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_6205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3602.12,"discounted_cash":3025.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_6206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":2875.46,"discounted_cash":2415.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_6623","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":4422.6,"discounted_cash":3714.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_6624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":4216.05,"discounted_cash":3541.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_6874","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":6734.0,"discounted_cash":5656.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_82946","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.77,"discounted_cash":475.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_88168","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_88169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_91860","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":6770.4,"discounted_cash":5687.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_91861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":8890.05,"discounted_cash":7467.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_9919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":6060.6,"discounted_cash":5090.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_9921","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":9175.23,"discounted_cash":7707.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_9924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":5919.08,"discounted_cash":4972.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_9925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":5919.08,"discounted_cash":4972.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_9926","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":6060.6,"discounted_cash":5090.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_9928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":6510.25,"discounted_cash":5468.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_9930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":6060.6,"discounted_cash":5090.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_9978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.68,"discounted_cash":362.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800012_9979","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.06,"discounted_cash":1026.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800014_85300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":3660.88,"discounted_cash":3075.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_100954","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_101022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_101065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_101073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_11217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2185.0,"discounted_cash":1835.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_11235","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3059.0,"discounted_cash":2569.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_11237","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3059.0,"discounted_cash":2569.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_11239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3059.0,"discounted_cash":2569.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_11241","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3059.0,"discounted_cash":2569.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_11242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3059.0,"discounted_cash":2569.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_11243","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3059.0,"discounted_cash":2569.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_12721","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3582.86,"discounted_cash":3009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_12722","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3597.31,"discounted_cash":3021.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_12723","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3611.76,"discounted_cash":3033.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_12727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_12731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3571.3,"discounted_cash":2999.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_12732","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3536.63,"discounted_cash":2970.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_12733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3533.96,"discounted_cash":2968.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_12734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_13985","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5096.0,"discounted_cash":4280.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_13986","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5036.5,"discounted_cash":4230.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_13987","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5096.0,"discounted_cash":4280.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_13988","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5016.67,"discounted_cash":4214.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_13998","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_13999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3582.86,"discounted_cash":3009.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3525.07,"discounted_cash":2961.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7194.61,"discounted_cash":6043.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7165.72,"discounted_cash":6019.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7165.72,"discounted_cash":6019.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14184","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14185","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14186","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7003.91,"discounted_cash":5883.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14187","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14194","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7165.72,"discounted_cash":6019.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7165.72,"discounted_cash":6019.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14196","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7142.6,"discounted_cash":5999.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14197","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7182.23,"discounted_cash":6033.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14198","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14199","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2185.0,"discounted_cash":1835.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5096.0,"discounted_cash":4280.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5096.0,"discounted_cash":4280.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7021.25,"discounted_cash":5897.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14213","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7050.14,"discounted_cash":5922.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14215","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14219","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14222","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14223","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3597.31,"discounted_cash":3021.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.25,"discounted_cash":895.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.12,"discounted_cash":902.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14241","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7211.95,"discounted_cash":6058.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7142.6,"discounted_cash":5999.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14247","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3496.0,"discounted_cash":2936.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3188.57,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2014.57,"discounted_cash":1692.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4879.18,"discounted_cash":4098.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4636.49,"discounted_cash":3894.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14277","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4977.0,"discounted_cash":4180.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4960.0,"discounted_cash":4166.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14279","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4858.0,"discounted_cash":4080.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3536.63,"discounted_cash":2970.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_14313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_20874","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8310.0,"discounted_cash":6980.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_20898","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1684.8,"discounted_cash":1415.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_21181","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15540.0,"discounted_cash":13053.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_21185","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5177.15,"discounted_cash":4348.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_21190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9758.4,"discounted_cash":8197.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_21191","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5261.79,"discounted_cash":4419.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_21272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":1397.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_21278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":1397.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_21279","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":1397.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_21611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2900.2,"discounted_cash":2436.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_21630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.9,"discounted_cash":2466.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_22309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_22844","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2080.0,"discounted_cash":1747.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_22855","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7174.61,"discounted_cash":6026.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_22947","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6508.2,"discounted_cash":5466.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_22950","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6770.4,"discounted_cash":5687.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_22999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6770.4,"discounted_cash":5687.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_23005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1977.42,"discounted_cash":1661.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_24586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5177.15,"discounted_cash":4348.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_28853","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.25,"discounted_cash":618.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_31260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.85,"discounted_cash":1486.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_32173","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2741.01,"discounted_cash":2302.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6188.0,"discounted_cash":5197.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33645","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5205.42,"discounted_cash":4372.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33646","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3011.84,"discounted_cash":2529.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33649","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9724.16,"discounted_cash":8168.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33650","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5005.69,"discounted_cash":4204.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9724.16,"discounted_cash":8168.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33652","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5177.24,"discounted_cash":4348.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33653","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3011.84,"discounted_cash":2529.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33655","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1706.0,"discounted_cash":1433.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9644.27,"discounted_cash":8101.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9724.16,"discounted_cash":8168.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33665","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33666","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33668","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5218.74,"discounted_cash":4383.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33670","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4869.92,"discounted_cash":4090.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_33671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5265.46,"discounted_cash":4422.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.62,"discounted_cash":384.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.04,"discounted_cash":1202.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34951","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.67,"discounted_cash":3631.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34966","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9963.84,"discounted_cash":8369.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34968","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5009.55,"discounted_cash":4208.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34969","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5135.55,"discounted_cash":4313.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34970","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5253.33,"discounted_cash":4412.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34971","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5227.97,"discounted_cash":4391.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34972","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3163.88,"discounted_cash":2657.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_34976","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3510.62,"discounted_cash":2948.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_35080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":1397.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_35463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3571.3,"discounted_cash":2999.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_35826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_36194","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1784.5,"discounted_cash":1498.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_36424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5293.61,"discounted_cash":4446.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_36832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_38028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.5,"discounted_cash":900.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_38710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":1397.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_39425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5291.75,"discounted_cash":4445.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_39426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5291.75,"discounted_cash":4445.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_39429","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5291.75,"discounted_cash":4445.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_39434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":325.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_40521","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":1397.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_40524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1706.0,"discounted_cash":1433.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_40532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":325.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_40533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.67,"discounted_cash":317.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_42781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3510.62,"discounted_cash":2948.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_42784","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5304.06,"discounted_cash":4455.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_42924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9676.22,"discounted_cash":8128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_43204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9580.35,"discounted_cash":8047.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_43523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3556.75,"discounted_cash":2987.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_43529","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3556.75,"discounted_cash":2987.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_43703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4548.98,"discounted_cash":3821.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_43704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5343.52,"discounted_cash":4488.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_43705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_43706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5177.24,"discounted_cash":4348.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_43707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_44685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_44724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6065.56,"discounted_cash":5095.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_44844","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5218.74,"discounted_cash":4383.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_44873","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_44929","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_44932","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9644.27,"discounted_cash":8101.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_44933","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4813.83,"discounted_cash":4043.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_44935","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_44977","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_44978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9664.24,"discounted_cash":8117.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_45177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5260.33,"discounted_cash":4418.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_45178","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_45328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_46939","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10791.92,"discounted_cash":9065.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7088.67,"discounted_cash":5954.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6959.34,"discounted_cash":5845.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6373.87,"discounted_cash":5354.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.52,"discounted_cash":816.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9644.27,"discounted_cash":8101.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10661.9,"discounted_cash":8956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47222","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":4892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":4892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47688","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6457.36,"discounted_cash":5424.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47715","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.07,"discounted_cash":356.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":545.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_47994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6552.0,"discounted_cash":5503.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_48059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5219.51,"discounted_cash":4384.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_48282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4273.85,"discounted_cash":3590.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_48283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2971.6,"discounted_cash":2496.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_48395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6770.4,"discounted_cash":5687.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_48474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4232.0,"discounted_cash":3554.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_48713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6065.56,"discounted_cash":5095.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_48778","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6552.0,"discounted_cash":5503.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_48993","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7302.83,"discounted_cash":6134.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_49397","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4191.76,"discounted_cash":3521.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_49430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":325.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_49650","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7173.19,"discounted_cash":6025.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12809.16,"discounted_cash":10759.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50088","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50155","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.3,"discounted_cash":557.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50156","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6312.94,"discounted_cash":5302.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50398","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10488.53,"discounted_cash":8810.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10713.9,"discounted_cash":8999.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8441.04,"discounted_cash":7090.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7156.24,"discounted_cash":6011.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7090.72,"discounted_cash":5956.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5432.7,"discounted_cash":4563.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.71,"discounted_cash":1027.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50926","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2425.35,"discounted_cash":2037.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2622.0,"discounted_cash":2202.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50929","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.85,"discounted_cash":765.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_50930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3597.31,"discounted_cash":3021.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9050.1,"discounted_cash":7602.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12407.3,"discounted_cash":10422.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51175","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2185.0,"discounted_cash":1835.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51176","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7302.83,"discounted_cash":6134.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14906.45,"discounted_cash":12521.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51178","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7294.04,"discounted_cash":6126.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51179","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12407.3,"discounted_cash":10422.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51317","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4550.0,"discounted_cash":3822.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":4586.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.44,"discounted_cash":1145.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51445","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.74,"discounted_cash":429.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51447","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9210.15,"discounted_cash":7736.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10488.53,"discounted_cash":8810.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10575.21,"discounted_cash":8883.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7895.39,"discounted_cash":6632.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7302.83,"discounted_cash":6134.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51953","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6214.14,"discounted_cash":5219.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_51965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12608.23,"discounted_cash":10590.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7487.38,"discounted_cash":6289.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5291.75,"discounted_cash":4445.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5339.21,"discounted_cash":4484.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":4892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.74,"discounted_cash":2413.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2367.07,"discounted_cash":1988.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.96,"discounted_cash":1543.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6362.72,"discounted_cash":5344.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52235","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2912.0,"discounted_cash":2446.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4486.25,"discounted_cash":3768.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5362.86,"discounted_cash":4504.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52436","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5642.67,"discounted_cash":4739.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3754.08,"discounted_cash":3153.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.99,"discounted_cash":356.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52866","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52904","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":1397.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52916","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4273.85,"discounted_cash":3590.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_52919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5629.71,"discounted_cash":4728.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5551.0,"discounted_cash":4662.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4511.0,"discounted_cash":3789.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53343","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7302.83,"discounted_cash":6134.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3876.05,"discounted_cash":3255.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3328.0,"discounted_cash":2795.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3902.0,"discounted_cash":3277.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53641","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3817.0,"discounted_cash":3206.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53645","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9963.84,"discounted_cash":8369.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53701","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":19748.75,"discounted_cash":16588.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7420.5,"discounted_cash":6233.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12639.79,"discounted_cash":10617.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53714","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4004.0,"discounted_cash":3363.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6814.08,"discounted_cash":5723.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53719","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6495.84,"discounted_cash":5456.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53751","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5432.7,"discounted_cash":4563.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53753","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53755","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3845.77,"discounted_cash":3230.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53757","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6246.0,"discounted_cash":5246.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53758","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9963.84,"discounted_cash":8369.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53906","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3510.62,"discounted_cash":2948.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5746.29,"discounted_cash":4826.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3621.08,"discounted_cash":3041.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9644.27,"discounted_cash":8101.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_53983","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9604.32,"discounted_cash":8067.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9963.84,"discounted_cash":8369.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10178.56,"discounted_cash":8549.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5763.56,"discounted_cash":4841.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54213","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2947.8,"discounted_cash":2476.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54215","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4479.17,"discounted_cash":3762.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3941.67,"discounted_cash":3311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8751.36,"discounted_cash":7351.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6065.56,"discounted_cash":5095.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54581","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4647.21,"discounted_cash":3903.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8991.04,"discounted_cash":7552.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9963.84,"discounted_cash":8369.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54661","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9927.68,"discounted_cash":8339.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4995.49,"discounted_cash":4196.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54666","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6370.92,"discounted_cash":5351.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54667","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3461.04,"discounted_cash":2907.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54668","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3461.04,"discounted_cash":2907.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4897.01,"discounted_cash":4113.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6495.84,"discounted_cash":5456.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4520.88,"discounted_cash":3797.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4450.5,"discounted_cash":3738.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10565.7,"discounted_cash":8875.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6526.98,"discounted_cash":5482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6370.92,"discounted_cash":5351.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54845","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13560.3,"discounted_cash":11390.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13560.3,"discounted_cash":11390.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54848","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54892","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.92,"discounted_cash":1090.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_54899","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_57917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4548.98,"discounted_cash":3821.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_57921","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_57922","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_57930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2623.0,"discounted_cash":2203.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_59031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2115.0,"discounted_cash":1776.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_59032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63668","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5177.15,"discounted_cash":4348.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63670","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5218.74,"discounted_cash":4383.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6214.14,"discounted_cash":5219.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63768","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5688.0,"discounted_cash":4777.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63769","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2924.0,"discounted_cash":2456.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63778","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8614.7,"discounted_cash":7236.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14906.45,"discounted_cash":12521.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63792","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9927.68,"discounted_cash":8339.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63797","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6246.0,"discounted_cash":5246.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63798","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6526.98,"discounted_cash":5482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63801","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7315.36,"discounted_cash":6144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63887","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9604.32,"discounted_cash":8067.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63888","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5177.15,"discounted_cash":4348.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63980","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63982","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5343.52,"discounted_cash":4488.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_63995","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10053.12,"discounted_cash":8444.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6065.56,"discounted_cash":5095.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6835.25,"discounted_cash":5741.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.25,"discounted_cash":3028.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64151","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5350.71,"discounted_cash":4494.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64152","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2971.6,"discounted_cash":2496.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":17905.53,"discounted_cash":15040.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64171","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3461.04,"discounted_cash":2907.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64289","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64290","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64293","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5343.52,"discounted_cash":4488.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8686.61,"discounted_cash":7296.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6814.08,"discounted_cash":5723.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10737.9,"discounted_cash":9019.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4883.86,"discounted_cash":4102.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5009.92,"discounted_cash":4208.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_64483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7173.19,"discounted_cash":6025.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_65708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_65709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7202.0,"discounted_cash":6049.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_65710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_65711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7444.67,"discounted_cash":6253.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_65712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_69594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3555.75,"discounted_cash":2986.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_69595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3499.79,"discounted_cash":2939.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_69596","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3547.5,"discounted_cash":2979.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_69597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3745.83,"discounted_cash":3146.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3669.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10185.0,"discounted_cash":8555.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72849","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4006.29,"discounted_cash":3365.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72867","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3669.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72870","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4164.0,"discounted_cash":3497.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72871","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4164.0,"discounted_cash":3497.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72872","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4164.0,"discounted_cash":3497.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72873","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3669.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72874","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3669.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5778.67,"discounted_cash":4854.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72894","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5642.67,"discounted_cash":4739.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72895","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.0,"discounted_cash":4663.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72896","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.0,"discounted_cash":4663.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72899","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":4892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72900","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5660.8,"discounted_cash":4755.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":4892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72902","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5746.29,"discounted_cash":4826.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72903","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5707.43,"discounted_cash":4794.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72904","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":4892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72926","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72945","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":4586.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72946","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":4586.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_72950","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":4586.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_73009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2592.5,"discounted_cash":2177.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_73016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2971.6,"discounted_cash":2496.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_73042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2828.8,"discounted_cash":2376.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_73043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2971.6,"discounted_cash":2496.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_73044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2939.87,"discounted_cash":2469.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_73048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4280.57,"discounted_cash":3595.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_73049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4232.0,"discounted_cash":3554.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_73073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1813.55,"discounted_cash":1523.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_73473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6823.71,"discounted_cash":5731.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_74513","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_74764","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75167","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75291","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75292","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75294","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75295","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13986.0,"discounted_cash":11748.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75296","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14275.82,"discounted_cash":11991.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75390","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4159.98,"discounted_cash":3494.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75921","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6380.01,"discounted_cash":5359.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75945","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75953","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75955","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7372.92,"discounted_cash":6193.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75957","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10135.53,"discounted_cash":8513.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_75997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10135.53,"discounted_cash":8513.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_76006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10135.53,"discounted_cash":8513.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_76064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_76104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_76106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_76147","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_76156","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_76178","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_76265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_77595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6743.1,"discounted_cash":5664.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_77818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1966.5,"discounted_cash":1651.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_77842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1966.5,"discounted_cash":1651.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_78201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14825.16,"discounted_cash":12453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_78262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14825.16,"discounted_cash":12453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_78696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4533.44,"discounted_cash":3808.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_78699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4986.44,"discounted_cash":4188.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_78779","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_78847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7302.83,"discounted_cash":6134.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_78868","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6814.08,"discounted_cash":5723.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_78871","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4004.0,"discounted_cash":3363.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_78872","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6552.0,"discounted_cash":5503.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":18453.75,"discounted_cash":15501.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":5274.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5291.75,"discounted_cash":4445.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13286.7,"discounted_cash":11160.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7535.74,"discounted_cash":6330.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79358","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9002.5,"discounted_cash":7562.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4598.47,"discounted_cash":3862.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5218.74,"discounted_cash":4383.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5343.52,"discounted_cash":4488.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5343.52,"discounted_cash":4488.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4563.19,"discounted_cash":3833.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9382.93,"discounted_cash":7881.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3817.0,"discounted_cash":3206.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79776","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79778","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5218.74,"discounted_cash":4383.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4377.1,"discounted_cash":3676.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79943","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6495.84,"discounted_cash":5456.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79944","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13889.7,"discounted_cash":11667.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_79945","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4520.88,"discounted_cash":3797.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9277.45,"discounted_cash":7793.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80341","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.25,"discounted_cash":4016.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80346","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9484.48,"discounted_cash":7966.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80347","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4004.0,"discounted_cash":3363.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15562.42,"discounted_cash":13072.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6399.0,"discounted_cash":5375.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7051.77,"discounted_cash":5923.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2185.0,"discounted_cash":1835.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80771","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3928.04,"discounted_cash":3299.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6191.22,"discounted_cash":5200.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10221.3,"discounted_cash":8585.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80894","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4004.0,"discounted_cash":3363.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80896","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6814.08,"discounted_cash":5723.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_80940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81088","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9927.68,"discounted_cash":8339.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":19748.75,"discounted_cash":16588.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6266.3,"discounted_cash":5263.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81184","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":23853.9,"discounted_cash":20037.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13286.7,"discounted_cash":11160.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81359","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6654.96,"discounted_cash":5590.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3328.0,"discounted_cash":2795.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6708.0,"discounted_cash":5634.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6246.0,"discounted_cash":5246.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7420.5,"discounted_cash":6233.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81722","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4511.0,"discounted_cash":3789.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9927.68,"discounted_cash":8339.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81872","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81875","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_81876","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_82142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4004.0,"discounted_cash":3363.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_82185","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13010.09,"discounted_cash":10928.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_82247","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7280.0,"discounted_cash":6115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_82545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9963.84,"discounted_cash":8369.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_82875","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_83023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13560.3,"discounted_cash":11390.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_83039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":19636.5,"discounted_cash":16494.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_83320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10791.92,"discounted_cash":9065.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_83327","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5343.52,"discounted_cash":4488.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_83695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_84923","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2799.72,"discounted_cash":2351.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_85294","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6552.0,"discounted_cash":5503.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_85819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_85830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5343.52,"discounted_cash":4488.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_85831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6224.4,"discounted_cash":5228.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_86651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3817.0,"discounted_cash":3206.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_86659","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6246.0,"discounted_cash":5246.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_86759","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9230.0,"discounted_cash":7753.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_86760","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9457.5,"discounted_cash":7944.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_87048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_87914","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_87928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4932.2,"discounted_cash":4143.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_87930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6795.1,"discounted_cash":5707.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_87935","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":6355.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_87937","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7420.5,"discounted_cash":6233.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_88337","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3649.36,"discounted_cash":3065.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_88343","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_88617","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.0,"discounted_cash":4663.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_88618","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_88621","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.0,"discounted_cash":4663.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_88622","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_89149","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_89150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.0,"discounted_cash":4663.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_89152","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5660.8,"discounted_cash":4755.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_89972","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10610.14,"discounted_cash":8912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10893.57,"discounted_cash":9150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.5,"discounted_cash":8188.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.5,"discounted_cash":8188.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10621.5,"discounted_cash":8922.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90541","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5048.4,"discounted_cash":4240.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90633","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":4892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9279.5,"discounted_cash":7794.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10621.5,"discounted_cash":8922.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_90921","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12967.5,"discounted_cash":10892.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_91128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_91136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7025.81,"discounted_cash":5901.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_91137","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7033.63,"discounted_cash":5908.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_91139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_91145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_91355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7050.14,"discounted_cash":5922.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_91689","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_91832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_91835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2849.24,"discounted_cash":2393.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_92469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7165.72,"discounted_cash":6019.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_92505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6731.43,"discounted_cash":5654.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_93601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.44,"discounted_cash":1145.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_94318","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.44,"discounted_cash":1145.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_96255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6814.08,"discounted_cash":5723.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_96648","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3669.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_98691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6916.0,"discounted_cash":5809.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800015_99444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800016_21167","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":8097.5,"discounted_cash":6801.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800016_23577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":7763.14,"discounted_cash":6521.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800016_23582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":7921.08,"discounted_cash":6653.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800016_80325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":8022.31,"discounted_cash":6738.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800016_82897","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":7368.2,"discounted_cash":6189.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800016_88647","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":7479.0,"discounted_cash":6282.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800017_23656","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800017_30502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":9199.2,"discounted_cash":7727.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800017_32290","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":17612.0,"discounted_cash":14794.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800017_5376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800017_63774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.3,"discounted_cash":236.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800017_64135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":8864.0,"discounted_cash":7445.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800017_82483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":1435.2,"discounted_cash":1205.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800017_82485","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":9282.27,"discounted_cash":7797.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_10597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.68,"discounted_cash":362.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_10598","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.86,"discounted_cash":377.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_10599","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1672.84,"discounted_cash":1405.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_10607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2228.7,"discounted_cash":1872.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_10781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1159.8,"discounted_cash":974.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_10866","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1556.21,"discounted_cash":1307.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_11187","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.2,"discounted_cash":859.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_11252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.37,"discounted_cash":1028.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_11253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1438.68,"discounted_cash":1208.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_11284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1213.36,"discounted_cash":1019.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_27781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.01,"discounted_cash":338.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_27782","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1323.05,"discounted_cash":1111.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_30341","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.6,"discounted_cash":233.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_30794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4819.0,"discounted_cash":4047.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_30795","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3352.69,"discounted_cash":2816.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_31781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2149.46,"discounted_cash":1805.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_31782","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":1848.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_32216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.74,"discounted_cash":2382.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_32950","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3550.51,"discounted_cash":2982.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_32951","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2977.66,"discounted_cash":2501.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_33284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3566.35,"discounted_cash":2995.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_33562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2067.65,"discounted_cash":1736.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_33594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.97,"discounted_cash":1075.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_36581","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3510.62,"discounted_cash":2948.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_36755","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":38205.47,"discounted_cash":32092.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_36763","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2088.96,"discounted_cash":1754.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_36764","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":46430.67,"discounted_cash":39001.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_44385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.87,"discounted_cash":966.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_44696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":23240.23,"discounted_cash":19521.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_48899","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":10440.5,"discounted_cash":8770.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_48900","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":30892.23,"discounted_cash":25949.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_49181","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":16588.8,"discounted_cash":13934.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_49184","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":8974.8,"discounted_cash":7538.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_49185","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":9428.4,"discounted_cash":7919.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_49826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":6830.1,"discounted_cash":5737.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_50536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.67,"discounted_cash":1160.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_51106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1273.28,"discounted_cash":1069.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_51272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1738.6,"discounted_cash":1460.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_51490","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2129.2,"discounted_cash":1788.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_51544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4694.11,"discounted_cash":3943.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_51545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3787.5,"discounted_cash":3181.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_51546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":5716.98,"discounted_cash":4802.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_51547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":6833.06,"discounted_cash":5739.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_51548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_51552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":7772.62,"discounted_cash":6529.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_51783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3571.16,"discounted_cash":2999.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_53922","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3891.16,"discounted_cash":3268.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_54126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3932.93,"discounted_cash":3303.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_6151","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2135.97,"discounted_cash":1794.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_63660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2540.83,"discounted_cash":2134.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_63923","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.23,"discounted_cash":455.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_79041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1676.84,"discounted_cash":1408.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_79042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1590.39,"discounted_cash":1335.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_79043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.04,"discounted_cash":1401.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_79218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.41,"discounted_cash":1305.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_85299","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3543.08,"discounted_cash":2976.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_88637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_90922","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1308.02,"discounted_cash":1098.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_90923","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3172.31,"discounted_cash":2664.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_96955","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.65,"discounted_cash":532.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_96956","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.65,"discounted_cash":532.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_96962","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_96963","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_96964","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1261.92,"discounted_cash":1060.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_96965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1651.77,"discounted_cash":1387.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_96975","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.82,"discounted_cash":354.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_96976","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.26,"discounted_cash":1151.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_96977","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1575.78,"discounted_cash":1323.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_96978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.19,"discounted_cash":2925.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_97629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800018_97631","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800019_94686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.93,"discounted_cash":697.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800019_94702","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800019_97091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.6,"discounted_cash":154.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800020_30138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1760.64,"discounted_cash":1478.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800020_32299","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1791.67,"discounted_cash":1505.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800020_32749","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.62,"discounted_cash":1492.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800020_6633","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1809.21,"discounted_cash":1519.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_63756","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4736.55,"discounted_cash":3978.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_80205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4736.55,"discounted_cash":3978.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_80556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4736.55,"discounted_cash":3978.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_80642","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4968.6,"discounted_cash":4173.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_81158","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4968.6,"discounted_cash":4173.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_81457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4968.6,"discounted_cash":4173.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_83332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4968.6,"discounted_cash":4173.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_84894","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4852.58,"discounted_cash":4076.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_88881","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4852.58,"discounted_cash":4076.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_91349","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_93156","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800021_95161","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4968.6,"discounted_cash":4173.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800022_45021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":45034.0,"discounted_cash":37828.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800022_64136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":23835.5,"discounted_cash":20021.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800022_87358","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":48384.0,"discounted_cash":40642.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800023_24299","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1821","type":"HCPCS"}],"standard_charges":[{"gross_charge":14504.0,"discounted_cash":12183.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800023_30506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1821","type":"HCPCS"}],"standard_charges":[{"gross_charge":4077.25,"discounted_cash":3424.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800023_51734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1821","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.85,"discounted_cash":209.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800023_52159","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1821","type":"HCPCS"}],"standard_charges":[{"gross_charge":7073.26,"discounted_cash":5941.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800023_81081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1821","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3669.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_11788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10661.9,"discounted_cash":8956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_11790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_21892","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7377.6,"discounted_cash":6197.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_22789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_23384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":24479.64,"discounted_cash":20562.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_23927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_23932","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10713.9,"discounted_cash":8999.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_23934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":25060.19,"discounted_cash":21050.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_23937","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":24067.88,"discounted_cash":20217.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_23940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_23944","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_25133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_26808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":18907.0,"discounted_cash":15881.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27800024_26943","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_27269","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":81575.0,"discounted_cash":68523.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_29533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7066.16,"discounted_cash":5935.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_29534","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7234.74,"discounted_cash":6077.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_30881","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10748.58,"discounted_cash":9028.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_30882","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10748.58,"discounted_cash":9028.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_30884","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10699.04,"discounted_cash":8987.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_30885","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10791.92,"discounted_cash":9065.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_30886","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":24769.92,"discounted_cash":20806.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_30891","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10661.9,"discounted_cash":8956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_32015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6882.68,"discounted_cash":5781.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_32399","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":24673.16,"discounted_cash":20725.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_32400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":23899.1,"discounted_cash":20075.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_32401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_32948","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11197.02,"discounted_cash":9405.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_32949","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_36162","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10575.21,"discounted_cash":8883.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_36658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":17417.75,"discounted_cash":14630.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_48455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7120.49,"discounted_cash":5981.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_48456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7160.69,"discounted_cash":6014.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_48457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7499.55,"discounted_cash":6299.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_48458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7430.35,"discounted_cash":6241.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_48459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8221.8,"discounted_cash":6906.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_48460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7142.1,"discounted_cash":5999.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_48461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7142.6,"discounted_cash":5999.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_48462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7499.55,"discounted_cash":6299.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_48463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7369.8,"discounted_cash":6190.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_48464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8154.25,"discounted_cash":6849.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1485.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.7,"discounted_cash":1515.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.4,"discounted_cash":1545.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.62,"discounted_cash":1522.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1485.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.62,"discounted_cash":1522.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1806.25,"discounted_cash":1517.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1790.31,"discounted_cash":1503.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.4,"discounted_cash":1545.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1485.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.48,"discounted_cash":1537.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49088","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1797.75,"discounted_cash":1510.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49089","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1485.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.4,"discounted_cash":1545.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1790.31,"discounted_cash":1503.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49096","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1823.78,"discounted_cash":1531.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49097","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1842.38,"discounted_cash":1547.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49098","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1827.5,"discounted_cash":1535.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1834.94,"discounted_cash":1541.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1797.75,"discounted_cash":1510.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1797.75,"discounted_cash":1510.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.62,"discounted_cash":1522.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.4,"discounted_cash":1545.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1834.94,"discounted_cash":1541.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1485.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.62,"discounted_cash":1522.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1844.5,"discounted_cash":1549.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1817.58,"discounted_cash":1526.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1827.5,"discounted_cash":1535.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.4,"discounted_cash":1545.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1485.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1806.25,"discounted_cash":1517.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49119","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1821.55,"discounted_cash":1530.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.62,"discounted_cash":1522.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_49123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.25,"discounted_cash":1560.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_51055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_51088","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1872.0,"discounted_cash":1572.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_51732","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10661.9,"discounted_cash":8956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_51733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_53912","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":82225.0,"discounted_cash":69069.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_79045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":21238.0,"discounted_cash":17839.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_79046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":20760.65,"discounted_cash":17438.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_79047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":21049.23,"discounted_cash":17681.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_79048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":21238.0,"discounted_cash":17839.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_79049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":21238.0,"discounted_cash":17839.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_81408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11295.77,"discounted_cash":9488.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_81527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6221.25,"discounted_cash":5225.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_82559","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10552.89,"discounted_cash":8864.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_82560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10648.99,"discounted_cash":8945.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1748.0,"discounted_cash":1468.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1748.0,"discounted_cash":1468.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1872.0,"discounted_cash":1572.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1748.0,"discounted_cash":1468.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1583.3,"discounted_cash":1329.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1666.5,"discounted_cash":1399.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.44,"discounted_cash":1341.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1605.94,"discounted_cash":1348.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83814","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1583.3,"discounted_cash":1329.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83817","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.0,"discounted_cash":1264.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1666.08,"discounted_cash":1399.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1524.32,"discounted_cash":1280.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1605.94,"discounted_cash":1348.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1527.94,"discounted_cash":1283.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.12,"discounted_cash":1269.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.14,"discounted_cash":1273.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1621.19,"discounted_cash":1361.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1643.67,"discounted_cash":1380.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1586.58,"discounted_cash":1332.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83829","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1558.76,"discounted_cash":1309.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1666.5,"discounted_cash":1399.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1580.46,"discounted_cash":1327.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1501.94,"discounted_cash":1261.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.15,"discounted_cash":1311.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1509.71,"discounted_cash":1268.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1571.41,"discounted_cash":1319.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1524.91,"discounted_cash":1280.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1600.2,"discounted_cash":1344.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1616.86,"discounted_cash":1358.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1526.82,"discounted_cash":1282.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83844","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83845","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1507.45,"discounted_cash":1266.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1540.59,"discounted_cash":1294.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1556.27,"discounted_cash":1307.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83848","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.68,"discounted_cash":1290.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83849","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.12,"discounted_cash":1313.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83850","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1619.17,"discounted_cash":1360.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83889","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.75,"discounted_cash":1341.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83890","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.6,"discounted_cash":1333.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83891","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.75,"discounted_cash":1253.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83892","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1480.5,"discounted_cash":1243.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83894","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83895","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.12,"discounted_cash":1269.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83897","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1519.0,"discounted_cash":1275.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83898","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.75,"discounted_cash":1253.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83902","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83904","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83908","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83909","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_83910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_84514","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1586.58,"discounted_cash":1332.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_84941","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9141.0,"discounted_cash":7678.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_85794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_86346","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1568.6,"discounted_cash":1317.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_86350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7501.98,"discounted_cash":6301.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_87404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7123.69,"discounted_cash":5983.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_87808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_89669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13077.91,"discounted_cash":10985.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_89670","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":12057.56,"discounted_cash":10128.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_90886","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7165.72,"discounted_cash":6019.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91269","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10661.9,"discounted_cash":8956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":14188.41,"discounted_cash":11918.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":14219.1,"discounted_cash":11944.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":14219.1,"discounted_cash":11944.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":39388.72,"discounted_cash":33086.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":39388.72,"discounted_cash":33086.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":39388.72,"discounted_cash":33086.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91720","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7194.61,"discounted_cash":6043.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_91962","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9562.26,"discounted_cash":8032.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92151","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10697.16,"discounted_cash":8985.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10697.16,"discounted_cash":8985.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92672","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_92673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800024_97403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15545.96,"discounted_cash":13058.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27800024_C1874_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1651.8,"discounted_cash":1387.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_11755","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4914.0,"discounted_cash":4127.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_26967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.33,"discounted_cash":1134.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_27164","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_27166","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4095.0,"discounted_cash":3439.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_27192","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_27196","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_27199","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4049.82,"discounted_cash":3401.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_29057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3451.03,"discounted_cash":2898.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_29094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_29095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_29101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_29102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_29174","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.96,"discounted_cash":2985.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_29176","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3450.77,"discounted_cash":2898.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_29249","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3637.96,"discounted_cash":3055.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_30424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_30430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3481.64,"discounted_cash":2924.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_30431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_30449","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_30450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3496.0,"discounted_cash":2936.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_30451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_31363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3772.2,"discounted_cash":3168.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_31367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3454.07,"discounted_cash":2901.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_31370","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_31397","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3352.62,"discounted_cash":2816.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_32040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_37833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_53864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7805.83,"discounted_cash":6556.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_53865","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7683.98,"discounted_cash":6454.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_53866","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7903.64,"discounted_cash":6639.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_53867","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7965.97,"discounted_cash":6691.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_53868","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7970.77,"discounted_cash":6695.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_53869","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7794.14,"discounted_cash":6547.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_53870","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7807.16,"discounted_cash":6558.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_53871","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7683.98,"discounted_cash":6454.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_79952","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.12,"discounted_cash":294.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_81133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6916.0,"discounted_cash":5809.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_81134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6593.0,"discounted_cash":5538.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_81658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8619.51,"discounted_cash":7240.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_86414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3999.38,"discounted_cash":3359.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_88788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6072.5,"discounted_cash":5100.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_90082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7599.87,"discounted_cash":6383.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800025_95988","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6552.0,"discounted_cash":5503.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800026_30160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.97,"discounted_cash":4080.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800026_32332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":6694.41,"discounted_cash":5623.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800026_32333","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":6485.66,"discounted_cash":5447.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800027_33864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":8075.65,"discounted_cash":6783.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800028_49999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1896","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27800028_C1896_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1896","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800029_22990","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3669.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800029_5378","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.5,"discounted_cash":1284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800029_63775","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_21170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1598.45,"discounted_cash":1342.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_29328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1577.64,"discounted_cash":1325.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_29329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1576.5,"discounted_cash":1324.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_30494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1477.06,"discounted_cash":1240.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_30877","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1477.06,"discounted_cash":1240.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_30996","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.55,"discounted_cash":1263.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_30997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1396.51,"discounted_cash":1173.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_33956","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1580.13,"discounted_cash":1327.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_35364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.6,"discounted_cash":1083.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_54279","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2946.45,"discounted_cash":2475.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_82090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1248.0,"discounted_cash":1048.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_86819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1574.31,"discounted_cash":1322.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800030_94320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1643.2,"discounted_cash":1380.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27800030_C1898_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1643.2,"discounted_cash":1380.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800031_21401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4138.68,"discounted_cash":3476.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800031_23676","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":5054.96,"discounted_cash":4246.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800031_24702","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4138.68,"discounted_cash":3476.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800031_35657","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":6916.0,"discounted_cash":5809.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800031_50328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800031_51765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":6409.17,"discounted_cash":5383.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800031_52190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":7107.93,"discounted_cash":5970.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800031_54917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":5737.28,"discounted_cash":4819.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800031_8752","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4193.28,"discounted_cash":3522.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800031_99914","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":6916.0,"discounted_cash":5809.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Pharmacy","code_information":[{"code":"27800031_C1900_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_10100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.78,"discounted_cash":395.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_10103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.38,"discounted_cash":485.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_10106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.38,"discounted_cash":485.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_10115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.38,"discounted_cash":485.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_10116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.62,"discounted_cash":497.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_10117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.62,"discounted_cash":497.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_10119","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.78,"discounted_cash":395.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_12016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.16,"discounted_cash":562.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_12017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.45,"discounted_cash":618.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_24326","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_24327","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_24331","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.76,"discounted_cash":409.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_24338","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.55,"discounted_cash":373.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_47853","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.54,"discounted_cash":420.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_48369","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_54556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.9,"discounted_cash":213.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_5528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.38,"discounted_cash":485.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_5529","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.4,"discounted_cash":490.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_5530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.7,"discounted_cash":490.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_5531","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.69,"discounted_cash":492.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_5674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.55,"discounted_cash":422.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_80794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.63,"discounted_cash":730.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_80795","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.41,"discounted_cash":710.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_80796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":848.74,"discounted_cash":712.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_81405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.44,"discounted_cash":218.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_83247","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.17,"discounted_cash":216.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_84260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.45,"discounted_cash":233.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_85865","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.38,"discounted_cash":233.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_87809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.45,"discounted_cash":456.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_89694","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.68,"discounted_cash":230.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_89695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":237.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800032_90026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":237.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_21432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.72,"discounted_cash":332.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_21888","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.27,"discounted_cash":711.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_21889","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.25,"discounted_cash":709.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_24870","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.49,"discounted_cash":829.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_24878","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.06,"discounted_cash":640.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_24880","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.81,"discounted_cash":521.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_24888","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.77,"discounted_cash":503.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_31780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.72,"discounted_cash":583.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_33752","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.95,"discounted_cash":584.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_34721","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.06,"discounted_cash":455.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_34722","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.64,"discounted_cash":450.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_45080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.72,"discounted_cash":703.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_5532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_5533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_79651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.69,"discounted_cash":624.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_83916","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.99,"discounted_cash":466.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_83917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.99,"discounted_cash":466.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_84258","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.2,"discounted_cash":635.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_84323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.58,"discounted_cash":649.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_84901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.14,"discounted_cash":456.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_86558","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.16,"discounted_cash":566.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_89242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.0,"discounted_cash":582.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800033_C2625_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.72,"discounted_cash":583.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800034_11306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9363","type":"HCPCS"}],"standard_charges":[{"gross_charge":13114.56,"discounted_cash":11016.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800034_11307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9363","type":"HCPCS"}],"standard_charges":[{"gross_charge":20239.05,"discounted_cash":17000.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800036_86756","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8606","type":"HCPCS"}],"standard_charges":[{"gross_charge":4131.69,"discounted_cash":3470.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800040_47602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1883","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.7,"discounted_cash":287.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800042_37814","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":32108.23,"discounted_cash":26970.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800042_37816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":7923.93,"discounted_cash":6656.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800042_49516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":32108.23,"discounted_cash":26970.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800042_52125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":30620.59,"discounted_cash":25721.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800042_82873","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":6043.5,"discounted_cash":5076.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800042_94166","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800042_96478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800046_16510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1878","type":"HCPCS"}],"standard_charges":[{"gross_charge":3124.55,"discounted_cash":2624.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27800046_50420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1878","type":"HCPCS"}],"standard_charges":[{"gross_charge":2950.13,"discounted_cash":2478.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2600.15,"discounted_cash":2184.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100096","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.33,"discounted_cash":608.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100097","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100098","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.72,"discounted_cash":1098.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.72,"discounted_cash":1098.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.72,"discounted_cash":1098.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2884.2,"discounted_cash":2422.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6872.32,"discounted_cash":5772.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7170.8,"discounted_cash":6023.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100904","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":342.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100905","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100907","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100915","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1502.84,"discounted_cash":1262.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100920","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.05,"discounted_cash":605.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100921","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100922","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4105.92,"discounted_cash":3448.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100926","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4116","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3487.26,"discounted_cash":2929.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100929","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1345.39,"discounted_cash":1130.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100941","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.11,"discounted_cash":150.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100942","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3172.62,"discounted_cash":2665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100944","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100948","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100949","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100950","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100954","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100956","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5891.34,"discounted_cash":4948.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100957","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100958","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3487.26,"discounted_cash":2929.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100961","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4105.92,"discounted_cash":3448.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100962","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100963","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100966","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.95,"discounted_cash":1596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4949.49,"discounted_cash":4157.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100968","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4586.4,"discounted_cash":3852.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100969","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5998.72,"discounted_cash":5038.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10715.35,"discounted_cash":9000.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100976","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.22,"discounted_cash":654.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100977","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5525.52,"discounted_cash":4641.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2392.58,"discounted_cash":2009.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100979","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.33,"discounted_cash":673.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100980","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5891.34,"discounted_cash":4948.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100981","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100982","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.35,"discounted_cash":156.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100983","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":298.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100984","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100985","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2753.1,"discounted_cash":2312.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100986","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2971.6,"discounted_cash":2496.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100987","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1813.55,"discounted_cash":1523.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100988","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100989","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5219.76,"discounted_cash":4384.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100990","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5749.38,"discounted_cash":4829.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100991","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3172.62,"discounted_cash":2665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100995","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100996","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.48,"discounted_cash":1850.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_100997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101219","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.24,"discounted_cash":557.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3808.9,"discounted_cash":3199.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6683.04,"discounted_cash":5613.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101227","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.81,"discounted_cash":775.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101397","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4105.92,"discounted_cash":3448.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101399","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":17964.24,"discounted_cash":15089.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5716.62,"discounted_cash":4801.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.69,"discounted_cash":689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101649","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101650","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6440.83,"discounted_cash":5410.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":935.18,"discounted_cash":785.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":21238.0,"discounted_cash":17839.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.93,"discounted_cash":1427.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101688","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.1,"discounted_cash":175.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101692","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5096.0,"discounted_cash":4280.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101693","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.84,"discounted_cash":665.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101694","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":298.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":298.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101698","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4469.92,"discounted_cash":3754.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4469.92,"discounted_cash":3754.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101701","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101702","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6890.52,"discounted_cash":5788.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.24,"discounted_cash":557.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.87,"discounted_cash":554.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_101712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.03,"discounted_cash":803.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_102145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_10781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1206.12,"discounted_cash":1013.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_11208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1835.4,"discounted_cash":1541.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_12601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":5692.74,"discounted_cash":4781.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_15425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.22,"discounted_cash":668.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_21630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2828.8,"discounted_cash":2376.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_23931","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3989.63,"discounted_cash":3351.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_26495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.05,"discounted_cash":605.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_278","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18907.0,"discounted_cash":15881.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_28057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9767.02,"discounted_cash":8204.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_28087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10260.66,"discounted_cash":8618.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_30506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4277.0,"discounted_cash":3592.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_30754","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_30764","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_31887","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":4586.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_32074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3355.12,"discounted_cash":2818.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_32831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4006.29,"discounted_cash":3365.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_35580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2075.75,"discounted_cash":1743.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_35788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6778.64,"discounted_cash":5694.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_36530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_37767","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6006.0,"discounted_cash":5045.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_39386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3581.04,"discounted_cash":3008.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_43016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_43095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_43097","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7280.0,"discounted_cash":6115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_43532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10124.35,"discounted_cash":8504.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_45041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2939.92,"discounted_cash":2469.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_45184","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.25,"discounted_cash":1927.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_46979","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_48446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.46,"discounted_cash":579.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_48479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.5,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_48519","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.17,"discounted_cash":517.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_48521","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.33,"discounted_cash":608.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_48524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.24,"discounted_cash":557.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_49148","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_49168","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6551.36,"discounted_cash":5503.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_49802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2630.37,"discounted_cash":2209.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_50020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7173.19,"discounted_cash":6025.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_50067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_50223","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_50811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.5,"discounted_cash":149.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_50832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.5,"discounted_cash":600.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_50833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_50834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_50838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_50901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.94,"discounted_cash":594.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_51139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4000.36,"discounted_cash":3360.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_51177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12407.3,"discounted_cash":10422.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_51203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.04,"discounted_cash":415.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_51726","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_52100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9609.98,"discounted_cash":8072.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_52133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.45,"discounted_cash":635.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_52234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.45,"discounted_cash":635.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_52427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.3,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_52807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4684.5,"discounted_cash":3934.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_52916","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_52918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.3,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_53114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.59,"discounted_cash":392.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_53148","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2185.0,"discounted_cash":1835.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_53149","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.76,"discounted_cash":715.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_53697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2075.75,"discounted_cash":1743.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_53712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10737.9,"discounted_cash":9019.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_53715","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3461.04,"discounted_cash":2907.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_53920","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.3,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_54099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.08,"discounted_cash":2143.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_54668","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6551.36,"discounted_cash":5503.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_54671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6814.08,"discounted_cash":5723.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_54837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3294.72,"discounted_cash":2767.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_54838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3294.72,"discounted_cash":2767.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_63674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6362.72,"discounted_cash":5344.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_63758","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15561.0,"discounted_cash":13071.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_63768","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.0,"discounted_cash":4663.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_63789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7185.66,"discounted_cash":6035.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_64475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2062.64,"discounted_cash":1732.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_65464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.42,"discounted_cash":157.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_65540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.56,"discounted_cash":1082.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_65594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3166.8,"discounted_cash":2660.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_69595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3432.0,"discounted_cash":2882.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_70192","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4122","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_70241","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6593.0,"discounted_cash":5538.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_70242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6593.0,"discounted_cash":5538.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_70260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_70449","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_70687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6922.65,"discounted_cash":5815.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_70697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_70918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.2,"discounted_cash":1030.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_71051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.75,"discounted_cash":305.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_71160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.74,"discounted_cash":423.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_71316","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.7,"discounted_cash":403.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_71373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.2,"discounted_cash":1030.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_72786","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7420.5,"discounted_cash":6233.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_72787","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7420.5,"discounted_cash":6233.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_72911","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_72952","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5205.0,"discounted_cash":4372.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_73048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5722.64,"discounted_cash":4807.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_73065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1726.4,"discounted_cash":1450.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_73089","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4164.0,"discounted_cash":3497.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_73362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_73363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_73473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6673.75,"discounted_cash":5605.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_73818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.15,"discounted_cash":1082.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_74764","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_75267","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_77854","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_78847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7671.92,"discounted_cash":6444.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_79077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6683.04,"discounted_cash":5613.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_79215","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18907.0,"discounted_cash":15881.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_79238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_79468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15437.5,"discounted_cash":12967.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_79831","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8659","type":"HCPCS"}],"standard_charges":[{"gross_charge":5122.39,"discounted_cash":4302.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_80126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_80341","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5183.36,"discounted_cash":4354.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_80782","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6065.56,"discounted_cash":5095.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_80785","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5343.52,"discounted_cash":4488.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_80995","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.78,"discounted_cash":712.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81161","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5122.39,"discounted_cash":4302.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81166","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15437.5,"discounted_cash":12967.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81348","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4823.0,"discounted_cash":4051.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6246.0,"discounted_cash":5246.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5465.25,"discounted_cash":4590.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8310.0,"discounted_cash":6980.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.46,"discounted_cash":579.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81576","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81723","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2185.0,"discounted_cash":1835.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81855","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81856","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.87,"discounted_cash":554.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_81880","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_82048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_82049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.33,"discounted_cash":608.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_82051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.94,"discounted_cash":594.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_82052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.92,"discounted_cash":581.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_82056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4914.0,"discounted_cash":4127.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_82057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_82185","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13010.09,"discounted_cash":10928.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_82507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_82949","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_82954","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8730.0,"discounted_cash":7333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_83027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7458.33,"discounted_cash":6265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_83232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":2142.4,"discounted_cash":1799.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_83234","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4309.74,"discounted_cash":3620.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_83319","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2730.16,"discounted_cash":2293.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_84271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7671.92,"discounted_cash":6444.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_85831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3176.48,"discounted_cash":2668.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_86257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4280.57,"discounted_cash":3595.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_86258","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2924.0,"discounted_cash":2456.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_86483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16317.0,"discounted_cash":13706.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_86486","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.15,"discounted_cash":715.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_86487","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.15,"discounted_cash":715.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_86493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.72,"discounted_cash":1098.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_86497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.72,"discounted_cash":1098.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_86658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":17964.24,"discounted_cash":15089.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_87910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.62,"discounted_cash":512.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_87914","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_87934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4004.0,"discounted_cash":3363.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_87938","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2849.24,"discounted_cash":2393.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1307.72,"discounted_cash":1098.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.33,"discounted_cash":608.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88339","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4309.74,"discounted_cash":3620.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88399","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.5,"discounted_cash":628.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.16,"discounted_cash":430.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88617","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88621","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.0,"discounted_cash":4663.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_88622","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89157","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4975.98,"discounted_cash":4179.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.49,"discounted_cash":137.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5441.8,"discounted_cash":4571.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.33,"discounted_cash":143.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89558","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.3,"discounted_cash":1020.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89715","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.52,"discounted_cash":1042.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.3,"discounted_cash":675.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89729","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6645.92,"discounted_cash":5582.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89747","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89797","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.22,"discounted_cash":668.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3059.0,"discounted_cash":2569.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89817","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6972.42,"discounted_cash":5856.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.16,"discounted_cash":150.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.16,"discounted_cash":150.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.16,"discounted_cash":430.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.21,"discounted_cash":1114.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.65,"discounted_cash":281.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.04,"discounted_cash":1202.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_89843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2075.75,"discounted_cash":1743.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.65,"discounted_cash":439.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.23,"discounted_cash":253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3487.26,"discounted_cash":2929.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.66,"discounted_cash":700.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.66,"discounted_cash":700.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5097.87,"discounted_cash":4282.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6972.42,"discounted_cash":5856.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.69,"discounted_cash":689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8877.85,"discounted_cash":7457.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.92,"discounted_cash":915.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.6,"discounted_cash":559.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.6,"discounted_cash":559.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_90997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.51,"discounted_cash":155.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6970.6,"discounted_cash":5855.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.02,"discounted_cash":121.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.35,"discounted_cash":372.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.41,"discounted_cash":485.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.98,"discounted_cash":497.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.02,"discounted_cash":121.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.26,"discounted_cash":290.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7170.8,"discounted_cash":6023.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9151.22,"discounted_cash":7687.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.29,"discounted_cash":547.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1343.68,"discounted_cash":1128.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91358","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91359","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.08,"discounted_cash":482.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91368","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4360.72,"discounted_cash":3663.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.41,"discounted_cash":282.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6646.78,"discounted_cash":5583.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91378","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6809.6,"discounted_cash":5720.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91689","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91786","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3817.0,"discounted_cash":3206.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91787","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.22,"discounted_cash":668.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.6,"discounted_cash":908.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.6,"discounted_cash":908.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.7,"discounted_cash":1361.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91791","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3505.83,"discounted_cash":2944.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91793","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.19,"discounted_cash":947.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91797","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91798","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91799","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5616.2,"discounted_cash":4717.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5615.12,"discounted_cash":4716.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91801","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2111.18,"discounted_cash":1773.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.08,"discounted_cash":482.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.08,"discounted_cash":482.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.27,"discounted_cash":155.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.64,"discounted_cash":307.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.41,"discounted_cash":282.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.64,"discounted_cash":160.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1792.96,"discounted_cash":1506.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1792.96,"discounted_cash":1506.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.55,"discounted_cash":409.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.55,"discounted_cash":409.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.5,"discounted_cash":635.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91814","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.55,"discounted_cash":409.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.44,"discounted_cash":861.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.44,"discounted_cash":861.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91817","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.44,"discounted_cash":861.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.44,"discounted_cash":861.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.44,"discounted_cash":861.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.32,"discounted_cash":883.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":863.4,"discounted_cash":725.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9556.5,"discounted_cash":8027.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10153.0,"discounted_cash":8528.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17155.41,"discounted_cash":14410.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.29,"discounted_cash":184.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.94,"discounted_cash":361.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.0,"discounted_cash":4663.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2870.4,"discounted_cash":2411.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.32,"discounted_cash":2278.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3057.6,"discounted_cash":2568.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3518.58,"discounted_cash":2955.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_91841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.96,"discounted_cash":4278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92470","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":698.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":698.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.79,"discounted_cash":633.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5480.86,"discounted_cash":4603.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6646.78,"discounted_cash":5583.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6646.78,"discounted_cash":5583.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.16,"discounted_cash":2143.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92485","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.69,"discounted_cash":689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92487","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2798.02,"discounted_cash":2350.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92488","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.7,"discounted_cash":149.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92489","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.29,"discounted_cash":123.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92490","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.66,"discounted_cash":112.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92491","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.7,"discounted_cash":414.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92492","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3319.68,"discounted_cash":2788.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.44,"discounted_cash":861.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.85,"discounted_cash":913.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92496","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.44,"discounted_cash":861.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.44,"discounted_cash":861.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92498","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1817.55,"discounted_cash":1526.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92499","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.58,"discounted_cash":181.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92501","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4125","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.05,"discounted_cash":605.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6593.0,"discounted_cash":5538.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3436.16,"discounted_cash":2886.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_92837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2288.0,"discounted_cash":1921.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.22,"discounted_cash":668.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10055.1,"discounted_cash":8446.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.66,"discounted_cash":700.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93137","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.66,"discounted_cash":700.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5891.34,"discounted_cash":4948.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93141","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5570.37,"discounted_cash":4679.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93144","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6646.78,"discounted_cash":5583.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2616.58,"discounted_cash":2197.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.88,"discounted_cash":815.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93147","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3364.14,"discounted_cash":2825.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93148","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.32,"discounted_cash":883.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93149","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.98,"discounted_cash":918.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93150","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1410.24,"discounted_cash":1184.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93151","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8747.2,"discounted_cash":7347.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93156","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4174.41,"discounted_cash":3506.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93159","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.85,"discounted_cash":8737.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4191.76,"discounted_cash":3521.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.92,"discounted_cash":1090.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2681.0,"discounted_cash":2252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.75,"discounted_cash":182.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5411.5,"discounted_cash":4545.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.58,"discounted_cash":181.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.07,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93860","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.29,"discounted_cash":123.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.48,"discounted_cash":731.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93906","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6809.6,"discounted_cash":5720.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93909","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":8968.27,"discounted_cash":7533.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_93910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9399","type":"HCPCS"}],"standard_charges":[{"gross_charge":10046.79,"discounted_cash":8439.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94163","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2622","type":"HCPCS"}],"standard_charges":[{"gross_charge":28506.27,"discounted_cash":23945.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94166","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94167","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":8071.78,"discounted_cash":6780.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2583.36,"discounted_cash":2170.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.4,"discounted_cash":2236.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94171","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.4,"discounted_cash":2236.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94174","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94175","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.29,"discounted_cash":123.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94176","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.22,"discounted_cash":668.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94177","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":577.41,"discounted_cash":485.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94178","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":577.41,"discounted_cash":485.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94183","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2774.72,"discounted_cash":2330.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94185","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.21,"discounted_cash":677.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.57,"discounted_cash":5825.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.55,"discounted_cash":338.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94369","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94370","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.28,"discounted_cash":2912.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12407.3,"discounted_cash":10422.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3319.68,"discounted_cash":2788.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7929.02,"discounted_cash":6660.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1193.01,"discounted_cash":1002.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94379","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1193.01,"discounted_cash":1002.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.16,"discounted_cash":150.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2891.2,"discounted_cash":2428.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.22,"discounted_cash":668.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94388","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6752.62,"discounted_cash":5672.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94389","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.56,"discounted_cash":283.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94390","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.33,"discounted_cash":438.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94391","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.82,"discounted_cash":492.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94392","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":959.52,"discounted_cash":806.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94393","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.77,"discounted_cash":231.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.85,"discounted_cash":167.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1915.93,"discounted_cash":1609.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6209.84,"discounted_cash":5216.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3487.26,"discounted_cash":2929.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3172.62,"discounted_cash":2665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_94712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.11,"discounted_cash":150.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95163","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.0,"discounted_cash":1676.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95164","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.12,"discounted_cash":963.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6643.0,"discounted_cash":5580.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95360","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":996.67,"discounted_cash":837.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2681.0,"discounted_cash":2252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95447","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.46,"discounted_cash":1522.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95449","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.12,"discounted_cash":963.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.0,"discounted_cash":1676.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6669.39,"discounted_cash":5602.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.86,"discounted_cash":267.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.49,"discounted_cash":128.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.16,"discounted_cash":430.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5547.36,"discounted_cash":4659.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4968.6,"discounted_cash":4173.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.98,"discounted_cash":365.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_95470","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.49,"discounted_cash":657.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8845.67,"discounted_cash":7430.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96267","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96268","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.2,"discounted_cash":904.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17327.1,"discounted_cash":14554.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96326","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8630","type":"HCPCS"}],"standard_charges":[{"gross_charge":6264.44,"discounted_cash":5262.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96327","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6916.0,"discounted_cash":5809.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.15,"discounted_cash":715.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.15,"discounted_cash":715.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96333","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7929.02,"discounted_cash":6660.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96339","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.2,"discounted_cash":587.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96342","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.39,"discounted_cash":626.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96486","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.63,"discounted_cash":142.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96487","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.63,"discounted_cash":142.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96489","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.94,"discounted_cash":408.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96490","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.78,"discounted_cash":275.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96491","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.78,"discounted_cash":275.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96492","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2429.72,"discounted_cash":2040.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1966.5,"discounted_cash":1651.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4608.93,"discounted_cash":3871.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96553","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.05,"discounted_cash":605.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96554","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.05,"discounted_cash":605.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96555","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.75,"discounted_cash":735.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.75,"discounted_cash":735.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.7,"discounted_cash":190.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.56,"discounted_cash":509.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96641","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.93,"discounted_cash":419.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96903","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4484.48,"discounted_cash":3766.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96904","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.12,"discounted_cash":347.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96905","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.12,"discounted_cash":347.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96906","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":298.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96907","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_96908","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10260.66,"discounted_cash":8618.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":4968.6,"discounted_cash":4173.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5219.76,"discounted_cash":4384.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97279","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.46,"discounted_cash":579.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97398","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97399","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97599","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10592.4,"discounted_cash":8897.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.93,"discounted_cash":1427.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.93,"discounted_cash":1427.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.93,"discounted_cash":1427.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.73,"discounted_cash":1207.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97868","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.73,"discounted_cash":1207.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97875","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":9312.0,"discounted_cash":7822.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97984","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5749.38,"discounted_cash":4829.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97986","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97988","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.75,"discounted_cash":2110.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97989","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15216.25,"discounted_cash":12781.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97991","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.75,"discounted_cash":2110.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97992","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8747.46,"discounted_cash":7347.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97993","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5733.0,"discounted_cash":4815.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5733.0,"discounted_cash":4815.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97995","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4670.12,"discounted_cash":3922.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_97996","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.2,"discounted_cash":587.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5891.34,"discounted_cash":4948.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.84,"discounted_cash":665.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7003.36,"discounted_cash":5882.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3120.18,"discounted_cash":2620.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10921.94,"discounted_cash":9174.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.01,"discounted_cash":534.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17560.2,"discounted_cash":14750.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1883.47,"discounted_cash":1582.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.2,"discounted_cash":904.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.2,"discounted_cash":904.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1212.68,"discounted_cash":1018.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.2,"discounted_cash":904.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98286","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":298.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98288","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2901.68,"discounted_cash":2437.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98289","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2901.68,"discounted_cash":2437.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98490","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7929.02,"discounted_cash":6660.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98491","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.0,"discounted_cash":1676.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98492","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1193.01,"discounted_cash":1002.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98496","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98498","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98499","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.95,"discounted_cash":1596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8715.45,"discounted_cash":7320.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4120.48,"discounted_cash":3461.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8177.1,"discounted_cash":6868.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2901.68,"discounted_cash":2437.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.35,"discounted_cash":568.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1048.8,"discounted_cash":880.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1048.8,"discounted_cash":880.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1048.8,"discounted_cash":880.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1048.8,"discounted_cash":880.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6006.0,"discounted_cash":5045.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98514","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.98,"discounted_cash":565.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.98,"discounted_cash":565.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.98,"discounted_cash":565.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7635.84,"discounted_cash":6414.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98521","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98522","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.54,"discounted_cash":795.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2392.58,"discounted_cash":2009.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5525.52,"discounted_cash":4641.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98526","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5749.38,"discounted_cash":4829.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5716.62,"discounted_cash":4801.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.49,"discounted_cash":128.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98531","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1212.68,"discounted_cash":1018.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6916.0,"discounted_cash":5809.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.88,"discounted_cash":504.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1442.1,"discounted_cash":1211.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7084.35,"discounted_cash":5950.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.24,"discounted_cash":557.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98701","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.24,"discounted_cash":557.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98702","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.28,"discounted_cash":583.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.75,"discounted_cash":642.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.68,"discounted_cash":602.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4841.2,"discounted_cash":4066.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5929.56,"discounted_cash":4980.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.8,"discounted_cash":1248.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98714","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3006.56,"discounted_cash":2525.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98717","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.16,"discounted_cash":430.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98719","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":298.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98720","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98721","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6173.44,"discounted_cash":5185.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98722","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98723","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.63,"discounted_cash":823.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98726","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4231.82,"discounted_cash":3554.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98960","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7987.95,"discounted_cash":6709.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_98961","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.33,"discounted_cash":1134.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18907.0,"discounted_cash":15881.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4660.0,"discounted_cash":3914.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.98,"discounted_cash":565.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.46,"discounted_cash":579.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.38,"discounted_cash":250.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":19766.88,"discounted_cash":16604.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.64,"discounted_cash":262.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99418","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1212.68,"discounted_cash":1018.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99419","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5749.38,"discounted_cash":4829.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.91,"discounted_cash":711.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.42,"discounted_cash":702.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.42,"discounted_cash":702.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.42,"discounted_cash":702.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6188.0,"discounted_cash":5197.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1005.1,"discounted_cash":844.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1005.1,"discounted_cash":844.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.9,"discounted_cash":624.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99428","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":440.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99429","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17319.33,"discounted_cash":14548.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6932.74,"discounted_cash":5823.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99433","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.2,"discounted_cash":904.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.2,"discounted_cash":904.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99435","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.76,"discounted_cash":723.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99436","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.58,"discounted_cash":429.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1209.48,"discounted_cash":1015.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3006.56,"discounted_cash":2525.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.45,"discounted_cash":6343.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99596","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.95,"discounted_cash":1596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6552.0,"discounted_cash":5503.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7535.74,"discounted_cash":6330.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3461.04,"discounted_cash":2907.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3461.04,"discounted_cash":2907.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6552.0,"discounted_cash":5503.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13286.7,"discounted_cash":11160.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99779","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3474.15,"discounted_cash":2918.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2871.09,"discounted_cash":2411.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.69,"discounted_cash":689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99784","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1835.4,"discounted_cash":1541.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99785","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1654.19,"discounted_cash":1389.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99786","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99787","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7281.29,"discounted_cash":6116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.88,"discounted_cash":366.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.76,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.2,"discounted_cash":904.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99791","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.2,"discounted_cash":904.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99792","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.75,"discounted_cash":735.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99793","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9690.3,"discounted_cash":8139.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.5,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99795","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4751.24,"discounted_cash":3991.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.69,"discounted_cash":2144.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.39,"discounted_cash":158.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.96,"discounted_cash":298.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.93,"discounted_cash":1427.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.73,"discounted_cash":1207.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.93,"discounted_cash":1427.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3640.65,"discounted_cash":3058.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_99815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5749.38,"discounted_cash":4829.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"27899999_C1713_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.71,"discounted_cash":1335.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Newborn Screening Panel (Hmd)","code_information":[{"code":"30000009","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":426.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Venipuncture","code_information":[{"code":"30000012","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Draw - Vad","code_information":[{"code":"30000013","type":"CDM"},{"code":"300","type":"RC"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc New Collection Blood Picc Line","code_information":[{"code":"30000014","type":"CDM"},{"code":"300","type":"RC"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Arterial Blood Gas Puncture","code_information":[{"code":"30000015","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":238.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Basic Metabolic Panel Total Ca","code_information":[{"code":"30000016","type":"CDM"},{"code":"300","type":"RC"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Comprehensive Metabolic Panel","code_information":[{"code":"30000017","type":"CDM"},{"code":"300","type":"RC"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Renal Function Panel","code_information":[{"code":"30000018","type":"CDM"},{"code":"300","type":"RC"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis Panel (A,B,C)","code_information":[{"code":"30000019","type":"CDM"},{"code":"300","type":"RC"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":272.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Amikacin","code_information":[{"code":"30000021","type":"CDM"},{"code":"300","type":"RC"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cyclosporine","code_information":[{"code":"30000022","type":"CDM"},{"code":"300","type":"RC"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"discounted_cash":492.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Gentamicin","code_information":[{"code":"30000023","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":278.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Haloperidol","code_information":[{"code":"30000024","type":"CDM"},{"code":"300","type":"RC"},{"code":"80173","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":316.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quan Lamotrigine","code_information":[{"code":"30000025","type":"CDM"},{"code":"300","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":162.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phenobarbital","code_information":[{"code":"30000026","type":"CDM"},{"code":"300","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phenytoin, Free","code_information":[{"code":"30000027","type":"CDM"},{"code":"300","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Primidone","code_information":[{"code":"30000028","type":"CDM"},{"code":"300","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Sirolimus","code_information":[{"code":"30000029","type":"CDM"},{"code":"300","type":"RC"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":326.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Tacrolimus","code_information":[{"code":"30000030","type":"CDM"},{"code":"300","type":"RC"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Topiramate","code_information":[{"code":"30000031","type":"CDM"},{"code":"300","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":165.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vancomycin","code_information":[{"code":"30000032","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":147.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Quantitative Assay Drug","code_information":[{"code":"30000033","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Alkaloids Nos","code_information":[{"code":"30000036","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":170.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Anabolic Steroid 1 Or 2","code_information":[{"code":"30000037","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":283.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Benzodiazepines1-12","code_information":[{"code":"30000038","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":276.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Fentanyl","code_information":[{"code":"30000039","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":160.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Methadone","code_information":[{"code":"30000040","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Opioids & Opiate Analogs 1/2","code_information":[{"code":"30000042","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":160.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Oxycodone","code_information":[{"code":"30000043","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Propoxyphene","code_information":[{"code":"30000044","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":194.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Stereoisomer Analysis","code_information":[{"code":"30000045","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug/Substance Nos 1-3","code_information":[{"code":"30000046","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":236.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urinalysis Nonauto W/O Scope","code_information":[{"code":"30000047","type":"CDM"},{"code":"300","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urine Pregnancy Color Compare","code_information":[{"code":"30000050","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bcr/Abl1 Gene Major Bp","code_information":[{"code":"30000051","type":"CDM"},{"code":"300","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1251.0,"discounted_cash":1050.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Braf Gene Analysis","code_information":[{"code":"30000052","type":"CDM"},{"code":"300","type":"RC"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":1038.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cftr Gene Com Variants","code_information":[{"code":"30000053","type":"CDM"},{"code":"300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.0,"discounted_cash":1054.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytogen M Array Copy No&Snp","code_information":[{"code":"30000054","type":"CDM"},{"code":"300","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":3123.0,"discounted_cash":2623.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egfr Gene Com Variants","code_information":[{"code":"30000055","type":"CDM"},{"code":"300","type":"RC"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1646.0,"discounted_cash":1382.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc F2 Gene Analysis","code_information":[{"code":"30000056","type":"CDM"},{"code":"300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":383.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc F5 Gene Analysis","code_information":[{"code":"30000057","type":"CDM"},{"code":"300","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fmr1 Gene Detection","code_information":[{"code":"30000058","type":"CDM"},{"code":"300","type":"RC"},{"code":"81243","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":317.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hemochromatosis Mutation Analysis","code_information":[{"code":"30000059","type":"CDM"},{"code":"300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":552.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Igh Gene Rearrange Amp Methodology","code_information":[{"code":"30000060","type":"CDM"},{"code":"300","type":"RC"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":199.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Igh Vari Regional Mutation","code_information":[{"code":"30000061","type":"CDM"},{"code":"300","type":"RC"},{"code":"81263","type":"HCPCS"}],"standard_charges":[{"gross_charge":1899.0,"discounted_cash":1595.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Jak2 V617F Gene Analysis","code_information":[{"code":"30000062","type":"CDM"},{"code":"300","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":885.0,"discounted_cash":743.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Kras Mutation Analysis","code_information":[{"code":"30000063","type":"CDM"},{"code":"300","type":"RC"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.0,"discounted_cash":762.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Meth 4 Hydrofolate Reduce Mutation","code_information":[{"code":"30000064","type":"CDM"},{"code":"300","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1331.0,"discounted_cash":1118.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mlh1 Gene Known Variants","code_information":[{"code":"30000065","type":"CDM"},{"code":"300","type":"RC"},{"code":"81293","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":582.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microsatellite Instability","code_information":[{"code":"30000066","type":"CDM"},{"code":"300","type":"RC"},{"code":"81301","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":438.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pml/Raralpha Com Breakpoints","code_information":[{"code":"30000067","type":"CDM"},{"code":"300","type":"RC"},{"code":"81315","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Serpina1 Gene Analysis","code_information":[{"code":"30000068","type":"CDM"},{"code":"300","type":"RC"},{"code":"81332","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla I Typing 1 Locus Lr","code_information":[{"code":"30000069","type":"CDM"},{"code":"300","type":"RC"},{"code":"81373","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":271.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla B27 Dna Typing","code_information":[{"code":"30000070","type":"CDM"},{"code":"300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla B5701 Typing","code_information":[{"code":"30000071","type":"CDM"},{"code":"300","type":"RC"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":640.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla Ii Typing 1 Allele Hr","code_information":[{"code":"30000072","type":"CDM"},{"code":"300","type":"RC"},{"code":"81383","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":569.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Molecular Pathology Procedure Level 1","code_information":[{"code":"30000073","type":"CDM"},{"code":"300","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":299.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Molecular Pathology Procedure Level 2","code_information":[{"code":"30000074","type":"CDM"},{"code":"300","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":664.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Molecular Pathology Procedure Level 3","code_information":[{"code":"30000075","type":"CDM"},{"code":"300","type":"RC"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":1042.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Molecular Pathology Procedure Level 4","code_information":[{"code":"30000076","type":"CDM"},{"code":"300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Molecular Pathology Procedure Level 5","code_information":[{"code":"30000077","type":"CDM"},{"code":"300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":350.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Molecular Pathology Procedure Level 7","code_information":[{"code":"30000078","type":"CDM"},{"code":"300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":2196.0,"discounted_cash":1844.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Unlisted Molecular Pathology","code_information":[{"code":"30000079","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":266.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Acetone Assay","code_information":[{"code":"30000080","type":"CDM"},{"code":"300","type":"RC"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Acylcarnitines Quant","code_information":[{"code":"30000081","type":"CDM"},{"code":"300","type":"RC"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":423.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Aldolase","code_information":[{"code":"30000084","type":"CDM"},{"code":"300","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Aldosterone","code_information":[{"code":"30000085","type":"CDM"},{"code":"300","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":404.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Alpha 1 Antitrypsin Total","code_information":[{"code":"30000086","type":"CDM"},{"code":"300","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":183.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Alpha-1-Antitrypsin Phenotype","code_information":[{"code":"30000087","type":"CDM"},{"code":"300","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Alpha Fetoprotein Serum","code_information":[{"code":"30000088","type":"CDM"},{"code":"300","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Aluminum","code_information":[{"code":"30000089","type":"CDM"},{"code":"300","type":"RC"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":196.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aminolevulinic Acid","code_information":[{"code":"30000090","type":"CDM"},{"code":"300","type":"RC"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Amino Acid Quan 6 Or More","code_information":[{"code":"30000091","type":"CDM"},{"code":"300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Angiotensin Ii","code_information":[{"code":"30000092","type":"CDM"},{"code":"300","type":"RC"},{"code":"82163","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":208.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Angiotensin I Enzyme Test","code_information":[{"code":"30000093","type":"CDM"},{"code":"300","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Apolipoprotein","code_information":[{"code":"30000094","type":"CDM"},{"code":"300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vitamin C","code_information":[{"code":"30000095","type":"CDM"},{"code":"300","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":169.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Atomic Absorption","code_information":[{"code":"30000096","type":"CDM"},{"code":"300","type":"RC"},{"code":"82190","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Beta-2 Protein","code_information":[{"code":"30000097","type":"CDM"},{"code":"300","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":224.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bile Acids Total","code_information":[{"code":"30000098","type":"CDM"},{"code":"300","type":"RC"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Occult Blood Other Sources","code_information":[{"code":"30000101","type":"CDM"},{"code":"300","type":"RC"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cadmium","code_information":[{"code":"30000102","type":"CDM"},{"code":"300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":240.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Calcitonin","code_information":[{"code":"30000104","type":"CDM"},{"code":"300","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc X-Ray Assay Calculus","code_information":[{"code":"30000106","type":"CDM"},{"code":"300","type":"RC"},{"code":"82370","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":169.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Carboxyhemoglobin Quantitative","code_information":[{"code":"30000107","type":"CDM"},{"code":"300","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":225.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Carnitine","code_information":[{"code":"30000109","type":"CDM"},{"code":"300","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":351.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Carotene","code_information":[{"code":"30000110","type":"CDM"},{"code":"300","type":"RC"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":169.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Catecholamines - Total Urine","code_information":[{"code":"30000111","type":"CDM"},{"code":"300","type":"RC"},{"code":"82382","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ceruloplasmin","code_information":[{"code":"30000113","type":"CDM"},{"code":"300","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Other Fluid Chlorides","code_information":[{"code":"30000115","type":"CDM"},{"code":"300","type":"RC"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Serum Cholinesterase","code_information":[{"code":"30000116","type":"CDM"},{"code":"300","type":"RC"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Rbc Cholinesterase","code_information":[{"code":"30000117","type":"CDM"},{"code":"300","type":"RC"},{"code":"82482","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Chromium","code_information":[{"code":"30000120","type":"CDM"},{"code":"300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":253.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Citrate","code_information":[{"code":"30000121","type":"CDM"},{"code":"300","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":406.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Collagen Crosslinks","code_information":[{"code":"30000122","type":"CDM"},{"code":"300","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Copper","code_information":[{"code":"30000123","type":"CDM"},{"code":"300","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cortisol Total","code_information":[{"code":"30000125","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Column Chromotography Quant","code_information":[{"code":"30000127","type":"CDM"},{"code":"300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Ck In Blood","code_information":[{"code":"30000130","type":"CDM"},{"code":"300","type":"RC"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Dibucaine Number","code_information":[{"code":"30000133","type":"CDM"},{"code":"300","type":"RC"},{"code":"82638","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":104.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pancreatic Elastase Fecal","code_information":[{"code":"30000134","type":"CDM"},{"code":"300","type":"RC"},{"code":"82656","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.0,"discounted_cash":399.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Erythropoietin","code_information":[{"code":"30000135","type":"CDM"},{"code":"300","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Estradiol","code_information":[{"code":"30000136","type":"CDM"},{"code":"300","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Estrogen, Total","code_information":[{"code":"30000137","type":"CDM"},{"code":"300","type":"RC"},{"code":"82672","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":261.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Estriol","code_information":[{"code":"30000138","type":"CDM"},{"code":"300","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ethylene Glycol","code_information":[{"code":"30000139","type":"CDM"},{"code":"300","type":"RC"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fetal Fibronectin","code_information":[{"code":"30000140","type":"CDM"},{"code":"300","type":"RC"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":735.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Iga/Igd/Igg/Igm Each","code_information":[{"code":"30000141","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":153.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunoglobulin E","code_information":[{"code":"30000142","type":"CDM"},{"code":"300","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":110.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ph Blood","code_information":[{"code":"30000143","type":"CDM"},{"code":"300","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Arterial Blood Gas Analysis","code_information":[{"code":"30000144","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Gases O2 Sat Only","code_information":[{"code":"30000145","type":"CDM"},{"code":"300","type":"RC"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Glucose 6 Phosphate Dehydrogenase Qt","code_information":[{"code":"30000147","type":"CDM"},{"code":"300","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":187.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Poc Glucose","code_information":[{"code":"30000148","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Glycated Protein","code_information":[{"code":"30000149","type":"CDM"},{"code":"300","type":"RC"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Haptoglobin Quant","code_information":[{"code":"30000150","type":"CDM"},{"code":"300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc H Pylori Breath Test","code_information":[{"code":"30000151","type":"CDM"},{"code":"300","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":510.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Quantitative Screen Metals","code_information":[{"code":"30000152","type":"CDM"},{"code":"300","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":199.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hemoglobin Chromotography","code_information":[{"code":"30000153","type":"CDM"},{"code":"300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Methemoglobin Assay","code_information":[{"code":"30000154","type":"CDM"},{"code":"300","type":"RC"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Hemosiderin Qual","code_information":[{"code":"30000155","type":"CDM"},{"code":"300","type":"RC"},{"code":"83070","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":124.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Histamine","code_information":[{"code":"30000156","type":"CDM"},{"code":"300","type":"RC"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":383.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Homocysteine","code_information":[{"code":"30000157","type":"CDM"},{"code":"300","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Homovanillic Acid","code_information":[{"code":"30000158","type":"CDM"},{"code":"300","type":"RC"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":257.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Corticosteroids 17","code_information":[{"code":"30000159","type":"CDM"},{"code":"300","type":"RC"},{"code":"83491","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hydroxyindoleacetic Acid, 5-(Hiaa)","code_information":[{"code":"30000160","type":"CDM"},{"code":"300","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunoassay Nonantibody","code_information":[{"code":"30000161","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":219.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ria Nonantibody","code_information":[{"code":"30000162","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":494.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Insulin Total","code_information":[{"code":"30000164","type":"CDM"},{"code":"300","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":148.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insulin Free","code_information":[{"code":"30000165","type":"CDM"},{"code":"300","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":211.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Lead","code_information":[{"code":"30000167","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lipoprotein A","code_information":[{"code":"30000169","type":"CDM"},{"code":"300","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":231.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lipoprotein Bld Hr Fraction","code_information":[{"code":"30000170","type":"CDM"},{"code":"300","type":"RC"},{"code":"83701","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lipoprotein Bld By Nmr","code_information":[{"code":"30000171","type":"CDM"},{"code":"300","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":312.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vldl Cholesterol","code_information":[{"code":"30000172","type":"CDM"},{"code":"300","type":"RC"},{"code":"83719","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lipoprotein, Direct Ldl","code_information":[{"code":"30000173","type":"CDM"},{"code":"300","type":"RC"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Magnesium (Sendout Only)","code_information":[{"code":"30000174","type":"CDM"},{"code":"300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Manganese","code_information":[{"code":"30000175","type":"CDM"},{"code":"300","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":317.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mass Spectrometry Quanitative","code_information":[{"code":"30000177","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":556.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Mercury","code_information":[{"code":"30000178","type":"CDM"},{"code":"300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Metanephrines","code_information":[{"code":"30000179","type":"CDM"},{"code":"300","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":474.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Nephelometry Not Spec","code_information":[{"code":"30000181","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":230.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc 5-Nucleotidase","code_information":[{"code":"30000182","type":"CDM"},{"code":"300","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":148.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Organic Acids Total Quant","code_information":[{"code":"30000183","type":"CDM"},{"code":"300","type":"RC"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":765.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Organic Acids Qual Each","code_information":[{"code":"30000184","type":"CDM"},{"code":"300","type":"RC"},{"code":"83919","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":258.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Organic Acid Single Quant","code_information":[{"code":"30000185","type":"CDM"},{"code":"300","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Osteocalcin","code_information":[{"code":"30000186","type":"CDM"},{"code":"300","type":"RC"},{"code":"83937","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Parathormone","code_information":[{"code":"30000187","type":"CDM"},{"code":"300","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":195.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Calprotectin Stool","code_information":[{"code":"30000189","type":"CDM"},{"code":"300","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prostatic Acid Phospatase","code_information":[{"code":"30000190","type":"CDM"},{"code":"300","type":"RC"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Alkaline Phosphatases; Isoenzymes","code_information":[{"code":"30000192","type":"CDM"},{"code":"300","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":81.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Porphobilinogen Urine","code_information":[{"code":"30000194","type":"CDM"},{"code":"300","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":148.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ruptured Membranes Test- Amnisure","code_information":[{"code":"30000195","type":"CDM"},{"code":"300","type":"RC"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":493.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Porphyrins,Urine","code_information":[{"code":"30000196","type":"CDM"},{"code":"300","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":283.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Porphyrins; Feces","code_information":[{"code":"30000197","type":"CDM"},{"code":"300","type":"RC"},{"code":"84126","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":367.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pregnenolone","code_information":[{"code":"30000199","type":"CDM"},{"code":"300","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc 17 Oh Hydroxypregnenolone","code_information":[{"code":"30000200","type":"CDM"},{"code":"300","type":"RC"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":231.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Progesterone","code_information":[{"code":"30000201","type":"CDM"},{"code":"300","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Procalcitonin (Pct)","code_information":[{"code":"30000202","type":"CDM"},{"code":"300","type":"RC"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Psa Free","code_information":[{"code":"30000204","type":"CDM"},{"code":"300","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":105.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Protein Urine","code_information":[{"code":"30000205","type":"CDM"},{"code":"300","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Protein Electrophoresis Serum","code_information":[{"code":"30000207","type":"CDM"},{"code":"300","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":157.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Protein E-Phoresis/Urine/Csf","code_information":[{"code":"30000208","type":"CDM"},{"code":"300","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Protein Western Blot Test","code_information":[{"code":"30000209","type":"CDM"},{"code":"300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Proinsulin","code_information":[{"code":"30000210","type":"CDM"},{"code":"300","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":477.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Endocrine Hormone","code_information":[{"code":"30000211","type":"CDM"},{"code":"300","type":"RC"},{"code":"84235","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":258.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Nonendocrine Receptor","code_information":[{"code":"30000212","type":"CDM"},{"code":"300","type":"RC"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":423.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Renin","code_information":[{"code":"30000213","type":"CDM"},{"code":"300","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vitamin B2","code_information":[{"code":"30000214","type":"CDM"},{"code":"300","type":"RC"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":326.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Selenium","code_information":[{"code":"30000215","type":"CDM"},{"code":"300","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Serotonin","code_information":[{"code":"30000216","type":"CDM"},{"code":"300","type":"RC"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":532.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Somatomedin","code_information":[{"code":"30000219","type":"CDM"},{"code":"300","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":404.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Somatostatin","code_information":[{"code":"30000220","type":"CDM"},{"code":"300","type":"RC"},{"code":"84307","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Spectrophotometry","code_information":[{"code":"30000221","type":"CDM"},{"code":"300","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sugars Single Quant","code_information":[{"code":"30000222","type":"CDM"},{"code":"300","type":"RC"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":140.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Testosterone,Free","code_information":[{"code":"30000223","type":"CDM"},{"code":"300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":199.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vitamin B1 Thiamine (Lc/Ms/Ms)","code_information":[{"code":"30000225","type":"CDM"},{"code":"300","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vitamin E","code_information":[{"code":"30000229","type":"CDM"},{"code":"300","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc T3, Free","code_information":[{"code":"30000231","type":"CDM"},{"code":"300","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc T3 Reverse","code_information":[{"code":"30000232","type":"CDM"},{"code":"300","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":404.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urea Nitrogen ; Urine","code_information":[{"code":"30000235","type":"CDM"},{"code":"300","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vanillymandelic Acid","code_information":[{"code":"30000237","type":"CDM"},{"code":"300","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vasoactive Intestinal Peptide","code_information":[{"code":"30000238","type":"CDM"},{"code":"300","type":"RC"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":432.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Arginine Vasopressin (Adh)","code_information":[{"code":"30000239","type":"CDM"},{"code":"300","type":"RC"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":411.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vitamin A","code_information":[{"code":"30000240","type":"CDM"},{"code":"300","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":241.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Nos Vitamin","code_information":[{"code":"30000241","type":"CDM"},{"code":"300","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Zinc","code_information":[{"code":"30000243","type":"CDM"},{"code":"300","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":152.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C-Peptide","code_information":[{"code":"30000244","type":"CDM"},{"code":"300","type":"RC"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Count Automated","code_information":[{"code":"30000248","type":"CDM"},{"code":"300","type":"RC"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bone Marrow Interpretation","code_information":[{"code":"30000249","type":"CDM"},{"code":"300","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":2098.0,"discounted_cash":1762.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Clot Lysis Time","code_information":[{"code":"30000250","type":"CDM"},{"code":"300","type":"RC"},{"code":"85175","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor Ii Prothrom Spec","code_information":[{"code":"30000251","type":"CDM"},{"code":"300","type":"RC"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":339.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Clot Factor V Test","code_information":[{"code":"30000252","type":"CDM"},{"code":"300","type":"RC"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":360.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor Vii Proconvertin","code_information":[{"code":"30000253","type":"CDM"},{"code":"300","type":"RC"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":360.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor Viii Vw Ristoctn","code_information":[{"code":"30000255","type":"CDM"},{"code":"300","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":309.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor Viii Vw Antigen","code_information":[{"code":"30000256","type":"CDM"},{"code":"300","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":304.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor Viii Multimetric","code_information":[{"code":"30000257","type":"CDM"},{"code":"300","type":"RC"},{"code":"85247","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":249.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor Ix Ptc/Chrstmas","code_information":[{"code":"30000258","type":"CDM"},{"code":"300","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":339.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor X Stuart-Power","code_information":[{"code":"30000259","type":"CDM"},{"code":"300","type":"RC"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":339.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor Xi Pta","code_information":[{"code":"30000260","type":"CDM"},{"code":"300","type":"RC"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":360.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor Xiii Fibrin Stab","code_information":[{"code":"30000261","type":"CDM"},{"code":"300","type":"RC"},{"code":"85290","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antithrombin Iii Act.","code_information":[{"code":"30000262","type":"CDM"},{"code":"300","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":337.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antithrombin Iii Antigen","code_information":[{"code":"30000263","type":"CDM"},{"code":"300","type":"RC"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":337.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Inhibit Protein C Antigen","code_information":[{"code":"30000264","type":"CDM"},{"code":"300","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Inhibit Prot S Total","code_information":[{"code":"30000265","type":"CDM"},{"code":"300","type":"RC"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Inhibit Prot S Free","code_information":[{"code":"30000266","type":"CDM"},{"code":"300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Activated Protein C","code_information":[{"code":"30000267","type":"CDM"},{"code":"300","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":182.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Coagulation Time Activated","code_information":[{"code":"30000268","type":"CDM"},{"code":"300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Euglobulin Clot Lysis Time","code_information":[{"code":"30000269","type":"CDM"},{"code":"300","type":"RC"},{"code":"85360","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fibrinolysins Screen I&R","code_information":[{"code":"30000271","type":"CDM"},{"code":"300","type":"RC"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clotting Funct Activity","code_information":[{"code":"30000272","type":"CDM"},{"code":"300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":305.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fibrinolytic Antiplasmin","code_information":[{"code":"30000273","type":"CDM"},{"code":"300","type":"RC"},{"code":"85410","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":202.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hemoglobin Fetal; Rosette","code_information":[{"code":"30000274","type":"CDM"},{"code":"300","type":"RC"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Heparin Assay","code_information":[{"code":"30000275","type":"CDM"},{"code":"300","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":320.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Muramidase","code_information":[{"code":"30000276","type":"CDM"},{"code":"300","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":219.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Platelet Aggregatin Ea Agent","code_information":[{"code":"30000277","type":"CDM"},{"code":"300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":131.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phospholipid Pltlt Neutralizati","code_information":[{"code":"30000278","type":"CDM"},{"code":"300","type":"RC"},{"code":"85597","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prothrombin Test","code_information":[{"code":"30000280","type":"CDM"},{"code":"300","type":"RC"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Russell Viper Venom Diluted","code_information":[{"code":"30000281","type":"CDM"},{"code":"300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Reptilase Clotting Test","code_information":[{"code":"30000282","type":"CDM"},{"code":"300","type":"RC"},{"code":"85635","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":199.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thrombin Time Plasma","code_information":[{"code":"30000283","type":"CDM"},{"code":"300","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thromboplastin Time Partial Plasma","code_information":[{"code":"30000285","type":"CDM"},{"code":"300","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Viscosity","code_information":[{"code":"30000286","type":"CDM"},{"code":"300","type":"RC"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":179.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hematology Procedure","code_information":[{"code":"30000287","type":"CDM"},{"code":"300","type":"RC"},{"code":"85999","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Agglutinins Febrile Antigen","code_information":[{"code":"30000288","type":"CDM"},{"code":"300","type":"RC"},{"code":"86000","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":204.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Wbc Antibody Identification","code_information":[{"code":"30000290","type":"CDM"},{"code":"300","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Platelet Antibodies","code_information":[{"code":"30000291","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":292.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antinuclear Antibodies","code_information":[{"code":"30000292","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antistreptolysin O Screen","code_information":[{"code":"30000293","type":"CDM"},{"code":"300","type":"RC"},{"code":"86063","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C-Reactive Protein Hs","code_information":[{"code":"30000294","type":"CDM"},{"code":"300","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Beta-2 Glycoprotein Antibody","code_information":[{"code":"30000295","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cardiolipin Antibody Ig","code_information":[{"code":"30000296","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Anti-Phosphatidylserine Antibody","code_information":[{"code":"30000297","type":"CDM"},{"code":"300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cold Agglutinins","code_information":[{"code":"30000298","type":"CDM"},{"code":"300","type":"RC"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Complement Total","code_information":[{"code":"30000300","type":"CDM"},{"code":"300","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cyclic Citrullinated Peptide","code_information":[{"code":"30000301","type":"CDM"},{"code":"300","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":211.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Deoxyribonuclease Antibody","code_information":[{"code":"30000302","type":"CDM"},{"code":"300","type":"RC"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":251.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dna Antibody Native","code_information":[{"code":"30000303","type":"CDM"},{"code":"300","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nuclear Antigen Antibody","code_information":[{"code":"30000304","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fluorescent Antibody Titter","code_information":[{"code":"30000306","type":"CDM"},{"code":"300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":261.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunoassay Tumor Ca 15-3","code_information":[{"code":"30000307","type":"CDM"},{"code":"300","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":263.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunoassay Tumor Ca 19-9","code_information":[{"code":"30000308","type":"CDM"},{"code":"300","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":293.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunoassay Tumor Ca 125","code_information":[{"code":"30000309","type":"CDM"},{"code":"300","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Human Epididymis Protein 4","code_information":[{"code":"30000310","type":"CDM"},{"code":"300","type":"RC"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.0,"discounted_cash":456.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunoassay Tumor Other Quantitative","code_information":[{"code":"30000311","type":"CDM"},{"code":"300","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":337.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunoassay Infectious Agent Quantitative","code_information":[{"code":"30000312","type":"CDM"},{"code":"300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immune Complex Assay","code_information":[{"code":"30000313","type":"CDM"},{"code":"300","type":"RC"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":284.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunofixation E-Phoresis Serum","code_information":[{"code":"30000314","type":"CDM"},{"code":"300","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":333.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inhibin A","code_information":[{"code":"30000315","type":"CDM"},{"code":"300","type":"RC"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insulin Antibodies","code_information":[{"code":"30000316","type":"CDM"},{"code":"300","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":313.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intrinsic Factor Antibody","code_information":[{"code":"30000317","type":"CDM"},{"code":"300","type":"RC"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":261.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Islet Cell Antibody","code_information":[{"code":"30000318","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lymphocyte Transformation","code_information":[{"code":"30000319","type":"CDM"},{"code":"300","type":"RC"},{"code":"86353","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":417.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc B Cells Total Count","code_information":[{"code":"30000320","type":"CDM"},{"code":"300","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nk Cells Total Count","code_information":[{"code":"30000321","type":"CDM"},{"code":"300","type":"RC"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc T Cells Total Count","code_information":[{"code":"30000322","type":"CDM"},{"code":"300","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc T Cell Absolute Count/Ratio","code_information":[{"code":"30000323","type":"CDM"},{"code":"300","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc T Cell Absolute Count","code_information":[{"code":"30000324","type":"CDM"},{"code":"300","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":332.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microsomal Antibody Each","code_information":[{"code":"30000325","type":"CDM"},{"code":"300","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":204.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Particle Agglutination Antibody Screen","code_information":[{"code":"30000326","type":"CDM"},{"code":"300","type":"RC"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":254.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rheumatoid Factor Test Qual","code_information":[{"code":"30000327","type":"CDM"},{"code":"300","type":"RC"},{"code":"86430","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rheumatoid Factor Quant","code_information":[{"code":"30000328","type":"CDM"},{"code":"300","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tb Test Cell Immun Measure","code_information":[{"code":"30000329","type":"CDM"},{"code":"300","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":429.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Adenovirus Antibody","code_information":[{"code":"30000331","type":"CDM"},{"code":"300","type":"RC"},{"code":"86603","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":240.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bacterium Antibody","code_information":[{"code":"30000332","type":"CDM"},{"code":"300","type":"RC"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":114.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bartonella Antibody","code_information":[{"code":"30000333","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":189.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bordetella Antibody","code_information":[{"code":"30000334","type":"CDM"},{"code":"300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lyme Disease Antibody Confirmatory Test","code_information":[{"code":"30000335","type":"CDM"},{"code":"300","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":153.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Candida Antibody","code_information":[{"code":"30000337","type":"CDM"},{"code":"300","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":175.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chlamydia Antibody","code_information":[{"code":"30000338","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chlamydia Igm Antibody","code_information":[{"code":"30000339","type":"CDM"},{"code":"300","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Coccidioides Antibody","code_information":[{"code":"30000340","type":"CDM"},{"code":"300","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Q Fever Antibody","code_information":[{"code":"30000341","type":"CDM"},{"code":"300","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":154.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cmv Antibody","code_information":[{"code":"30000342","type":"CDM"},{"code":"300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cmv Antibody Igm","code_information":[{"code":"30000343","type":"CDM"},{"code":"300","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Diphtheria Antibody","code_information":[{"code":"30000344","type":"CDM"},{"code":"300","type":"RC"},{"code":"86648","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":280.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Encephalitis California Antibody","code_information":[{"code":"30000345","type":"CDM"},{"code":"300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Encephalitis East Equine Antibody","code_information":[{"code":"30000346","type":"CDM"},{"code":"300","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":165.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Encephalitis St Louis Antibody","code_information":[{"code":"30000347","type":"CDM"},{"code":"300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Encephalitis West Equine Antibody","code_information":[{"code":"30000348","type":"CDM"},{"code":"300","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echovirus Antibody","code_information":[{"code":"30000349","type":"CDM"},{"code":"300","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Epstein-Barr Antibody","code_information":[{"code":"30000350","type":"CDM"},{"code":"300","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":342.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Epstein-Barr Nuclear Antigen","code_information":[{"code":"30000351","type":"CDM"},{"code":"300","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Epstein-Barr Capsid Vca","code_information":[{"code":"30000352","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Erhlichia Antibody","code_information":[{"code":"30000353","type":"CDM"},{"code":"300","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fungus Nes Antibody","code_information":[{"code":"30000354","type":"CDM"},{"code":"300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":254.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Helicobacter Pylori Antibody","code_information":[{"code":"30000355","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Helminth Antibody","code_information":[{"code":"30000356","type":"CDM"},{"code":"300","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":325.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Haemophilus Influenza Antibody","code_information":[{"code":"30000357","type":"CDM"},{"code":"300","type":"RC"},{"code":"86684","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis Delta Agent Antibody","code_information":[{"code":"30000358","type":"CDM"},{"code":"300","type":"RC"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Herpes Simplex Nes Antbdy","code_information":[{"code":"30000359","type":"CDM"},{"code":"300","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":400.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Herpes Simplex Type 1 Test","code_information":[{"code":"30000360","type":"CDM"},{"code":"300","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Herpes Simplex Type 2 Test","code_information":[{"code":"30000361","type":"CDM"},{"code":"300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Histoplasma Antibody","code_information":[{"code":"30000362","type":"CDM"},{"code":"300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hiv-2 Antibody","code_information":[{"code":"30000364","type":"CDM"},{"code":"300","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hiv-1/Hiv-2 1 Result Antbdy","code_information":[{"code":"30000365","type":"CDM"},{"code":"300","type":"RC"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis B Core Total Antibody","code_information":[{"code":"30000366","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":219.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis B Core Igm Antibody","code_information":[{"code":"30000367","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hep B Surface Antibody","code_information":[{"code":"30000368","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":156.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis Be Antibody","code_information":[{"code":"30000369","type":"CDM"},{"code":"300","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":175.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis A Igm Antibody","code_information":[{"code":"30000370","type":"CDM"},{"code":"300","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Influenza Virus Antibody","code_information":[{"code":"30000371","type":"CDM"},{"code":"300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Legionella Antibody","code_information":[{"code":"30000372","type":"CDM"},{"code":"300","type":"RC"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Leptospira Antibodies","code_information":[{"code":"30000373","type":"CDM"},{"code":"300","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lymph Choriomeningitis Antibody","code_information":[{"code":"30000374","type":"CDM"},{"code":"300","type":"RC"},{"code":"86727","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":152.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mumps Antibody","code_information":[{"code":"30000375","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":240.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mycoplasma Antibody","code_information":[{"code":"30000376","type":"CDM"},{"code":"300","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Parvovirus Antibody","code_information":[{"code":"30000377","type":"CDM"},{"code":"300","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Protozoa Antibody Nos","code_information":[{"code":"30000378","type":"CDM"},{"code":"300","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":131.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rickettsia Antibody","code_information":[{"code":"30000379","type":"CDM"},{"code":"300","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rubeola Antibody","code_information":[{"code":"30000381","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":237.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tetanus Antibody","code_information":[{"code":"30000382","type":"CDM"},{"code":"300","type":"RC"},{"code":"86774","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Toxoplasma Antibody","code_information":[{"code":"30000383","type":"CDM"},{"code":"300","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Toxoplasma Antibody Igm","code_information":[{"code":"30000384","type":"CDM"},{"code":"300","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":144.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Treponema Pallidum","code_information":[{"code":"30000385","type":"CDM"},{"code":"300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Varicella-Zoster Antibody","code_information":[{"code":"30000386","type":"CDM"},{"code":"300","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":242.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc West Nile Virus Ab Igm","code_information":[{"code":"30000387","type":"CDM"},{"code":"300","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":131.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc West Nile Virus Antibody","code_information":[{"code":"30000388","type":"CDM"},{"code":"300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":131.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Virus Antibody Nos","code_information":[{"code":"30000389","type":"CDM"},{"code":"300","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":280.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thyroglobulin Antibody","code_information":[{"code":"30000390","type":"CDM"},{"code":"300","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":204.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis C Antibody","code_information":[{"code":"30000391","type":"CDM"},{"code":"300","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytotoxic Antibody Screening","code_information":[{"code":"30000392","type":"CDM"},{"code":"300","type":"RC"},{"code":"86807","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.0,"discounted_cash":841.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla Typing A B Or C, Multiple","code_information":[{"code":"30000393","type":"CDM"},{"code":"300","type":"RC"},{"code":"86813","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":551.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Antibody Screen","code_information":[{"code":"30000394","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Antibody Elution","code_information":[{"code":"30000395","type":"CDM"},{"code":"300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Antibody Identification","code_information":[{"code":"30000396","type":"CDM"},{"code":"300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":721.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Coombs Test Direct","code_information":[{"code":"30000397","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Coombs Test Indirect Qual","code_information":[{"code":"30000398","type":"CDM"},{"code":"300","type":"RC"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Coombs Test Indirect Titer","code_information":[{"code":"30000399","type":"CDM"},{"code":"300","type":"RC"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bbd Autologous Blood Process Donor","code_information":[{"code":"30000400","type":"CDM"},{"code":"300","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":446.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Typing Serologic Abo","code_information":[{"code":"30000401","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Typing Rh (D)","code_information":[{"code":"30000402","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Type Antigen Donor Ea","code_information":[{"code":"30000403","type":"CDM"},{"code":"300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":721.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Typing Rbc Antigens","code_information":[{"code":"30000404","type":"CDM"},{"code":"300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":721.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Typing Rh Phenotype","code_information":[{"code":"30000405","type":"CDM"},{"code":"300","type":"RC"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Compatibility Test Spin","code_information":[{"code":"30000406","type":"CDM"},{"code":"300","type":"RC"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Compatibility Test Incubate","code_information":[{"code":"30000407","type":"CDM"},{"code":"300","type":"RC"},{"code":"86921","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Compatibility Test Antiglob","code_information":[{"code":"30000408","type":"CDM"},{"code":"300","type":"RC"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Compatibility Test Electric","code_information":[{"code":"30000409","type":"CDM"},{"code":"300","type":"RC"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Product/Irradiation","code_information":[{"code":"30000410","type":"CDM"},{"code":"300","type":"RC"},{"code":"86945","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Pretx Incubatj W/Chemical","code_information":[{"code":"30000411","type":"CDM"},{"code":"300","type":"RC"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Pretx Incubatj W/Enzymes","code_information":[{"code":"30000412","type":"CDM"},{"code":"300","type":"RC"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":721.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Serum Pretx Id Dilution","code_information":[{"code":"30000413","type":"CDM"},{"code":"300","type":"RC"},{"code":"86976","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Pretreatment Serum","code_information":[{"code":"30000414","type":"CDM"},{"code":"300","type":"RC"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":131.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Split Blood Or Products","code_information":[{"code":"30000415","type":"CDM"},{"code":"300","type":"RC"},{"code":"86985","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":178.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transfusion Procedure","code_information":[{"code":"30000416","type":"CDM"},{"code":"300","type":"RC"},{"code":"86999","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Culture Aerobic Identify","code_information":[{"code":"30000421","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fungus Isolation Culture","code_information":[{"code":"30000423","type":"CDM"},{"code":"300","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fungi Identification Yeast","code_information":[{"code":"30000425","type":"CDM"},{"code":"300","type":"RC"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":148.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fungi Identification Mold","code_information":[{"code":"30000426","type":"CDM"},{"code":"300","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mycoplasma","code_information":[{"code":"30000427","type":"CDM"},{"code":"300","type":"RC"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":322.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chlamydia Culture","code_information":[{"code":"30000428","type":"CDM"},{"code":"300","type":"RC"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":362.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Culture Typing Glc/Hplc","code_information":[{"code":"30000429","type":"CDM"},{"code":"300","type":"RC"},{"code":"87143","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Culture Type Immunologic","code_information":[{"code":"30000430","type":"CDM"},{"code":"300","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dna/Rna Amplified Probe","code_information":[{"code":"30000431","type":"CDM"},{"code":"300","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Culture Typing Added Method","code_information":[{"code":"30000432","type":"CDM"},{"code":"300","type":"RC"},{"code":"87158","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":324.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ova And Parasites Smears","code_information":[{"code":"30000433","type":"CDM"},{"code":"300","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microbe Susceptible Diffuse","code_information":[{"code":"30000434","type":"CDM"},{"code":"300","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microbe Suscept Macrobroth","code_information":[{"code":"30000437","type":"CDM"},{"code":"300","type":"RC"},{"code":"87188","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microbe Suscept Mycobacteri","code_information":[{"code":"30000438","type":"CDM"},{"code":"300","type":"RC"},{"code":"87190","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Smear Complex Stain","code_information":[{"code":"30000441","type":"CDM"},{"code":"300","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":147.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Virus Inoculation Tissue","code_information":[{"code":"30000442","type":"CDM"},{"code":"300","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":703.0,"discounted_cash":590.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Virus Inoculation Shell Via","code_information":[{"code":"30000443","type":"CDM"},{"code":"300","type":"RC"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":283.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Genet Virus Isolate Hsv","code_information":[{"code":"30000444","type":"CDM"},{"code":"300","type":"RC"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":498.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Adenovirus Ag If","code_information":[{"code":"30000445","type":"CDM"},{"code":"300","type":"RC"},{"code":"87260","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":329.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cryptosporidium Ag If","code_information":[{"code":"30000446","type":"CDM"},{"code":"300","type":"RC"},{"code":"87272","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":105.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Parainfluenza Ag If","code_information":[{"code":"30000447","type":"CDM"},{"code":"300","type":"RC"},{"code":"87279","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aspergillus Ag Eia","code_information":[{"code":"30000448","type":"CDM"},{"code":"300","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":271.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clostridium Ag Eia","code_information":[{"code":"30000449","type":"CDM"},{"code":"300","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Giardia Ag Eia","code_information":[{"code":"30000450","type":"CDM"},{"code":"300","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Helicobacter Pylori Antigen Stool","code_information":[{"code":"30000451","type":"CDM"},{"code":"300","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":345.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis B Surface Ag Eia","code_information":[{"code":"30000452","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0499","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis Be Ag Eia","code_information":[{"code":"30000453","type":"CDM"},{"code":"300","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":213.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Influenza A/B Ag Eia","code_information":[{"code":"30000454","type":"CDM"},{"code":"300","type":"RC"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rotavirus Ag Eia","code_information":[{"code":"30000455","type":"CDM"},{"code":"300","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":358.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Shiga-Like Toxin Ag Eia","code_information":[{"code":"30000456","type":"CDM"},{"code":"300","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ag Detect Nos Eia Mult","code_information":[{"code":"30000457","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":392.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lyme Dis Dna Amp Probe","code_information":[{"code":"30000458","type":"CDM"},{"code":"300","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":893.0,"discounted_cash":750.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chylmd Trach Dna Amp Probe","code_information":[{"code":"30000459","type":"CDM"},{"code":"300","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C Diff Amplified Probe","code_information":[{"code":"30000460","type":"CDM"},{"code":"300","type":"RC"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":409.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytomeg Dna Amp Probe","code_information":[{"code":"30000461","type":"CDM"},{"code":"300","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":729.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytomeg Dna Quant","code_information":[{"code":"30000462","type":"CDM"},{"code":"300","type":"RC"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.0,"discounted_cash":821.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Enterovirus Probe&Revrs Trns","code_information":[{"code":"30000463","type":"CDM"},{"code":"300","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.0,"discounted_cash":836.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Influenza Dna Amp Probe","code_information":[{"code":"30000464","type":"CDM"},{"code":"300","type":"RC"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.0,"discounted_cash":999.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Influenza Dna Amp Prob Addl","code_information":[{"code":"30000465","type":"CDM"},{"code":"300","type":"RC"},{"code":"87503","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis B Dna Quant","code_information":[{"code":"30000466","type":"CDM"},{"code":"300","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis C Probe&Rvrs Trnsc","code_information":[{"code":"30000467","type":"CDM"},{"code":"300","type":"RC"},{"code":"87521","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":672.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis C Revrs Trnscrpj","code_information":[{"code":"30000468","type":"CDM"},{"code":"300","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":771.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hsv Dna Amp Probe","code_information":[{"code":"30000469","type":"CDM"},{"code":"300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":217.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hiv-1 Probe&Reverse Trnscrpj","code_information":[{"code":"30000470","type":"CDM"},{"code":"300","type":"RC"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.0,"discounted_cash":702.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hiv-1 Quant&Revrse Trnscrpj","code_information":[{"code":"30000471","type":"CDM"},{"code":"300","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.0,"discounted_cash":656.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc M.Tuberculo Dna Amp Probe","code_information":[{"code":"30000472","type":"CDM"},{"code":"300","type":"RC"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":535.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N.Gonorrhoeae Dna Amp Prob","code_information":[{"code":"30000473","type":"CDM"},{"code":"300","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":217.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hpv High-Risk Types","code_information":[{"code":"30000474","type":"CDM"},{"code":"300","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":353.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Resp Virus 3-5 Targets","code_information":[{"code":"30000475","type":"CDM"},{"code":"300","type":"RC"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":1176.0,"discounted_cash":987.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Detect Agent Nos Dna Quant","code_information":[{"code":"30000477","type":"CDM"},{"code":"300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.0,"discounted_cash":762.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strep A Assay W/Optic","code_information":[{"code":"30000478","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Genotype Dna Hiv Reverse T","code_information":[{"code":"30000479","type":"CDM"},{"code":"300","type":"RC"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1885.0,"discounted_cash":1583.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Genotype Dna/Rna Hep C","code_information":[{"code":"30000480","type":"CDM"},{"code":"300","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":1885.0,"discounted_cash":1583.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phenotype Dna Hiv W/Culture","code_information":[{"code":"30000481","type":"CDM"},{"code":"300","type":"RC"},{"code":"87903","type":"HCPCS"}],"standard_charges":[{"gross_charge":2015.0,"discounted_cash":1692.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phenotype Dna Hiv W/Clt Add","code_information":[{"code":"30000482","type":"CDM"},{"code":"300","type":"RC"},{"code":"87904","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":357.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Genotype Dna Hepatitis B","code_information":[{"code":"30000483","type":"CDM"},{"code":"300","type":"RC"},{"code":"87912","type":"HCPCS"}],"standard_charges":[{"gross_charge":1577.0,"discounted_cash":1324.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytopath Fl Nongyn Smears","code_information":[{"code":"30000484","type":"CDM"},{"code":"300","type":"RC"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytopath C/V Thin Layer","code_information":[{"code":"30000485","type":"CDM"},{"code":"311","type":"RC"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytopath C/V Index Add-On","code_information":[{"code":"30000486","type":"CDM"},{"code":"300","type":"RC"},{"code":"88155","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytopath Smear Other Source","code_information":[{"code":"30000487","type":"CDM"},{"code":"300","type":"RC"},{"code":"88160","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytopath Smear Other Source; Preparation","code_information":[{"code":"30000488","type":"CDM"},{"code":"300","type":"RC"},{"code":"88161","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":194.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytopath Smear Other Source; Extended","code_information":[{"code":"30000489","type":"CDM"},{"code":"300","type":"RC"},{"code":"88162","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytopath Tbs C/V Manual","code_information":[{"code":"30000490","type":"CDM"},{"code":"300","type":"RC"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytp Dx Eval Fna 1St Ea Site","code_information":[{"code":"30000491","type":"CDM"},{"code":"300","type":"RC"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":276.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Flow Cytometry; Cell Cycle Or Dna Analysis","code_information":[{"code":"30000492","type":"CDM"},{"code":"300","type":"RC"},{"code":"88182","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":409.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Flowcytometry/ Tc 1 Marker","code_information":[{"code":"30000493","type":"CDM"},{"code":"300","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":721.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Flowcytometry/ Tc Add On","code_information":[{"code":"30000494","type":"CDM"},{"code":"300","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Flowcytometry/Read 2-8","code_information":[{"code":"30000495","type":"CDM"},{"code":"300","type":"RC"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Flowcytometry/Read 9-15","code_information":[{"code":"30000496","type":"CDM"},{"code":"300","type":"RC"},{"code":"88188","type":"HCPCS"}],"standard_charges":[{"gross_charge":1374.0,"discounted_cash":1154.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tissue Culture Bone Marrow","code_information":[{"code":"30000498","type":"CDM"},{"code":"300","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":433.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chromosome Analysis 20-25","code_information":[{"code":"30000500","type":"CDM"},{"code":"300","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":427.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytogenetics Dna Probe","code_information":[{"code":"30000501","type":"CDM"},{"code":"300","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":185.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytogenetics 25-99","code_information":[{"code":"30000502","type":"CDM"},{"code":"300","type":"RC"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":207.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytogenetics 100-300","code_information":[{"code":"30000503","type":"CDM"},{"code":"300","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chromosome Karyotype Study","code_information":[{"code":"30000504","type":"CDM"},{"code":"300","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Histochemical Stains Add-On","code_information":[{"code":"30000508","type":"CDM"},{"code":"300","type":"RC"},{"code":"88314","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":299.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Consult Referred Slides","code_information":[{"code":"30000509","type":"CDM"},{"code":"300","type":"RC"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":373.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Consult & Report Referred Matter","code_information":[{"code":"30000510","type":"CDM"},{"code":"300","type":"RC"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ihc Qual Each Add Stain","code_information":[{"code":"30000511","type":"CDM"},{"code":"300","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":272.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ihc Qual Ea Stain Multiplex","code_information":[{"code":"30000513","type":"CDM"},{"code":"300","type":"RC"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":459.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Morphometric Analysis Tumor","code_information":[{"code":"30000515","type":"CDM"},{"code":"300","type":"RC"},{"code":"88358","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insitu Hybridization (Fish)","code_information":[{"code":"30000516","type":"CDM"},{"code":"300","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":350.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microdissection Manual","code_information":[{"code":"30000517","type":"CDM"},{"code":"300","type":"RC"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":761.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bilirubin Transcutaneous; Total","code_information":[{"code":"30000518","type":"CDM"},{"code":"300","type":"RC"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Body Fluid Cell Count","code_information":[{"code":"30000519","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":147.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Exam Synovial Fluid Crystals","code_information":[{"code":"30000520","type":"CDM"},{"code":"300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Semen Analysis Volume/Count/Motility","code_information":[{"code":"30000521","type":"CDM"},{"code":"300","type":"RC"},{"code":"89320","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":248.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Semen Analysis Sperm Detection","code_information":[{"code":"30000522","type":"CDM"},{"code":"300","type":"RC"},{"code":"89321","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":157.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Psa Screen","code_information":[{"code":"30000523","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Catheterize For Urine Spec","code_information":[{"code":"30000525","type":"CDM"},{"code":"300","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":279.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fetal Hemoglobin, Apt Test","code_information":[{"code":"30000526","type":"CDM"},{"code":"300","type":"RC"},{"code":"83033","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc L/S Ratio, Lamellar Body Density","code_information":[{"code":"30000527","type":"CDM"},{"code":"300","type":"RC"},{"code":"83664","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Homogenization, Tissue, For Culture","code_information":[{"code":"30000528","type":"CDM"},{"code":"300","type":"RC"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nasal Smear For Eosinophils","code_information":[{"code":"30000529","type":"CDM"},{"code":"300","type":"RC"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Thyroglobulin","code_information":[{"code":"30000530","type":"CDM"},{"code":"300","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":287.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Culture Typing, Fluorescent","code_information":[{"code":"30000531","type":"CDM"},{"code":"300","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":140.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Oxalate","code_information":[{"code":"30000532","type":"CDM"},{"code":"300","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fats/Lipids, Feces, Qualitative","code_information":[{"code":"30000533","type":"CDM"},{"code":"300","type":"RC"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":152.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quantitative Gabapentin","code_information":[{"code":"30000534","type":"CDM"},{"code":"300","type":"RC"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Ldh Isoenzymes","code_information":[{"code":"30000535","type":"CDM"},{"code":"300","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Rbc Protoporphyrin","code_information":[{"code":"30000536","type":"CDM"},{"code":"300","type":"RC"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":272.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Cryoglobulin","code_information":[{"code":"30000537","type":"CDM"},{"code":"300","type":"RC"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quantitative Caffeine","code_information":[{"code":"30000538","type":"CDM"},{"code":"300","type":"RC"},{"code":"80155","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunfix E-Phorsis/Urine/Csf","code_information":[{"code":"30000539","type":"CDM"},{"code":"300","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":284.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sugars Single Qualitative, Each Specimen","code_information":[{"code":"30000540","type":"CDM"},{"code":"300","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay 17-(17-Ks)Ketosteroids","code_information":[{"code":"30000541","type":"CDM"},{"code":"300","type":"RC"},{"code":"83586","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ihc Qual Initial Stain (Sendout)","code_information":[{"code":"30000542","type":"CDM"},{"code":"300","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":314.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ihc Qual Each Add Stain (Sendout)","code_information":[{"code":"30000543","type":"CDM"},{"code":"300","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":272.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Consult & Report Referred Matter (Sendout)","code_information":[{"code":"30000544","type":"CDM"},{"code":"300","type":"RC"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chg Antibiotic Sens,Enzyme Detection,Each","code_information":[{"code":"30000545","type":"CDM"},{"code":"300","type":"RC"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fecal Blood Scrn Immunoassay","code_information":[{"code":"30000546","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0328","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Methylenedioxyamphetamines","code_information":[{"code":"30000547","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":282.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Leukocyte Assmt Fecal Qual/Semiquantitative","code_information":[{"code":"30000548","type":"CDM"},{"code":"300","type":"RC"},{"code":"89055","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Oncology Colon Mrna Gene Expression 12 Genes","code_information":[{"code":"30000549","type":"CDM"},{"code":"300","type":"RC"},{"code":"81525","type":"HCPCS"}],"standard_charges":[{"gross_charge":9545.0,"discounted_cash":8017.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Obstetric Panel W/ Hiv","code_information":[{"code":"30000550","type":"CDM"},{"code":"300","type":"RC"},{"code":"80081","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":368.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ugt1A1 Gene Analysis Common Variants","code_information":[{"code":"30000551","type":"CDM"},{"code":"300","type":"RC"},{"code":"81350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":932.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antibody Trichinella","code_information":[{"code":"30000552","type":"CDM"},{"code":"300","type":"RC"},{"code":"86784","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thromboxane Metabolite W/Wo Thromboxane Urine","code_information":[{"code":"30000553","type":"CDM"},{"code":"300","type":"RC"},{"code":"84431","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cyp2C19 Gene Analysis Common Variants","code_information":[{"code":"30000554","type":"CDM"},{"code":"300","type":"RC"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.0,"discounted_cash":1161.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Abl1 Gene Analysis Kinase Domain Variants","code_information":[{"code":"30000555","type":"CDM"},{"code":"300","type":"RC"},{"code":"81170","type":"HCPCS"}],"standard_charges":[{"gross_charge":1219.0,"discounted_cash":1023.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Cyanide","code_information":[{"code":"30000556","type":"CDM"},{"code":"300","type":"RC"},{"code":"82600","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fetal Chromosomal Microdeltj Genomic Seq Analys","code_information":[{"code":"30000557","type":"CDM"},{"code":"300","type":"RC"},{"code":"81422","type":"HCPCS"}],"standard_charges":[{"gross_charge":3600.0,"discounted_cash":3024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Smn1 Gene Analysis Dosage/Delet Alys W/Smn2 Alys","code_information":[{"code":"30000558","type":"CDM"},{"code":"300","type":"RC"},{"code":"81329","type":"HCPCS"}],"standard_charges":[{"gross_charge":2223.0,"discounted_cash":1867.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Drug Assay Everolimus","code_information":[{"code":"30000559","type":"CDM"},{"code":"300","type":"RC"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clotting Factor Xiii Fibrn Stabiliz Screen Solub","code_information":[{"code":"30000560","type":"CDM"},{"code":"300","type":"RC"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":81.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clotting Factor Xii Hageman","code_information":[{"code":"30000561","type":"CDM"},{"code":"300","type":"RC"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dihydrotestosterone","code_information":[{"code":"30000563","type":"CDM"},{"code":"300","type":"RC"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Toxin/Antitoxin Assay Tissue Culture","code_information":[{"code":"30000564","type":"CDM"},{"code":"300","type":"RC"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antidepressants Serotonergic Class 1 Or 2","code_information":[{"code":"30000565","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":442.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Lrh Hormone","code_information":[{"code":"30000566","type":"CDM"},{"code":"300","type":"RC"},{"code":"83727","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":345.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc M. Genitalium Amp Probe","code_information":[{"code":"30000567","type":"CDM"},{"code":"300","type":"RC"},{"code":"87563","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":136.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Venipuncture, Blood Draw Kit, Sendout","code_information":[{"code":"30000568","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hpa-1 Genotyping Gene Analysis Common Variant","code_information":[{"code":"30000569","type":"CDM"},{"code":"300","type":"RC"},{"code":"81105","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Lacosamide","code_information":[{"code":"30000570","type":"CDM"},{"code":"300","type":"RC"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":105.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tpmt Gene Com Variants","code_information":[{"code":"30000571","type":"CDM"},{"code":"300","type":"RC"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":698.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Voriconazole","code_information":[{"code":"30000572","type":"CDM"},{"code":"300","type":"RC"},{"code":"80285","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":329.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Adalimumab","code_information":[{"code":"30000573","type":"CDM"},{"code":"300","type":"RC"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sars-Cov-2 Pcr","code_information":[{"code":"30000574","type":"CDM"},{"code":"300","type":"RC"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"30000575","type":"CDM"},{"code":"300","type":"RC"},{"code":"G2023","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug/Substance Nos 4-6","code_information":[{"code":"30000576","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":442.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Onco (Ovar) Two Proteins","code_information":[{"code":"30000577","type":"CDM"},{"code":"300","type":"RC"},{"code":"81500","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.0,"discounted_cash":838.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hbb Full Gene Sequence","code_information":[{"code":"30000578","type":"CDM"},{"code":"300","type":"RC"},{"code":"81364","type":"HCPCS"}],"standard_charges":[{"gross_charge":1540.0,"discounted_cash":1293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Occult Fecal Hgb Deter Ia Qual Feces 1-3","code_information":[{"code":"30000579","type":"CDM"},{"code":"300","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sars-Cov-2 Covid-19 Antibody","code_information":[{"code":"30000580","type":"CDM"},{"code":"300","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":131.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hemoglobin Fractj/Quantj Electrophoresis","code_information":[{"code":"30000581","type":"CDM"},{"code":"300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hemoglobin-Oxygen Affinity","code_information":[{"code":"30000582","type":"CDM"},{"code":"300","type":"RC"},{"code":"82820","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Detect Agent Nos Dna Amp Parvo B19 Dna","code_information":[{"code":"30000583","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":136.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Detect Agent Nos Dna Amp Jc Poly Dna","code_information":[{"code":"30000584","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":355.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Detect Agent Nos Dna Amp Bord Pertussis Pcr","code_information":[{"code":"30000585","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":465.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Detect Agent Nos Dna Amp Toxoplasma Dna","code_information":[{"code":"30000586","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":322.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Detect Agent Nos Dna Amp Ehrlichia Dna","code_information":[{"code":"30000587","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":336.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Detect Agent Nos Dna Amp Babesia Microti Dna","code_information":[{"code":"30000588","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.0,"discounted_cash":593.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Vedolizumab","code_information":[{"code":"30000589","type":"CDM"},{"code":"300","type":"RC"},{"code":"80280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1062.0,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Detect Agent Nos Dna Amp Bord Pertussis Pcr (Rp)","code_information":[{"code":"30000590","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":136.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antibody Hla Class I & Class Ii Antigens Qual","code_information":[{"code":"30000591","type":"CDM"},{"code":"300","type":"RC"},{"code":"86828","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":224.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Detect Agent Nos Dna Amp V Zoster Dna","code_information":[{"code":"30000592","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Detect Agent Nos Dna Amp Hep D Rna Pcr","code_information":[{"code":"30000593","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":392.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Factor Inhibitor Test","code_information":[{"code":"30000594","type":"CDM"},{"code":"300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tpmt Nudt15 Gene Analysis Common Variants","code_information":[{"code":"30000595","type":"CDM"},{"code":"300","type":"RC"},{"code":"0034U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1786.0,"discounted_cash":1500.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pca3/Klk3 Antigen","code_information":[{"code":"30000596","type":"CDM"},{"code":"300","type":"RC"},{"code":"81313","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":1017.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Drug Assay Infliximab","code_information":[{"code":"30000597","type":"CDM"},{"code":"300","type":"RC"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1062.0,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Hsv Dna Quant","code_information":[{"code":"30000598","type":"CDM"},{"code":"300","type":"RC"},{"code":"87530","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":167.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Galectin-3","code_information":[{"code":"30000599","type":"CDM"},{"code":"300","type":"RC"},{"code":"82777","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hbb Gene Com Variants","code_information":[{"code":"30000600","type":"CDM"},{"code":"300","type":"RC"},{"code":"81361","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":698.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aspa Gene","code_information":[{"code":"30000601","type":"CDM"},{"code":"300","type":"RC"},{"code":"81200","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":188.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blm Gene","code_information":[{"code":"30000602","type":"CDM"},{"code":"300","type":"RC"},{"code":"81209","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":157.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fancc Gene Analysis Common Variant","code_information":[{"code":"30000603","type":"CDM"},{"code":"300","type":"RC"},{"code":"81242","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":144.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gba Gene","code_information":[{"code":"30000604","type":"CDM"},{"code":"300","type":"RC"},{"code":"81251","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":188.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hexa Gene","code_information":[{"code":"30000605","type":"CDM"},{"code":"300","type":"RC"},{"code":"81255","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ikbkap Gene","code_information":[{"code":"30000606","type":"CDM"},{"code":"300","type":"RC"},{"code":"81260","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":366.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mcoln1 Gene","code_information":[{"code":"30000607","type":"CDM"},{"code":"300","type":"RC"},{"code":"81290","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":354.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Smpd1 Gene Common Variants","code_information":[{"code":"30000608","type":"CDM"},{"code":"300","type":"RC"},{"code":"81330","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":188.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hhv-6 Dna Quant","code_information":[{"code":"30000609","type":"CDM"},{"code":"300","type":"RC"},{"code":"87533","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Drug Screen Quantitative Lidocaine","code_information":[{"code":"30000610","type":"CDM"},{"code":"300","type":"RC"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Genetic Testing For Severe Inherited Conditions","code_information":[{"code":"30000611","type":"CDM"},{"code":"300","type":"RC"},{"code":"81443","type":"HCPCS"}],"standard_charges":[{"gross_charge":3477.0,"discounted_cash":2920.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Jak2 Gene Trgt Sequence Alys","code_information":[{"code":"30000612","type":"CDM"},{"code":"300","type":"RC"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.0,"discounted_cash":702.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Drug Assay Methotrexate","code_information":[{"code":"30000613","type":"CDM"},{"code":"300","type":"RC"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Jak2 Gene Analysis Trgt Seq Alys Exons 12-15","code_information":[{"code":"30000614","type":"CDM"},{"code":"300","type":"RC"},{"code":"0027U","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.0,"discounted_cash":756.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mpl Gene Common Variants","code_information":[{"code":"30000615","type":"CDM"},{"code":"300","type":"RC"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":569.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Drug Assay Felbamate","code_information":[{"code":"30000616","type":"CDM"},{"code":"300","type":"RC"},{"code":"80167","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla Ii Typing 1 Loc Hr","code_information":[{"code":"30000617","type":"CDM"},{"code":"300","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":469.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla Ii Typing 1 Locus Lr","code_information":[{"code":"30000618","type":"CDM"},{"code":"300","type":"RC"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":463.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mpl Gene Seq Alys Exon 11","code_information":[{"code":"30000619","type":"CDM"},{"code":"300","type":"RC"},{"code":"81339","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.0,"discounted_cash":702.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Estrogens Fractionated","code_information":[{"code":"30000620","type":"CDM"},{"code":"300","type":"RC"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.0,"discounted_cash":435.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Zika Virus Dna/Rna Amp Probe","code_information":[{"code":"30000621","type":"CDM"},{"code":"300","type":"RC"},{"code":"87662","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":192.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ccnd1/Igh Translocation Alys","code_information":[{"code":"30000622","type":"CDM"},{"code":"300","type":"RC"},{"code":"81168","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":786.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iaad Ia Cryptosporidium","code_information":[{"code":"30000623","type":"CDM"},{"code":"300","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lipoprotein-Associated Phospholipase A3","code_information":[{"code":"30000624","type":"CDM"},{"code":"300","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":162.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dpyd Gene Common Variants","code_information":[{"code":"30000625","type":"CDM"},{"code":"300","type":"RC"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":618.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cryptococcus Antibody","code_information":[{"code":"30000626","type":"CDM"},{"code":"300","type":"RC"},{"code":"86641","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Basic Metabolic Panel Calcium Ionized","code_information":[{"code":"30000627","type":"CDM"},{"code":"300","type":"RC"},{"code":"80047","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Creatine","code_information":[{"code":"30000628","type":"CDM"},{"code":"300","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Zika Virus Igm Antibody","code_information":[{"code":"30000629","type":"CDM"},{"code":"300","type":"RC"},{"code":"86794","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cyp2D6 Gene Com Variants","code_information":[{"code":"30000630","type":"CDM"},{"code":"300","type":"RC"},{"code":"81226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":913.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tp53 Gene Full Gene Sequence","code_information":[{"code":"30000631","type":"CDM"},{"code":"300","type":"RC"},{"code":"81351","type":"HCPCS"}],"standard_charges":[{"gross_charge":2600.0,"discounted_cash":2184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Digoxin Free","code_information":[{"code":"30000632","type":"CDM"},{"code":"300","type":"RC"},{"code":"80163","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":294.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Anca Titer Each Antibody","code_information":[{"code":"30000633","type":"CDM"},{"code":"300","type":"RC"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Interleukin-6 (Il-6)","code_information":[{"code":"30000634","type":"CDM"},{"code":"300","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":165.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sarscov2 & Inf A&B Amp Prb","code_information":[{"code":"30000635","type":"CDM"},{"code":"300","type":"RC"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":592.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mog-Igg1 Antb Cba Each","code_information":[{"code":"30000636","type":"CDM"},{"code":"300","type":"RC"},{"code":"86362","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.0,"discounted_cash":593.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tiss Trnsgltmnase Ea Ig Clas","code_information":[{"code":"30000637","type":"CDM"},{"code":"300","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Elastase Pancreatic Fecal Quantitative","code_information":[{"code":"30000638","type":"CDM"},{"code":"300","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ig Light Chains Free Each","code_information":[{"code":"30000639","type":"CDM"},{"code":"300","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Actin Antibody Each","code_information":[{"code":"30000640","type":"CDM"},{"code":"300","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Anca Screen Each Antibody","code_information":[{"code":"30000641","type":"CDM"},{"code":"300","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aquaporin-4 Antb Elisa","code_information":[{"code":"30000642","type":"CDM"},{"code":"300","type":"RC"},{"code":"86051","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":316.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aquaporin-4 Antb Cba Each","code_information":[{"code":"30000643","type":"CDM"},{"code":"300","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.0,"discounted_cash":748.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ema Each Ig Class","code_information":[{"code":"30000644","type":"CDM"},{"code":"300","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gliadin Antibody Ea Ig Class","code_information":[{"code":"30000645","type":"CDM"},{"code":"300","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mitochondrial Antibody Each","code_information":[{"code":"30000646","type":"CDM"},{"code":"300","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Voltage-Gtd Ca Chnl Antb Ea","code_information":[{"code":"30000647","type":"CDM"},{"code":"300","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":147.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Dir Meas Fr Estradiol","code_information":[{"code":"30000649","type":"CDM"},{"code":"300","type":"RC"},{"code":"82681","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":94.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fibrinogen Antigen","code_information":[{"code":"30000650","type":"CDM"},{"code":"300","type":"RC"},{"code":"85385","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fibrinolytic Plasminogen","code_information":[{"code":"30000651","type":"CDM"},{"code":"300","type":"RC"},{"code":"85415","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":157.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Path Clin Consltj Sf 5-21","code_information":[{"code":"30000652","type":"CDM"},{"code":"300","type":"RC"},{"code":"80503","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":179.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Htt Gene Analysis Detect Abnormal Alleles","code_information":[{"code":"30000653","type":"CDM"},{"code":"300","type":"RC"},{"code":"81271","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":466.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cftr Gene Dup/Delet Variants","code_information":[{"code":"30000654","type":"CDM"},{"code":"300","type":"RC"},{"code":"81222","type":"HCPCS"}],"standard_charges":[{"gross_charge":1763.0,"discounted_cash":1480.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cftr Gene Full Sequence","code_information":[{"code":"30000655","type":"CDM"},{"code":"300","type":"RC"},{"code":"81223","type":"HCPCS"}],"standard_charges":[{"gross_charge":2022.0,"discounted_cash":1698.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pneumocystis Carinii Ag If","code_information":[{"code":"30000656","type":"CDM"},{"code":"300","type":"RC"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Asy Hydroxychloroquine","code_information":[{"code":"30000657","type":"CDM"},{"code":"300","type":"RC"},{"code":"80220","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":611.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Iadna Orthopoxvirus Amplified Probe Technique Ea","code_information":[{"code":"30000658","type":"CDM"},{"code":"300","type":"RC"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":145.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Amino Acids Quant 2-6","code_information":[{"code":"30000660","type":"CDM"},{"code":"300","type":"RC"},{"code":"82136","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":213.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Borrelia Antibody","code_information":[{"code":"30000661","type":"CDM"},{"code":"300","type":"RC"},{"code":"86619","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Legion Pneumophilia Ag If","code_information":[{"code":"30000662","type":"CDM"},{"code":"300","type":"RC"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Virus Inoculate Tissue Addl","code_information":[{"code":"30000663","type":"CDM"},{"code":"300","type":"RC"},{"code":"87253","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla I Typing 1 Locus Hr","code_information":[{"code":"30000664","type":"CDM"},{"code":"300","type":"RC"},{"code":"81380","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":574.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chrmsm Count 45 Cell Mosaicism 2Karyotype","code_information":[{"code":"30000665","type":"CDM"},{"code":"300","type":"RC"},{"code":"88263","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Unlisted Multianalyte Assay Algorithmic Analysis","code_information":[{"code":"30000666","type":"CDM"},{"code":"300","type":"RC"},{"code":"81599","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":771.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tiss Cul Neo Disorders Solid Tumor","code_information":[{"code":"30000667","type":"CDM"},{"code":"300","type":"RC"},{"code":"88239","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":477.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Occult Fecal Hgb Deter Ia Qual Feces 1-3","code_information":[{"code":"30000668","type":"CDM"},{"code":"300","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Glyca Nuc Mr Spectrsc Quan","code_information":[{"code":"30000669","type":"CDM"},{"code":"300","type":"RC"},{"code":"0024U","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":110.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Neuro Csf Prion Prtn Qual","code_information":[{"code":"30000670","type":"CDM"},{"code":"300","type":"RC"},{"code":"0035U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2087.0,"discounted_cash":1753.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Kit Gene Analys D816 Variant","code_information":[{"code":"30000671","type":"CDM"},{"code":"300","type":"RC"},{"code":"81273","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":404.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Posaconazole","code_information":[{"code":"30000672","type":"CDM"},{"code":"300","type":"RC"},{"code":"80187","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":356.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Thiopurine S-Methyltransferase","code_information":[{"code":"30000673","type":"CDM"},{"code":"300","type":"RC"},{"code":"84433","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":185.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Babesia Microti Amplified Probe Technique","code_information":[{"code":"30000674","type":"CDM"},{"code":"300","type":"RC"},{"code":"87469","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nfct Ds Bv Rna Vag Flu Alg","code_information":[{"code":"30000675","type":"CDM"},{"code":"300","type":"RC"},{"code":"81513","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Heparin Neutralization","code_information":[{"code":"30000676","type":"CDM"},{"code":"300","type":"RC"},{"code":"85525","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"30000677","type":"CDM"},{"code":"300","type":"RC"},{"code":"C9803","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Acetaminophen","code_information":[{"code":"30000678","type":"CDM"},{"code":"300","type":"RC"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Salicylate","code_information":[{"code":"30000679","type":"CDM"},{"code":"300","type":"RC"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Nickel","code_information":[{"code":"30000680","type":"CDM"},{"code":"300","type":"RC"},{"code":"83885","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Oncoprotein Her-2/Neu","code_information":[{"code":"30000681","type":"CDM"},{"code":"300","type":"RC"},{"code":"83950","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":641.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Anaplsma Phgcytophlm Amp Prb","code_information":[{"code":"30000682","type":"CDM"},{"code":"300","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":131.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aquaporin-4 Antibody Flow Cytometry Each","code_information":[{"code":"30000683","type":"CDM"},{"code":"300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":472.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Myeloperoxidase","code_information":[{"code":"30000684","type":"CDM"},{"code":"300","type":"RC"},{"code":"83876","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":157.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ag Detection Polyval If","code_information":[{"code":"30000685","type":"CDM"},{"code":"300","type":"RC"},{"code":"87300","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mycobacteric Identification","code_information":[{"code":"30000686","type":"CDM"},{"code":"300","type":"RC"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ehrlicha Chaffeensis Amp Prb","code_information":[{"code":"30000687","type":"CDM"},{"code":"300","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":131.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skeletal Muscle Relaxant 1/3","code_information":[{"code":"30000688","type":"CDM"},{"code":"300","type":"RC"},{"code":"80369","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nudt15 Gene Common Variants","code_information":[{"code":"30000689","type":"CDM"},{"code":"300","type":"RC"},{"code":"81306","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.0,"discounted_cash":899.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mopath Procedure Level 9","code_information":[{"code":"30000690","type":"CDM"},{"code":"300","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":3675.0,"discounted_cash":3087.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Liver Ds Alys 3 Biomarkers Ia Srm Prognostic Alg","code_information":[{"code":"30000691","type":"CDM"},{"code":"300","type":"RC"},{"code":"81517","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":599.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mog-Igg1 Antb Flo Cytmtry Ea","code_information":[{"code":"30000692","type":"CDM"},{"code":"300","type":"RC"},{"code":"86363","type":"HCPCS"}],"standard_charges":[{"gross_charge":1366.0,"discounted_cash":1147.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Rufinamide","code_information":[{"code":"30000693","type":"CDM"},{"code":"300","type":"RC"},{"code":"80210","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Acetylcholn Rcptr Bndng Antb","code_information":[{"code":"30000694","type":"CDM"},{"code":"300","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Acetylcholn Rcptr Blckg Antb","code_information":[{"code":"30000695","type":"CDM"},{"code":"300","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Acetylcholn Rcptr Modlg Antb","code_information":[{"code":"30000696","type":"CDM"},{"code":"300","type":"RC"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Vitamin K","code_information":[{"code":"30000697","type":"CDM"},{"code":"300","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor Viii Reltd Antgn","code_information":[{"code":"30000698","type":"CDM"},{"code":"300","type":"RC"},{"code":"85244","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":157.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mycobacteria Dna Amp Probe","code_information":[{"code":"30000699","type":"CDM"},{"code":"300","type":"RC"},{"code":"87551","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":597.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mycobacteria Dna Quant","code_information":[{"code":"30000700","type":"CDM"},{"code":"300","type":"RC"},{"code":"87552","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":377.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Mycobacteria Avium-Intraclre Amp Prb","code_information":[{"code":"30000701","type":"CDM"},{"code":"300","type":"RC"},{"code":"87561","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":317.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Borrelia Miyamotoi Amp Prb","code_information":[{"code":"30000702","type":"CDM"},{"code":"300","type":"RC"},{"code":"87478","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":131.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hbb Gene Dup/Del Variants","code_information":[{"code":"30000703","type":"CDM"},{"code":"300","type":"RC"},{"code":"81363","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":624.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antibody Francisella Tularensis","code_information":[{"code":"30000704","type":"CDM"},{"code":"300","type":"RC"},{"code":"86668","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":271.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tp53 Gene Trgt Sequence Alys","code_information":[{"code":"30000705","type":"CDM"},{"code":"300","type":"RC"},{"code":"81352","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":1017.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hep B Surface Ag Neutrlzj Ia","code_information":[{"code":"30000706","type":"CDM"},{"code":"300","type":"RC"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Leflunomide","code_information":[{"code":"30000707","type":"CDM"},{"code":"300","type":"RC"},{"code":"80193","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"30000708","type":"CDM"},{"code":"300","type":"RC"},{"code":"0346U","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":756.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ig Paraprotein Qual Bld/Ur","code_information":[{"code":"30000709","type":"CDM"},{"code":"300","type":"RC"},{"code":"0077U","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Campylobacter Antibody","code_information":[{"code":"30000710","type":"CDM"},{"code":"300","type":"RC"},{"code":"86625","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":101.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Fluoride","code_information":[{"code":"30000711","type":"CDM"},{"code":"300","type":"RC"},{"code":"82735","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Clozapine","code_information":[{"code":"30000712","type":"CDM"},{"code":"300","type":"RC"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iaad Ia Adenovirus Enteric Typ 40/41","code_information":[{"code":"30000713","type":"CDM"},{"code":"300","type":"RC"},{"code":"87301","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tau Phosphorylated Each","code_information":[{"code":"30000714","type":"CDM"},{"code":"300","type":"RC"},{"code":"84393","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Beta-Amyloid 1-40 (Abeta 40)","code_information":[{"code":"30000715","type":"CDM"},{"code":"300","type":"RC"},{"code":"82233","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Beta-Amyloid 1-42 (Abeta 42)","code_information":[{"code":"30000716","type":"CDM"},{"code":"300","type":"RC"},{"code":"82234","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strptcs Pneum Antb Serot Ia","code_information":[{"code":"30000717","type":"CDM"},{"code":"300","type":"RC"},{"code":"86581","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mtb Rifampin Rst Amp Prb Tq","code_information":[{"code":"30000718","type":"CDM"},{"code":"300","type":"RC"},{"code":"87564","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pneumcysts Jirovecii Amp Prb","code_information":[{"code":"30000719","type":"CDM"},{"code":"300","type":"RC"},{"code":"87594","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Total Tau (Ttau)","code_information":[{"code":"30000721","type":"CDM"},{"code":"300","type":"RC"},{"code":"84394","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hered Colon Ca-Rlatd Do 5+","code_information":[{"code":"30000722","type":"CDM"},{"code":"300","type":"RC"},{"code":"81435","type":"HCPCS"}],"standard_charges":[{"gross_charge":4564.0,"discounted_cash":3833.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Neurflmnt Light Chain","code_information":[{"code":"30000723","type":"CDM"},{"code":"300","type":"RC"},{"code":"83884","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Amphetamines 3 Or 4","code_information":[{"code":"30000724","type":"CDM"},{"code":"300","type":"RC"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Itraconazole","code_information":[{"code":"30000725","type":"CDM"},{"code":"300","type":"RC"},{"code":"80189","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis D Quantification","code_information":[{"code":"30000726","type":"CDM"},{"code":"300","type":"RC"},{"code":"87523","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":594.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Galactose","code_information":[{"code":"30000727","type":"CDM"},{"code":"300","type":"RC"},{"code":"82760","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Galactose Transferase","code_information":[{"code":"30000728","type":"CDM"},{"code":"300","type":"RC"},{"code":"82775","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":470.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Legion Pneumo Dna Amp Prob","code_information":[{"code":"30000729","type":"CDM"},{"code":"300","type":"RC"},{"code":"87541","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hemoglobin Unstable Screen","code_information":[{"code":"30000730","type":"CDM"},{"code":"300","type":"RC"},{"code":"83068","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hba1/Hba2 Full Gene Sequence","code_information":[{"code":"30000731","type":"CDM"},{"code":"300","type":"RC"},{"code":"81259","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hba1/Hba2 Gene Dup/Del Vrnts","code_information":[{"code":"30000732","type":"CDM"},{"code":"300","type":"RC"},{"code":"81269","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":594.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Path Clin Consltj Mod 21-40","code_information":[{"code":"30000733","type":"CDM"},{"code":"300","type":"RC"},{"code":"80504","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":535.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Path Clin Consltj High 41-60","code_information":[{"code":"30000734","type":"CDM"},{"code":"300","type":"RC"},{"code":"80505","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":535.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc ?Path Clin Consltj Prolng Svc","code_information":[{"code":"30000735","type":"CDM"},{"code":"300","type":"RC"},{"code":"80506","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Assay Carbamazepine Free","code_information":[{"code":"30001236","type":"CDM"},{"code":"300","type":"RC"},{"code":"80157","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Electrolytes","code_information":[{"code":"30100001","type":"CDM"},{"code":"301","type":"RC"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lipid Panel","code_information":[{"code":"30100003","type":"CDM"},{"code":"301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatic Function Panel","code_information":[{"code":"30100004","type":"CDM"},{"code":"301","type":"RC"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Carbamazepine Total","code_information":[{"code":"30100006","type":"CDM"},{"code":"301","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Digoxin Total","code_information":[{"code":"30100007","type":"CDM"},{"code":"301","type":"RC"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Valproic Acid Total","code_information":[{"code":"30100008","type":"CDM"},{"code":"301","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":143.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Ethosuximide","code_information":[{"code":"30100009","type":"CDM"},{"code":"301","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":208.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lithium","code_information":[{"code":"30100011","type":"CDM"},{"code":"301","type":"RC"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phenytoin, Total","code_information":[{"code":"30100013","type":"CDM"},{"code":"301","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":148.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Theophylline","code_information":[{"code":"30100014","type":"CDM"},{"code":"301","type":"RC"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":186.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tobramycin","code_information":[{"code":"30100015","type":"CDM"},{"code":"301","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":128.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quantalcohols","code_information":[{"code":"30100018","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":253.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Analgesics Non-Opioid 1 Or 2","code_information":[{"code":"30100019","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":257.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Buprenorphine","code_information":[{"code":"30100020","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":160.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Opiates 1 Or More","code_information":[{"code":"30100021","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Alpha Globin Common Mutation Anls","code_information":[{"code":"30100022","type":"CDM"},{"code":"301","type":"RC"},{"code":"81257","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.0,"discounted_cash":799.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Test For Acetone/Ketones","code_information":[{"code":"30100024","type":"CDM"},{"code":"301","type":"RC"},{"code":"82009","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Adrenocorticotropic Hormone","code_information":[{"code":"30100025","type":"CDM"},{"code":"301","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":404.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Serum Albumin","code_information":[{"code":"30100026","type":"CDM"},{"code":"301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Urine Albumin","code_information":[{"code":"30100027","type":"CDM"},{"code":"301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microalbumin Quantitative","code_information":[{"code":"30100028","type":"CDM"},{"code":"301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Ammonia","code_information":[{"code":"30100029","type":"CDM"},{"code":"301","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Amylase","code_information":[{"code":"30100030","type":"CDM"},{"code":"301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Androstenedione","code_information":[{"code":"30100031","type":"CDM"},{"code":"301","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":346.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Arsenic","code_information":[{"code":"30100032","type":"CDM"},{"code":"301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bilirubin Total","code_information":[{"code":"30100033","type":"CDM"},{"code":"301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bilirubin Direct","code_information":[{"code":"30100034","type":"CDM"},{"code":"301","type":"RC"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Occult Blood Feces 1-3","code_information":[{"code":"30100035","type":"CDM"},{"code":"301","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vitamin D 25-Hydroxy","code_information":[{"code":"30100036","type":"CDM"},{"code":"301","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":234.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Calcium Total","code_information":[{"code":"30100037","type":"CDM"},{"code":"301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ionized Calcium","code_information":[{"code":"30100038","type":"CDM"},{"code":"301","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":157.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Calcium In Urine","code_information":[{"code":"30100039","type":"CDM"},{"code":"301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Carbon Dioxide","code_information":[{"code":"30100040","type":"CDM"},{"code":"301","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Carcinoembryonic Antigen","code_information":[{"code":"30100041","type":"CDM"},{"code":"301","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Three Catecholamines","code_information":[{"code":"30100042","type":"CDM"},{"code":"301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":362.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chemiluminescent Assay","code_information":[{"code":"30100043","type":"CDM"},{"code":"301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":321.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Blood Chloride","code_information":[{"code":"30100044","type":"CDM"},{"code":"301","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Urine Chloride","code_information":[{"code":"30100045","type":"CDM"},{"code":"301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Bld/Serum Cholesterol","code_information":[{"code":"30100046","type":"CDM"},{"code":"301","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cortisol Free","code_information":[{"code":"30100047","type":"CDM"},{"code":"301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Ck (Pk)","code_information":[{"code":"30100048","type":"CDM"},{"code":"301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Creatine Mb Fraction","code_information":[{"code":"30100049","type":"CDM"},{"code":"301","type":"RC"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":120.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Creatinine","code_information":[{"code":"30100050","type":"CDM"},{"code":"301","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Urine Creatinine","code_information":[{"code":"30100051","type":"CDM"},{"code":"301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Creatinine Clearance Test","code_information":[{"code":"30100052","type":"CDM"},{"code":"301","type":"RC"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Cryofibrinogen","code_information":[{"code":"30100053","type":"CDM"},{"code":"301","type":"RC"},{"code":"82585","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":120.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vitamin B12","code_information":[{"code":"30100054","type":"CDM"},{"code":"301","type":"RC"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":195.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cystatin C","code_information":[{"code":"30100055","type":"CDM"},{"code":"301","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dehydroepiandrosterone","code_information":[{"code":"30100056","type":"CDM"},{"code":"301","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":432.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dehydroepiandrosterone Sulfate","code_information":[{"code":"30100057","type":"CDM"},{"code":"301","type":"RC"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":287.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vitamin D 1,25 Dihydroxy","code_information":[{"code":"30100058","type":"CDM"},{"code":"301","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Estrone","code_information":[{"code":"30100059","type":"CDM"},{"code":"301","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":349.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Blood Fatty Acids","code_information":[{"code":"30100060","type":"CDM"},{"code":"301","type":"RC"},{"code":"82725","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ferritin","code_information":[{"code":"30100061","type":"CDM"},{"code":"301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Folic Acid Serum","code_information":[{"code":"30100062","type":"CDM"},{"code":"301","type":"RC"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Folic Acid Rbc Quest","code_information":[{"code":"30100063","type":"CDM"},{"code":"301","type":"RC"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Igg 1 2 3 Or 4 Each","code_information":[{"code":"30100065","type":"CDM"},{"code":"301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gastrin","code_information":[{"code":"30100066","type":"CDM"},{"code":"301","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":183.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Glucagon","code_information":[{"code":"30100067","type":"CDM"},{"code":"301","type":"RC"},{"code":"82943","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":272.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Glucose Other Fluid","code_information":[{"code":"30100068","type":"CDM"},{"code":"301","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Glucose Blood Quant","code_information":[{"code":"30100069","type":"CDM"},{"code":"301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Glucose Test","code_information":[{"code":"30100070","type":"CDM"},{"code":"301","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":38.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Glucose Tolerance Test 3 Spec","code_information":[{"code":"30100071","type":"CDM"},{"code":"301","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Glucose Tolerance Test 3 Spec Add","code_information":[{"code":"30100072","type":"CDM"},{"code":"301","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Ggt","code_information":[{"code":"30100073","type":"CDM"},{"code":"301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Gonadotropin (Fsh)","code_information":[{"code":"30100074","type":"CDM"},{"code":"301","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Gonadotropin (Lh)","code_information":[{"code":"30100075","type":"CDM"},{"code":"301","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":224.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Growth Hormone","code_information":[{"code":"30100076","type":"CDM"},{"code":"301","type":"RC"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":153.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Glycosylated Hemoglobin Test","code_information":[{"code":"30100077","type":"CDM"},{"code":"301","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":154.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Plasma Hemoglobin","code_information":[{"code":"30100078","type":"CDM"},{"code":"301","type":"RC"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Progesterone 17-D","code_information":[{"code":"30100079","type":"CDM"},{"code":"301","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunoassay Quant Nos Nonab","code_information":[{"code":"30100080","type":"CDM"},{"code":"301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":346.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Iron","code_information":[{"code":"30100081","type":"CDM"},{"code":"301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lactic Acid","code_information":[{"code":"30100082","type":"CDM"},{"code":"301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lactate (Ld) (Ldh) Enzyme","code_information":[{"code":"30100083","type":"CDM"},{"code":"301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lipase","code_information":[{"code":"30100084","type":"CDM"},{"code":"301","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hdl Cholesterol","code_information":[{"code":"30100085","type":"CDM"},{"code":"301","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Magnesium","code_information":[{"code":"30100086","type":"CDM"},{"code":"301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Csf Protein","code_information":[{"code":"30100087","type":"CDM"},{"code":"301","type":"RC"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":258.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Myoglobin","code_information":[{"code":"30100088","type":"CDM"},{"code":"301","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Natriuretic Peptide","code_information":[{"code":"30100089","type":"CDM"},{"code":"301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Oligoclonal Bands","code_information":[{"code":"30100090","type":"CDM"},{"code":"301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":236.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Osmolality; Blood","code_information":[{"code":"30100091","type":"CDM"},{"code":"301","type":"RC"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Osmolality Urine","code_information":[{"code":"30100092","type":"CDM"},{"code":"301","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Ph Body Fluid Nos","code_information":[{"code":"30100093","type":"CDM"},{"code":"301","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Alkaline Phosphatase","code_information":[{"code":"30100094","type":"CDM"},{"code":"301","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phosphorus","code_information":[{"code":"30100095","type":"CDM"},{"code":"301","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phosphorus Urine","code_information":[{"code":"30100096","type":"CDM"},{"code":"301","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Potassium","code_information":[{"code":"30100097","type":"CDM"},{"code":"301","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Potassium; Urine","code_information":[{"code":"30100098","type":"CDM"},{"code":"301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prealbumin","code_information":[{"code":"30100099","type":"CDM"},{"code":"301","type":"RC"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prolactin","code_information":[{"code":"30100100","type":"CDM"},{"code":"301","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":341.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Psa Total","code_information":[{"code":"30100101","type":"CDM"},{"code":"301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Protein Total","code_information":[{"code":"30100102","type":"CDM"},{"code":"301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":68.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Protein Body Fluid","code_information":[{"code":"30100103","type":"CDM"},{"code":"301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vitamin B6","code_information":[{"code":"30100104","type":"CDM"},{"code":"301","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":404.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pyruvate Blood","code_information":[{"code":"30100105","type":"CDM"},{"code":"301","type":"RC"},{"code":"84210","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sex Hormone Binding Globulin","code_information":[{"code":"30100106","type":"CDM"},{"code":"301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sodium","code_information":[{"code":"30100107","type":"CDM"},{"code":"301","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sodium Urine","code_information":[{"code":"30100108","type":"CDM"},{"code":"301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Sweat Sodium","code_information":[{"code":"30100109","type":"CDM"},{"code":"301","type":"RC"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Specific Gravity Fluid","code_information":[{"code":"30100110","type":"CDM"},{"code":"301","type":"RC"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Testosterone Total","code_information":[{"code":"30100111","type":"CDM"},{"code":"301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":200.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thyroxine Total","code_information":[{"code":"30100112","type":"CDM"},{"code":"301","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thyroxine Free","code_information":[{"code":"30100113","type":"CDM"},{"code":"301","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":157.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Thyroid Stim Hormone","code_information":[{"code":"30100114","type":"CDM"},{"code":"301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":191.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thyroid Stimulating Immunoglobulin","code_information":[{"code":"30100115","type":"CDM"},{"code":"301","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":609.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transferase Ast","code_information":[{"code":"30100116","type":"CDM"},{"code":"301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Alanine Amino (Alt) (Sgpt","code_information":[{"code":"30100117","type":"CDM"},{"code":"301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transferrin","code_information":[{"code":"30100118","type":"CDM"},{"code":"301","type":"RC"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Triglycerides","code_information":[{"code":"30100119","type":"CDM"},{"code":"301","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Thyroid (T3 Or T4)","code_information":[{"code":"30100120","type":"CDM"},{"code":"301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc T3, Total","code_information":[{"code":"30100121","type":"CDM"},{"code":"301","type":"RC"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Troponin","code_information":[{"code":"30100122","type":"CDM"},{"code":"301","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":140.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urea Nitrogen","code_information":[{"code":"30100123","type":"CDM"},{"code":"301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood/Uric Acid","code_information":[{"code":"30100124","type":"CDM"},{"code":"301","type":"RC"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Uric Acid; Urine","code_information":[{"code":"30100125","type":"CDM"},{"code":"301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Volatiles","code_information":[{"code":"30100126","type":"CDM"},{"code":"301","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Xylose Absorption Test","code_information":[{"code":"30100127","type":"CDM"},{"code":"301","type":"RC"},{"code":"84620","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gonadotropin, Chorionic Hcg Quant","code_information":[{"code":"30100128","type":"CDM"},{"code":"301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gonadotropin, Chorionic Hcg Qualitative","code_information":[{"code":"30100129","type":"CDM"},{"code":"301","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clinical Chemistry Test","code_information":[{"code":"30100130","type":"CDM"},{"code":"301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":191.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Leukocyte Histamine Release","code_information":[{"code":"30100134","type":"CDM"},{"code":"301","type":"RC"},{"code":"86343","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dna/Rna Sequencing","code_information":[{"code":"30100138","type":"CDM"},{"code":"301","type":"RC"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.0,"discounted_cash":1071.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Macroscopic Exam Parasite","code_information":[{"code":"30100139","type":"CDM"},{"code":"301","type":"RC"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":144.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Genotype Dna/Rna Hiv","code_information":[{"code":"30100143","type":"CDM"},{"code":"301","type":"RC"},{"code":"87906","type":"HCPCS"}],"standard_charges":[{"gross_charge":1625.0,"discounted_cash":1365.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Calculus Spectroscopy","code_information":[{"code":"30100146","type":"CDM"},{"code":"301","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iron Binding Test","code_information":[{"code":"30100147","type":"CDM"},{"code":"301","type":"RC"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":189.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Scrn Quan Levetiracetam","code_information":[{"code":"30100148","type":"CDM"},{"code":"301","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc General Health Panel","code_information":[{"code":"30100149","type":"CDM"},{"code":"301","type":"RC"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":308.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Test Prsmv Chem Anlyzr","code_information":[{"code":"30100150","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Test Prsmv Qual Instrmnt Optcl Obs Per Day","code_information":[{"code":"30100151","type":"CDM"},{"code":"301","type":"RC"},{"code":"80306","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lipoprotein Blood Electrophorectic Sep&Quan","code_information":[{"code":"30100152","type":"CDM"},{"code":"301","type":"RC"},{"code":"83700","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Opioids And Opiate Analogs 3 Or 4","code_information":[{"code":"30100153","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":408.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Opioids & Opiate Analogs 5/More","code_information":[{"code":"30100154","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":408.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antidepressants Tricyclic Other Cyclicals 1 Or 2","code_information":[{"code":"30100155","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antidepressants Tricyclic Other Cyclicals 3-5","code_information":[{"code":"30100156","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antidepressants Tricyclic Other Cyclicals 6/More","code_information":[{"code":"30100157","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Prostaglndin Each","code_information":[{"code":"30100158","type":"CDM"},{"code":"301","type":"RC"},{"code":"84150","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Pyruvate Kinase","code_information":[{"code":"30100159","type":"CDM"},{"code":"301","type":"RC"},{"code":"84220","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Occult Peroxidase Actv Qual Feces 1-3 Spec","code_information":[{"code":"30100160","type":"CDM"},{"code":"301","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phospholipid Neutralization Hexagonal","code_information":[{"code":"30100161","type":"CDM"},{"code":"301","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Protein Westrn Blot I&R Blood/Other Fluid","code_information":[{"code":"30100162","type":"CDM"},{"code":"301","type":"RC"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":213.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gastrin Secretin Stimulation Test","code_information":[{"code":"30100163","type":"CDM"},{"code":"301","type":"RC"},{"code":"82938","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Sedative Hypnotics","code_information":[{"code":"30100164","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quant Amphetamines 1 Or 2","code_information":[{"code":"30100165","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Barbiturates","code_information":[{"code":"30100166","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Cannabinoids Natural, Marijuana","code_information":[{"code":"30100167","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":150.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Cocaine","code_information":[{"code":"30100168","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Tramadol","code_information":[{"code":"30100169","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":145.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug/Substance Definitive Qual/Quant Nos 7/More","code_information":[{"code":"30100170","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":202.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cyanocobalamin Vit B-12 Unsat Binding Capacity","code_information":[{"code":"30100171","type":"CDM"},{"code":"301","type":"RC"},{"code":"82608","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":199.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Phencyclidine","code_information":[{"code":"30100172","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Tyrosine","code_information":[{"code":"30100173","type":"CDM"},{"code":"301","type":"RC"},{"code":"84510","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":199.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Enzyme Cell Activity, Each","code_information":[{"code":"30100174","type":"CDM"},{"code":"301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Electrophoretic Test","code_information":[{"code":"30100175","type":"CDM"},{"code":"301","type":"RC"},{"code":"82664","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":207.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urine Sulfate","code_information":[{"code":"30100176","type":"CDM"},{"code":"301","type":"RC"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quant, Dipropylacetic Acid, Free","code_information":[{"code":"30100177","type":"CDM"},{"code":"301","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ht Stbl Alkaline Phosphatase","code_information":[{"code":"30100178","type":"CDM"},{"code":"301","type":"RC"},{"code":"84078","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Carb Deficient Transrerrin","code_information":[{"code":"30100179","type":"CDM"},{"code":"301","type":"RC"},{"code":"82373","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":171.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Assay Of Thyroxine Binding Globulin","code_information":[{"code":"30100180","type":"CDM"},{"code":"301","type":"RC"},{"code":"84442","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quantitative Mycophenolate","code_information":[{"code":"30100181","type":"CDM"},{"code":"301","type":"RC"},{"code":"80180","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lactoferrin Fecal Quantitative","code_information":[{"code":"30100182","type":"CDM"},{"code":"301","type":"RC"},{"code":"83631","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Scrn Quant Oxcarbazepin","code_information":[{"code":"30100183","type":"CDM"},{"code":"301","type":"RC"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antiepileptics Nos 1-3","code_information":[{"code":"30100184","type":"CDM"},{"code":"301","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":160.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Deoxycortisol 11-","code_information":[{"code":"30100185","type":"CDM"},{"code":"301","type":"RC"},{"code":"82634","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":169.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Desoxycorticosterone 11-","code_information":[{"code":"30100186","type":"CDM"},{"code":"301","type":"RC"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":178.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quantitative Zonisamide","code_information":[{"code":"30100187","type":"CDM"},{"code":"301","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quant Tiagabine","code_information":[{"code":"30100188","type":"CDM"},{"code":"301","type":"RC"},{"code":"80199","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Heroin Metabolite","code_information":[{"code":"30100189","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":480.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Corticosterone","code_information":[{"code":"30100190","type":"CDM"},{"code":"301","type":"RC"},{"code":"82528","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fat/Lipids Feces Quantitative","code_information":[{"code":"30100191","type":"CDM"},{"code":"301","type":"RC"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lactoferrin Fecal (Qual)","code_information":[{"code":"30100192","type":"CDM"},{"code":"301","type":"RC"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Afp-L3 Fraction Isoform & Total Afp W/Ratio","code_information":[{"code":"30100193","type":"CDM"},{"code":"301","type":"RC"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":230.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quant Alcohols Biomarkers 1 Or 2","code_information":[{"code":"30100194","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":236.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Quant Amphetamines 5 Or More","code_information":[{"code":"30100195","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":236.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screen Analgesics Non-Opioid 3-5","code_information":[{"code":"30100196","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":236.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antidepressants Not Otherwise Specified","code_information":[{"code":"30100197","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antidepressants Serotonergic Class 3-5","code_information":[{"code":"30100198","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":236.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antiepileptics Not Otherwise Specified 4-6","code_information":[{"code":"30100199","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":236.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antipsychotics Not Otherwise Specified 7/More","code_information":[{"code":"30100200","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":288.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Pregabalin","code_information":[{"code":"30100201","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Tapentadol","code_information":[{"code":"30100202","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Gabapentin Non-Blood","code_information":[{"code":"30100203","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Ketamine And Norketamine","code_information":[{"code":"30100204","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drug Screening Methylphenidate","code_information":[{"code":"30100205","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skel Musc Relaxant 3 Or More","code_information":[{"code":"30100206","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":236.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla I Typing Complete Lr","code_information":[{"code":"30200000","type":"CDM"},{"code":"302","type":"RC"},{"code":"81372","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":577.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Allergen Specific Ige","code_information":[{"code":"30200001","type":"CDM"},{"code":"302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":131.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C-Reactive Protein","code_information":[{"code":"30200002","type":"CDM"},{"code":"302","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Complement Antigen","code_information":[{"code":"30200003","type":"CDM"},{"code":"302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Complement /Function Activity","code_information":[{"code":"30200004","type":"CDM"},{"code":"302","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fluorescent Antibody Screen","code_information":[{"code":"30200005","type":"CDM"},{"code":"302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":233.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Heterophile Antibody Screen","code_information":[{"code":"30200006","type":"CDM"},{"code":"302","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunodiffusion Ouchterlony Qualitative","code_information":[{"code":"30200007","type":"CDM"},{"code":"302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rheumatoid Factor Test Quant","code_information":[{"code":"30200008","type":"CDM"},{"code":"302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Syphilis Test Non-Treponemal Antibody Qualitative","code_information":[{"code":"30200009","type":"CDM"},{"code":"302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Syphilis Test Non-Treponemal Antibody Quantitative","code_information":[{"code":"30200010","type":"CDM"},{"code":"302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":185.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aspergillus Antibody","code_information":[{"code":"30200011","type":"CDM"},{"code":"302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":169.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blastomyces Antibody","code_information":[{"code":"30200012","type":"CDM"},{"code":"302","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":169.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lyme Disease Antibody","code_information":[{"code":"30200013","type":"CDM"},{"code":"302","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":169.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hiv-1 Ab Conf By Western Blot","code_information":[{"code":"30200014","type":"CDM"},{"code":"302","type":"RC"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hiv-1Antibody","code_information":[{"code":"30200015","type":"CDM"},{"code":"302","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":114.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hepatitis A Total Antibody","code_information":[{"code":"30200016","type":"CDM"},{"code":"302","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nocardia Antibody","code_information":[{"code":"30200017","type":"CDM"},{"code":"302","type":"RC"},{"code":"86744","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rubella Antibody","code_information":[{"code":"30200018","type":"CDM"},{"code":"302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hep C Ab Test Confirm","code_information":[{"code":"30200019","type":"CDM"},{"code":"302","type":"RC"},{"code":"86804","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":414.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla Typing A B Or C, Single","code_information":[{"code":"30200020","type":"CDM"},{"code":"302","type":"RC"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":293.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antistreptolysin O Titer","code_information":[{"code":"30200023","type":"CDM"},{"code":"302","type":"RC"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tb Ag Response T-Cell Susp","code_information":[{"code":"30200024","type":"CDM"},{"code":"302","type":"RC"},{"code":"86481","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":397.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cellular Function Assay Stimul&Detect Biomarker","code_information":[{"code":"30200025","type":"CDM"},{"code":"302","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":924.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antibody Salmonella","code_information":[{"code":"30200026","type":"CDM"},{"code":"302","type":"RC"},{"code":"86768","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dna Antibody Single Stranded","code_information":[{"code":"30200027","type":"CDM"},{"code":"302","type":"RC"},{"code":"86226","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Neutralization Test, Viral","code_information":[{"code":"30200028","type":"CDM"},{"code":"302","type":"RC"},{"code":"86382","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Allergen Specific Igg Quan/Semiquan Ea Allergen","code_information":[{"code":"30200029","type":"CDM"},{"code":"302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Brucella Antibodies","code_information":[{"code":"30200030","type":"CDM"},{"code":"302","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":147.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antibody Yersinia","code_information":[{"code":"30200031","type":"CDM"},{"code":"302","type":"RC"},{"code":"86793","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Serum Incubation With Inhibitors, Each","code_information":[{"code":"30200032","type":"CDM"},{"code":"302","type":"RC"},{"code":"86977","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":425.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ab; Leishmania","code_information":[{"code":"30200033","type":"CDM"},{"code":"302","type":"RC"},{"code":"86717","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":131.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Legionella Pneumophila Antibody (Igg), Ifa","code_information":[{"code":"30200034","type":"CDM"},{"code":"302","type":"RC"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antibody John Cunningham Virus","code_information":[{"code":"30200035","type":"CDM"},{"code":"302","type":"RC"},{"code":"86711","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Particle Agglutination Titer Each Antibody","code_information":[{"code":"30200036","type":"CDM"},{"code":"302","type":"RC"},{"code":"86406","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antinuclear Ab (Ana); Titer","code_information":[{"code":"30200037","type":"CDM"},{"code":"302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Allergen Spec Ige Recombinant/Purified Compnt Ea","code_information":[{"code":"30200039","type":"CDM"},{"code":"302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antibody Identification Platelet Immunogl Assay","code_information":[{"code":"30200040","type":"CDM"},{"code":"302","type":"RC"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunodiffusion Not Elsewhere Specified","code_information":[{"code":"30200041","type":"CDM"},{"code":"302","type":"RC"},{"code":"86329","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mononuclear Cell Antigen Quantitative Nos Ea","code_information":[{"code":"30200042","type":"CDM"},{"code":"302","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":125.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antibody; Respiratory Syncytial Virus","code_information":[{"code":"30200043","type":"CDM"},{"code":"302","type":"RC"},{"code":"86756","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cbc Manual Diff","code_information":[{"code":"30500000","type":"CDM"},{"code":"305","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":66.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hematocrit","code_information":[{"code":"30500001","type":"CDM"},{"code":"305","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hemoglobin","code_information":[{"code":"30500002","type":"CDM"},{"code":"305","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Complete Cbc With Diff","code_information":[{"code":"30500003","type":"CDM"},{"code":"305","type":"RC"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Complete Cbc Without Diff","code_information":[{"code":"30500004","type":"CDM"},{"code":"305","type":"RC"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Reticulocyte Count","code_information":[{"code":"30500005","type":"CDM"},{"code":"305","type":"RC"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Automated Leukocyte Count","code_information":[{"code":"30500006","type":"CDM"},{"code":"305","type":"RC"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Platelet Count","code_information":[{"code":"30500007","type":"CDM"},{"code":"305","type":"RC"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Factor Viii Ahg 1 Stage","code_information":[{"code":"30500008","type":"CDM"},{"code":"305","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":360.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clot Inhibit Protein C Activity","code_information":[{"code":"30500009","type":"CDM"},{"code":"305","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":293.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fibrin Degradation Quant","code_information":[{"code":"30500010","type":"CDM"},{"code":"305","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fibrinogen Activity","code_information":[{"code":"30500011","type":"CDM"},{"code":"305","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hemoglobin Fetal; Differential Lysis","code_information":[{"code":"30500012","type":"CDM"},{"code":"305","type":"RC"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prothrombin Time","code_information":[{"code":"30500013","type":"CDM"},{"code":"305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Sed Rate Automated","code_information":[{"code":"30500014","type":"CDM"},{"code":"305","type":"RC"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Sickle Cell Test","code_information":[{"code":"30500015","type":"CDM"},{"code":"305","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":89.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thromboplastin Time Partial","code_information":[{"code":"30500016","type":"CDM"},{"code":"305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":81.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Smear, Peripheral, Interpret By Physician With Written Report","code_information":[{"code":"30500017","type":"CDM"},{"code":"305","type":"RC"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":81.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Osmotic Fragility Rbc; Incubated","code_information":[{"code":"30500018","type":"CDM"},{"code":"305","type":"RC"},{"code":"85557","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fibrin Dgradj Splt Produxs Aggluj Slide Semiquan","code_information":[{"code":"30500019","type":"CDM"},{"code":"305","type":"RC"},{"code":"85362","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thromboplastin Inhibition Tissue","code_information":[{"code":"30500020","type":"CDM"},{"code":"305","type":"RC"},{"code":"85705","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":45.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Reticulated Platelet Assay","code_information":[{"code":"30500021","type":"CDM"},{"code":"305","type":"RC"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clotting Assay Whole Blood","code_information":[{"code":"30500022","type":"CDM"},{"code":"305","type":"RC"},{"code":"85396","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Specimen Infect Agnt Concntj","code_information":[{"code":"30600000","type":"CDM"},{"code":"306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Culture For Bacteria","code_information":[{"code":"30600001","type":"CDM"},{"code":"306","type":"RC"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":188.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Feces Culture Aerobic Bact","code_information":[{"code":"30600002","type":"CDM"},{"code":"306","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":287.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Stool Culture Aerobic Bacteria Each","code_information":[{"code":"30600003","type":"CDM"},{"code":"306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Culture Othr Specimn Aerobic","code_information":[{"code":"30600004","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":246.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cultr Bacteria Except Blood","code_information":[{"code":"30600005","type":"CDM"},{"code":"306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Culture Screen Only","code_information":[{"code":"30600006","type":"CDM"},{"code":"306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urine Culture/Colony Count","code_information":[{"code":"30600007","type":"CDM"},{"code":"306","type":"RC"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":135.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Fungus Culture","code_information":[{"code":"30600008","type":"CDM"},{"code":"306","type":"RC"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mycobacteria Culture","code_information":[{"code":"30600009","type":"CDM"},{"code":"306","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Macroscopic Exam Arthropod","code_information":[{"code":"30600010","type":"CDM"},{"code":"306","type":"RC"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pinworm Exam","code_information":[{"code":"30600011","type":"CDM"},{"code":"306","type":"RC"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microbe Susceptible Disk","code_information":[{"code":"30600012","type":"CDM"},{"code":"306","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microbe Susceptible Mic","code_information":[{"code":"30600013","type":"CDM"},{"code":"306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":127.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Smear Gram Stain","code_information":[{"code":"30600014","type":"CDM"},{"code":"306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Smear Fluorescent/Acid Stai","code_information":[{"code":"30600015","type":"CDM"},{"code":"306","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":94.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Smear Special Stain","code_information":[{"code":"30600016","type":"CDM"},{"code":"306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Smear Wet Mount Saline/Ink","code_information":[{"code":"30600017","type":"CDM"},{"code":"306","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tissue Exam For Fungi","code_information":[{"code":"30600018","type":"CDM"},{"code":"306","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Histoplasma Capsul Ag Eia","code_information":[{"code":"30600019","type":"CDM"},{"code":"306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":345.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Resp Syncytial Ag Eia","code_information":[{"code":"30600020","type":"CDM"},{"code":"306","type":"RC"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc S. Aureus, Dna, Amp Probe","code_information":[{"code":"30600021","type":"CDM"},{"code":"306","type":"RC"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":217.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mrsa, Dna, Amp Probe","code_information":[{"code":"30600022","type":"CDM"},{"code":"306","type":"RC"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":217.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chg Cult Spec, Anaerb W/Addn Methods","code_information":[{"code":"30600023","type":"CDM"},{"code":"306","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Detect Agnt Mult Dna Ampli","code_information":[{"code":"30600024","type":"CDM"},{"code":"306","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":574.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hhv-6 Dna Amp Probe","code_information":[{"code":"30600025","type":"CDM"},{"code":"306","type":"RC"},{"code":"87532","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":257.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strep B Dna Amp Probe","code_information":[{"code":"30600026","type":"CDM"},{"code":"306","type":"RC"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":257.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Candida Dna Amp Probe","code_information":[{"code":"30600027","type":"CDM"},{"code":"306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":288.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gardner Vag Dna Quant","code_information":[{"code":"30600028","type":"CDM"},{"code":"306","type":"RC"},{"code":"87512","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":232.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Mycoplsm Pneumoniae Amplified Probe Tq","code_information":[{"code":"30600029","type":"CDM"},{"code":"306","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":246.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna-Dna/Rna Gi Pthgn Multiplex Probe Tq 12-25","code_information":[{"code":"30600030","type":"CDM"},{"code":"306","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":3651.0,"discounted_cash":3066.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cns Dna/Rna Amp Probe Multiple Subtypes 12-25","code_information":[{"code":"30600031","type":"CDM"},{"code":"306","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":3505.0,"discounted_cash":2944.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single","code_information":[{"code":"30600032","type":"CDM"},{"code":"306","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":237.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Respir Probe & Rev Transcrip 6-11 Targets","code_information":[{"code":"30600033","type":"CDM"},{"code":"306","type":"RC"},{"code":"87632","type":"HCPCS"}],"standard_charges":[{"gross_charge":2098.0,"discounted_cash":1762.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Hiv-2 Amp Probe & Reverse Transcription","code_information":[{"code":"30600034","type":"CDM"},{"code":"306","type":"RC"},{"code":"87538","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":667.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Respiratry Probe & Rev Trnscr 12-25 Target","code_information":[{"code":"30600035","type":"CDM"},{"code":"306","type":"RC"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":2225.0,"discounted_cash":1869.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Trichomonas Vaginalis Amplified Probe Tech","code_information":[{"code":"30600036","type":"CDM"},{"code":"306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Agent Nos Assay W/Optic","code_information":[{"code":"30600037","type":"CDM"},{"code":"306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Varicella Zoster Ag By Dfa","code_information":[{"code":"30600038","type":"CDM"},{"code":"306","type":"RC"},{"code":"87290","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nos Infectious Ag By If","code_information":[{"code":"30600039","type":"CDM"},{"code":"306","type":"RC"},{"code":"87299","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Entamoeb Hist Group Ag Ia","code_information":[{"code":"30600040","type":"CDM"},{"code":"306","type":"RC"},{"code":"87337","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.0,"discounted_cash":923.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chylmd Pneum Dna Amp Probe","code_information":[{"code":"30600041","type":"CDM"},{"code":"306","type":"RC"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1659.0,"discounted_cash":1393.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phenotype Infect Agent Drug","code_information":[{"code":"30600042","type":"CDM"},{"code":"306","type":"RC"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":162.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Bartonella Amplified Probe Technique","code_information":[{"code":"30600043","type":"CDM"},{"code":"306","type":"RC"},{"code":"87471","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":251.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Candida Species Direct Probe Tq","code_information":[{"code":"30600044","type":"CDM"},{"code":"306","type":"RC"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Gardnerella Vaginalis Direct Probe Tq","code_information":[{"code":"30600045","type":"CDM"},{"code":"306","type":"RC"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Trichomonas Vaginalis Direct Probe Tq","code_information":[{"code":"30600046","type":"CDM"},{"code":"306","type":"RC"},{"code":"87660","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":87.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sars-Cov-2 Pcr Aries","code_information":[{"code":"30600047","type":"CDM"},{"code":"306","type":"RC"},{"code":"U0002","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":185.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Dna/Rna Rsv Amplified Probe Technique","code_information":[{"code":"30600048","type":"CDM"},{"code":"306","type":"RC"},{"code":"87634","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nfct Ds Vir Resp Rna 3 Trgt","code_information":[{"code":"30600049","type":"CDM"},{"code":"306","type":"RC"},{"code":"0240U","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":609.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nfct Ds Vir Resp Rna 4 Trgt","code_information":[{"code":"30600050","type":"CDM"},{"code":"306","type":"RC"},{"code":"0241U","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":809.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna-Dna/Rna Probe Tq 6-11","code_information":[{"code":"30600051","type":"CDM"},{"code":"306","type":"RC"},{"code":"87506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.0,"discounted_cash":1030.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iadna Streptococcus Group A Amplified Probe Tq","code_information":[{"code":"30600052","type":"CDM"},{"code":"306","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":152.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dna/Rna Direct Probe","code_information":[{"code":"30600053","type":"CDM"},{"code":"306","type":"RC"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Heredtry Nurondcrn Tum Dsrdr","code_information":[{"code":"30600054","type":"CDM"},{"code":"300","type":"RC"},{"code":"81437","type":"HCPCS"}],"standard_charges":[{"gross_charge":5846.0,"discounted_cash":4910.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Autoimmune Rheumatoid Arthr","code_information":[{"code":"30600055","type":"CDM"},{"code":"300","type":"RC"},{"code":"81490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.0,"discounted_cash":2860.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cul Typ Id Bld Pthgn 6+ Trgt","code_information":[{"code":"30600056","type":"CDM"},{"code":"306","type":"RC"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":861.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urinalysis Auto W/Scope","code_information":[{"code":"30700000","type":"CDM"},{"code":"307","type":"RC"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urinalysis Auto W/O Scope","code_information":[{"code":"30700001","type":"CDM"},{"code":"307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urinalysis Qual","code_information":[{"code":"30700002","type":"CDM"},{"code":"307","type":"RC"},{"code":"81005","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microscopic Exam Of Urine","code_information":[{"code":"30700003","type":"CDM"},{"code":"307","type":"RC"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Specimen Fat Stain","code_information":[{"code":"30900000","type":"CDM"},{"code":"309","type":"RC"},{"code":"89125","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytopath Concentrate Technique","code_information":[{"code":"31000000","type":"CDM"},{"code":"310","type":"RC"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":192.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surgical Path Level 1","code_information":[{"code":"31000001","type":"CDM"},{"code":"310","type":"RC"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surgical Path Level 2","code_information":[{"code":"31000002","type":"CDM"},{"code":"310","type":"RC"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":346.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surgical Path Level 3","code_information":[{"code":"31000003","type":"CDM"},{"code":"310","type":"RC"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":442.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surgical Path Level 4","code_information":[{"code":"31000004","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":474.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surgical Path Level 5","code_information":[{"code":"31000005","type":"CDM"},{"code":"310","type":"RC"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1141.0,"discounted_cash":958.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surgical Path Level 6","code_information":[{"code":"31000006","type":"CDM"},{"code":"310","type":"RC"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1847.0,"discounted_cash":1551.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Decalcification Procedure","code_information":[{"code":"31000007","type":"CDM"},{"code":"310","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Special Stain Group 1","code_information":[{"code":"31000008","type":"CDM"},{"code":"310","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Special Stain Group 2","code_information":[{"code":"31000009","type":"CDM"},{"code":"310","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":278.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Path Consult Introp","code_information":[{"code":"31000010","type":"CDM"},{"code":"310","type":"RC"},{"code":"88329","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":185.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Path Consult Intraop 1 Block","code_information":[{"code":"31000011","type":"CDM"},{"code":"310","type":"RC"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":376.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Path Consult Intraop Addl","code_information":[{"code":"31000012","type":"CDM"},{"code":"310","type":"RC"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intraop Cyto Path Consult 1","code_information":[{"code":"31000013","type":"CDM"},{"code":"310","type":"RC"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":1935.0,"discounted_cash":1625.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ihc Qual Initial Stain","code_information":[{"code":"31000014","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":314.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunofluorescent Study; Direct Method","code_information":[{"code":"31000015","type":"CDM"},{"code":"310","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Electron Microscopy, Diagnostic","code_information":[{"code":"31000016","type":"CDM"},{"code":"310","type":"RC"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":1935.0,"discounted_cash":1625.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tumor Immunohistochem/Computer (Sendout)","code_information":[{"code":"31000018","type":"CDM"},{"code":"310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":721.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Xm Archive Tissue Molecular Analysis","code_information":[{"code":"31000019","type":"CDM"},{"code":"310","type":"RC"},{"code":"88363","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insitu Hybridization Manual","code_information":[{"code":"31000020","type":"CDM"},{"code":"310","type":"RC"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":1187.0,"discounted_cash":997.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Special Stain Group 1 (Sendout)","code_information":[{"code":"31000021","type":"CDM"},{"code":"310","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Special Stain Group 2 (Sendout)","code_information":[{"code":"31000022","type":"CDM"},{"code":"310","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":278.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc M/Phmtrc Alys Ish Quant/Semiq Mnl Each Multiprb","code_information":[{"code":"31000024","type":"CDM"},{"code":"310","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1015.0,"discounted_cash":852.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intraoperative Cyto Path Consult, Add Sites","code_information":[{"code":"31000025","type":"CDM"},{"code":"310","type":"RC"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":107.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tumor Immunohistochem/Manual","code_information":[{"code":"31000026","type":"CDM"},{"code":"310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":823.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc In Situ Hybridization (Fish) Ea Add Single Probe","code_information":[{"code":"31000027","type":"CDM"},{"code":"310","type":"RC"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":244.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Trb@ Rearrangement Anal Amplification Method","code_information":[{"code":"31000028","type":"CDM"},{"code":"310","type":"RC"},{"code":"81340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1425.0,"discounted_cash":1197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Trg@ Gene Rearrangement Analysis","code_information":[{"code":"31000029","type":"CDM"},{"code":"310","type":"RC"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":1151.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cebpa Gene Analysis Full Gene Sequence","code_information":[{"code":"31000030","type":"CDM"},{"code":"310","type":"RC"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":1646.0,"discounted_cash":1382.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Calr Gene Analysis Common Variants In Exon 9","code_information":[{"code":"31000031","type":"CDM"},{"code":"310","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":698.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Flt3 Gene Analysis Internal Tandem Dup Variants","code_information":[{"code":"31000032","type":"CDM"},{"code":"310","type":"RC"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":698.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Flt3 Gene Anlys Tyrosine Kinase Domain Variants","code_information":[{"code":"31000033","type":"CDM"},{"code":"310","type":"RC"},{"code":"81246","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Kit Gene Analysis Targeted Sequence Analysis","code_information":[{"code":"31000034","type":"CDM"},{"code":"310","type":"RC"},{"code":"81272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1646.0,"discounted_cash":1382.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Kras Gene Analysis Additional Variant(S)","code_information":[{"code":"31000035","type":"CDM"},{"code":"310","type":"RC"},{"code":"81276","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":828.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mgmt Methylation Analysis","code_information":[{"code":"31000036","type":"CDM"},{"code":"310","type":"RC"},{"code":"81287","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Npm1 Nucleophosmin Gene Anal Exon 12 Variants","code_information":[{"code":"31000037","type":"CDM"},{"code":"310","type":"RC"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":1036.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Microdissection Prep Identified Target Laser","code_information":[{"code":"31000039","type":"CDM"},{"code":"310","type":"RC"},{"code":"88380","type":"HCPCS"}],"standard_charges":[{"gross_charge":3473.0,"discounted_cash":2917.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bcr/Abl1 Minor Breakpnt Qualitative/Quantitative","code_information":[{"code":"31000040","type":"CDM"},{"code":"310","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":828.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hla Ii Low Resolution One Antigen Equivalent, Each","code_information":[{"code":"31000041","type":"CDM"},{"code":"310","type":"RC"},{"code":"81377","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gene Rearrangement Detection Abnormal Clonal Pop","code_information":[{"code":"31000042","type":"CDM"},{"code":"310","type":"RC"},{"code":"81264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1188.0,"discounted_cash":997.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vkorci Gene Analysis Variants","code_information":[{"code":"31000043","type":"CDM"},{"code":"310","type":"RC"},{"code":"81355","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":395.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cyp2C9 Gene Analysis Common Variants","code_information":[{"code":"31000044","type":"CDM"},{"code":"310","type":"RC"},{"code":"81227","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.0,"discounted_cash":856.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mecp2 Gene Analysis Full Sequence","code_information":[{"code":"31000046","type":"CDM"},{"code":"310","type":"RC"},{"code":"81302","type":"HCPCS"}],"standard_charges":[{"gross_charge":2129.0,"discounted_cash":1788.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inherited Cardmypthy 5 Gns","code_information":[{"code":"31000047","type":"CDM"},{"code":"310","type":"RC"},{"code":"81439","type":"HCPCS"}],"standard_charges":[{"gross_charge":4015.0,"discounted_cash":3372.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nras Gene Analysis Variants In Exon 2&3","code_information":[{"code":"31000048","type":"CDM"},{"code":"310","type":"RC"},{"code":"81311","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":1385.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pdgfra Gene Analys Targeted Sequence Analys","code_information":[{"code":"31000049","type":"CDM"},{"code":"310","type":"RC"},{"code":"81314","type":"HCPCS"}],"standard_charges":[{"gross_charge":1833.0,"discounted_cash":1539.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Brca1&2 Seq & Full Dup/Del","code_information":[{"code":"31000050","type":"CDM"},{"code":"310","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":13837.0,"discounted_cash":11623.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Targeted Genomic Seq Analys","code_information":[{"code":"31000051","type":"CDM"},{"code":"310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3121.0,"discounted_cash":2621.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mopath Procedure Level 6","code_information":[{"code":"31000052","type":"CDM"},{"code":"310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":304.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Oncology Tum Unknown Origin Mrna 92 Genes","code_information":[{"code":"31000053","type":"CDM"},{"code":"310","type":"RC"},{"code":"81540","type":"HCPCS"}],"standard_charges":[{"gross_charge":11041.0,"discounted_cash":9274.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prostate Biopsy, Any Mthd","code_information":[{"code":"31000054","type":"CDM"},{"code":"310","type":"RC"},{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"gross_charge":1467.0,"discounted_cash":1232.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunofluorescence Per Spec Add Singl Antb Stain","code_information":[{"code":"31000055","type":"CDM"},{"code":"310","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":349.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Snrpn/Ube3A Methylation Analysis","code_information":[{"code":"31000056","type":"CDM"},{"code":"310","type":"RC"},{"code":"81331","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":265.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Idh1 Common Variants","code_information":[{"code":"31000057","type":"CDM"},{"code":"310","type":"RC"},{"code":"81120","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":685.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Idh2 Common Variants","code_information":[{"code":"31000058","type":"CDM"},{"code":"310","type":"RC"},{"code":"81121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":1047.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Comparative Anal Str Markers Patient&Comp Spec","code_information":[{"code":"31000059","type":"CDM"},{"code":"310","type":"RC"},{"code":"81265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":939.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fetal Chromosomal Aneuploidy Genomic Seq Analys","code_information":[{"code":"31000060","type":"CDM"},{"code":"310","type":"RC"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":3200.0,"discounted_cash":2688.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pten Gene Analysis Full Sequence Analysis","code_information":[{"code":"31000061","type":"CDM"},{"code":"310","type":"RC"},{"code":"81321","type":"HCPCS"}],"standard_charges":[{"gross_charge":2531.0,"discounted_cash":2126.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pten Gene Analysis Duplication/Deletion Variant","code_information":[{"code":"31000062","type":"CDM"},{"code":"310","type":"RC"},{"code":"81323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1266.0,"discounted_cash":1063.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nfct Ds Chrnc Hcv 6 Biochem Assay Srm Alg Lvr","code_information":[{"code":"31000063","type":"CDM"},{"code":"310","type":"RC"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":276.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mlh1 Gene Analysis Promoter Methylation Analysis","code_information":[{"code":"31000064","type":"CDM"},{"code":"310","type":"RC"},{"code":"81288","type":"HCPCS"}],"standard_charges":[{"gross_charge":1894.0,"discounted_cash":1590.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytopath Eval Fna Report","code_information":[{"code":"31100000","type":"CDM"},{"code":"311","type":"RC"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":332.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytp Fna Eval Ea Addl","code_information":[{"code":"31100001","type":"CDM"},{"code":"311","type":"RC"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Flowcytometry/Read 16 & >","code_information":[{"code":"31100002","type":"CDM"},{"code":"311","type":"RC"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chromosome Analysis 15-20","code_information":[{"code":"31100003","type":"CDM"},{"code":"311","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":517.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tissue Culture, Lymphocyte","code_information":[{"code":"31100004","type":"CDM"},{"code":"311","type":"RC"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":539.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chrmsm Analysis Addl High Resolution Study","code_information":[{"code":"31100005","type":"CDM"},{"code":"311","type":"RC"},{"code":"88289","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytp Urne 3-5 Probes Ea Spec","code_information":[{"code":"31100006","type":"CDM"},{"code":"311","type":"RC"},{"code":"88120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":1005.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Molecular Cytogenetics Chrmoml Ish 10-30 Cll","code_information":[{"code":"31100007","type":"CDM"},{"code":"311","type":"RC"},{"code":"88273","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":219.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys","code_information":[{"code":"31100008","type":"CDM"},{"code":"311","type":"RC"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":252.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cytp Slctv Cell Enhancement Interpj Xcpt C/V","code_information":[{"code":"31100009","type":"CDM"},{"code":"311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thorocentesis W Cath /Guidance","code_information":[{"code":"32000001","type":"CDM"},{"code":"320","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":10551.0,"discounted_cash":8862.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2005.0,"discounted_cash":1684.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sc Lung Unlisted","code_information":[{"code":"32000002","type":"CDM"},{"code":"320","type":"RC"},{"code":"32999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1958.0,"discounted_cash":1644.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1092.0,"discounted_cash":917.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Av Dialysis Shunt","code_information":[{"code":"32000003","type":"CDM"},{"code":"320","type":"RC"},{"code":"36901","type":"HCPCS"}],"standard_charges":[{"gross_charge":3566.0,"discounted_cash":2995.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2675.0,"discounted_cash":2247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Needle Biopsy Of Liver","code_information":[{"code":"32000004","type":"CDM"},{"code":"320","type":"RC"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3852.0,"discounted_cash":3235.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Renal Biopsy Percutaneous","code_information":[{"code":"32000005","type":"CDM"},{"code":"320","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3852.0,"discounted_cash":3235.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3082.0,"discounted_cash":2588.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inj Foramen Epidural C/T","code_information":[{"code":"32000006","type":"CDM"},{"code":"320","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":4441.0,"discounted_cash":3730.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2637.0,"discounted_cash":2215.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inj Foramen Epidural; Cervical Or Thoracic Add-On","code_information":[{"code":"32000007","type":"CDM"},{"code":"320","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":6649.0,"discounted_cash":5585.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2111.0,"discounted_cash":1773.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inj Foramen Epidural L/S","code_information":[{"code":"32000008","type":"CDM"},{"code":"320","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":4595.0,"discounted_cash":3859.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2637.0,"discounted_cash":2215.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cisternography","code_information":[{"code":"32000009","type":"CDM"},{"code":"320","type":"RC"},{"code":"70015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":1155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":953.0,"discounted_cash":800.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Eye Detection (Fb)","code_information":[{"code":"32000010","type":"CDM"},{"code":"320","type":"RC"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":438.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mandible <4 Views","code_information":[{"code":"32000011","type":"CDM"},{"code":"320","type":"RC"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mandible-Min 4 Views","code_information":[{"code":"32000012","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":298.0,"discounted_cash":250.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mastoids-Min 3 Views","code_information":[{"code":"32000013","type":"CDM"},{"code":"320","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Facial Bones-<3 Views","code_information":[{"code":"32000014","type":"CDM"},{"code":"320","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":446.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Facial Bones-Min 3 View","code_information":[{"code":"32000015","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":473.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":361.0,"discounted_cash":303.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Nasal Bones","code_information":[{"code":"32000016","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Orbits Complete","code_information":[{"code":"32000017","type":"CDM"},{"code":"320","type":"RC"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sinus 2 View","code_information":[{"code":"32000018","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":287.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":218.0,"discounted_cash":183.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sinus Complete","code_information":[{"code":"32000019","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Skull Limited","code_information":[{"code":"32000020","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Skull","code_information":[{"code":"32000021","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":442.0,"discounted_cash":371.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Temporomandibular Joint","code_information":[{"code":"32000022","type":"CDM"},{"code":"320","type":"RC"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cephalogram Orthodontc","code_information":[{"code":"32000023","type":"CDM"},{"code":"320","type":"RC"},{"code":"70350","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":362.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":261.0,"discounted_cash":219.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Orthopantomogram","code_information":[{"code":"32000024","type":"CDM"},{"code":"320","type":"RC"},{"code":"70355","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Neck Soft Tissue","code_information":[{"code":"32000025","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":314.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":262.0,"discounted_cash":220.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sialogram","code_information":[{"code":"32000026","type":"CDM"},{"code":"320","type":"RC"},{"code":"70390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"discounted_cash":1253.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":993.0,"discounted_cash":834.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ribs Wo/Pa Chest","code_information":[{"code":"32000027","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ribs W/Pa Chest","code_information":[{"code":"32000028","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":298.0,"discounted_cash":250.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Breastbone 2/>Vws","code_information":[{"code":"32000029","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":477.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":362.0,"discounted_cash":304.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sternoclavicular Joints","code_information":[{"code":"32000030","type":"CDM"},{"code":"320","type":"RC"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":306.0,"discounted_cash":257.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Entire Spine 2/3 Views","code_information":[{"code":"32000031","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":512.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":392.0,"discounted_cash":329.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine Single View Any Level","code_information":[{"code":"32000032","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine Cervical 2-3 View","code_information":[{"code":"32000033","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine Cervical 4-5 View","code_information":[{"code":"32000034","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":800.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":611.0,"discounted_cash":513.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine Cervical 6-7 View","code_information":[{"code":"32000035","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":800.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":611.0,"discounted_cash":513.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Entire Spine 1 View","code_information":[{"code":"32000036","type":"CDM"},{"code":"320","type":"RC"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":309.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":235.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine Thoracic Two View","code_information":[{"code":"32000037","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine Thora Ap/Lat/Swim","code_information":[{"code":"32000038","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine T-Lumbar 2 Views","code_information":[{"code":"32000039","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":426.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine Lumbar 2-3 Views","code_information":[{"code":"32000041","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine Lumbar 4-5 Views","code_information":[{"code":"32000042","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":442.0,"discounted_cash":371.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine Lumbar 6 Or More","code_information":[{"code":"32000043","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":442.0,"discounted_cash":371.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pelvis 1 Or 2 View","code_information":[{"code":"32000044","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pelvis 3 Views","code_information":[{"code":"32000045","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sacroiliac Joints","code_information":[{"code":"32000046","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spine Sacrum/Coccyx","code_information":[{"code":"32000047","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Myelogrm Cervical W/Rad","code_information":[{"code":"32000048","type":"CDM"},{"code":"320","type":"RC"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2410.0,"discounted_cash":2024.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1865.0,"discounted_cash":1566.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Myelogrm Thoracic W/Rad","code_information":[{"code":"32000049","type":"CDM"},{"code":"320","type":"RC"},{"code":"72255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2410.0,"discounted_cash":2024.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1706.0,"discounted_cash":1433.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Myelogram Lumbar W/Rad","code_information":[{"code":"32000050","type":"CDM"},{"code":"320","type":"RC"},{"code":"72265","type":"HCPCS"}],"standard_charges":[{"gross_charge":2410.0,"discounted_cash":2024.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1865.0,"discounted_cash":1566.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Myelogrm Complete W/Rad","code_information":[{"code":"32000051","type":"CDM"},{"code":"320","type":"RC"},{"code":"72270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2410.0,"discounted_cash":2024.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1709.0,"discounted_cash":1435.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Clavicle Complete","code_information":[{"code":"32000052","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Scapula Complete","code_information":[{"code":"32000053","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Shoulder Single View","code_information":[{"code":"32000054","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":246.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":189.0,"discounted_cash":158.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Shoulder 2 Views","code_information":[{"code":"32000055","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Arthrogram Shoulder","code_information":[{"code":"32000056","type":"CDM"},{"code":"320","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1368.0,"discounted_cash":1149.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1057.0,"discounted_cash":887.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Acromioclavicular Jts","code_information":[{"code":"32000057","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Humerus 2 Views","code_information":[{"code":"32000058","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Elbow Ap/Lateral","code_information":[{"code":"32000059","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Elbow Complete 3 Views","code_information":[{"code":"32000060","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Arthrogram Elbow","code_information":[{"code":"32000061","type":"CDM"},{"code":"320","type":"RC"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1368.0,"discounted_cash":1149.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":616.0,"discounted_cash":517.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Forearm 2 Views","code_information":[{"code":"32000062","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Infant Upper Ext 2 Views","code_information":[{"code":"32000063","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":298.0,"discounted_cash":250.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Wrist Ap/Lateral","code_information":[{"code":"32000064","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":279.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Wrist Complete 3 Views","code_information":[{"code":"32000065","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Arthrogram Wrist","code_information":[{"code":"32000066","type":"CDM"},{"code":"320","type":"RC"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1482.0,"discounted_cash":1244.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1112.0,"discounted_cash":934.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Hand Ap/Lateral","code_information":[{"code":"32000067","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Hand Complete 3 Views","code_information":[{"code":"32000068","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":349.0,"discounted_cash":293.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Finger Or Fingers 2 Views","code_information":[{"code":"32000069","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":301.0,"discounted_cash":252.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Hip Uni 1 View","code_information":[{"code":"32000070","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":349.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":267.0,"discounted_cash":224.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Hip Uni 2-3 Views","code_information":[{"code":"32000071","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":349.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":267.0,"discounted_cash":224.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Hips Bi 2 Views","code_information":[{"code":"32000072","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":512.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":392.0,"discounted_cash":329.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Arthrogram Hip","code_information":[{"code":"32000073","type":"CDM"},{"code":"320","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1368.0,"discounted_cash":1149.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1057.0,"discounted_cash":887.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Of Femur 2/>","code_information":[{"code":"32000076","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":309.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":235.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Knee 1 Or 2 Views","code_information":[{"code":"32000077","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Knee 3 Views","code_information":[{"code":"32000078","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Knee 4 Views","code_information":[{"code":"32000079","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Knees Bilat Ap Wt/Bear","code_information":[{"code":"32000080","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":201.0,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Arthrogram Knee","code_information":[{"code":"32000081","type":"CDM"},{"code":"320","type":"RC"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1482.0,"discounted_cash":1244.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1112.0,"discounted_cash":934.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Lower Leg 2 Views","code_information":[{"code":"32000082","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Infant Lower Ext 2 Views","code_information":[{"code":"32000083","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":242.0,"discounted_cash":203.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ankle Ap/Lat","code_information":[{"code":"32000084","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":279.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":216.0,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ankle Complete 3 Views","code_information":[{"code":"32000085","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":390.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Foot Ap/Lat","code_information":[{"code":"32000086","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Foot Complete 3 Views","code_information":[{"code":"32000087","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Heel 2 Views","code_information":[{"code":"32000088","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Toe Or Toes 2 Views","code_information":[{"code":"32000089","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Abd Obstruction Series","code_information":[{"code":"32000093","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":469.0,"discounted_cash":393.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ba Swallow Cerv Esoph","code_information":[{"code":"32000094","type":"CDM"},{"code":"320","type":"RC"},{"code":"74210","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":402.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":335.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ba Swallow/Esophagus","code_information":[{"code":"32000095","type":"CDM"},{"code":"320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":402.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":335.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Video Swallowing Eval","code_information":[{"code":"32000096","type":"CDM"},{"code":"320","type":"RC"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":415.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":347.0,"discounted_cash":291.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Upper Gi Single W/O Kub","code_information":[{"code":"32000097","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":597.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":498.0,"discounted_cash":418.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Small Bowel Series","code_information":[{"code":"32000103","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":619.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":516.0,"discounted_cash":433.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Barium Enema Single","code_information":[{"code":"32000104","type":"CDM"},{"code":"320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":597.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":498.0,"discounted_cash":418.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Barium Enema W/Air","code_information":[{"code":"32000105","type":"CDM"},{"code":"320","type":"RC"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":600.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":501.0,"discounted_cash":420.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cholangiogram O.R.","code_information":[{"code":"32000106","type":"CDM"},{"code":"320","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":757.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":451.0,"discounted_cash":378.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc T Tube Cholangiogram Image/Inj","code_information":[{"code":"32000107","type":"CDM"},{"code":"320","type":"RC"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":9385.0,"discounted_cash":7883.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3918.0,"discounted_cash":3291.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ptc Image/Inject","code_information":[{"code":"32000108","type":"CDM"},{"code":"320","type":"RC"},{"code":"47532","type":"HCPCS"}],"standard_charges":[{"gross_charge":10400.0,"discounted_cash":8736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8046.0,"discounted_cash":6758.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Bile Duct Endoscopy","code_information":[{"code":"32000109","type":"CDM"},{"code":"320","type":"RC"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":1011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":843.0,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Bile/Panc Endoscopy","code_information":[{"code":"32000110","type":"CDM"},{"code":"320","type":"RC"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":2226.0,"discounted_cash":1869.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1558.0,"discounted_cash":1308.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Gastrointestingal Tube","code_information":[{"code":"32000111","type":"CDM"},{"code":"320","type":"RC"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":674.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":361.0,"discounted_cash":303.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ivp Routine","code_information":[{"code":"32000112","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2000.0,"discounted_cash":1680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1330.0,"discounted_cash":1117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Retrograde W/Wo Kub","code_information":[{"code":"32000113","type":"CDM"},{"code":"320","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.0,"discounted_cash":1091.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":909.0,"discounted_cash":763.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Loopogram/Nephrostogram","code_information":[{"code":"32000114","type":"CDM"},{"code":"320","type":"RC"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":1016.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":847.0,"discounted_cash":711.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cystogram No Void","code_information":[{"code":"32000115","type":"CDM"},{"code":"320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":1016.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":847.0,"discounted_cash":711.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Urethrogram-Retro","code_information":[{"code":"32000116","type":"CDM"},{"code":"320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":1016.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":847.0,"discounted_cash":711.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cystourethrogram Void","code_information":[{"code":"32000117","type":"CDM"},{"code":"320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1440.0,"discounted_cash":1209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1008.0,"discounted_cash":846.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Plmt Nephrostomy Catheter","code_information":[{"code":"32000118","type":"CDM"},{"code":"320","type":"RC"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":7196.0,"discounted_cash":6044.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5757.0,"discounted_cash":4835.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Hysterosalpingogram","code_information":[{"code":"32000120","type":"CDM"},{"code":"320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"discounted_cash":1253.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1044.0,"discounted_cash":876.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Contrast Exam Thoracic Aorta","code_information":[{"code":"32000121","type":"CDM"},{"code":"320","type":"RC"},{"code":"75605","type":"HCPCS"}],"standard_charges":[{"gross_charge":6969.0,"discounted_cash":5853.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Abdominal Aorta Run","code_information":[{"code":"32000122","type":"CDM"},{"code":"320","type":"RC"},{"code":"75630","type":"HCPCS"}],"standard_charges":[{"gross_charge":5872.0,"discounted_cash":4932.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Angiography Extremity Unilateral Rs&I","code_information":[{"code":"32000123","type":"CDM"},{"code":"320","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":9727.0,"discounted_cash":8170.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3444.0,"discounted_cash":2892.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Angiography Visceral Selective/Supraselective","code_information":[{"code":"32000124","type":"CDM"},{"code":"320","type":"RC"},{"code":"75726","type":"HCPCS"}],"standard_charges":[{"gross_charge":18203.0,"discounted_cash":15290.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":14562.0,"discounted_cash":12232.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pelvic Selective","code_information":[{"code":"32000125","type":"CDM"},{"code":"320","type":"RC"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":9560.0,"discounted_cash":8030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7648.0,"discounted_cash":6424.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Select Addit Vessel-Ea","code_information":[{"code":"32000126","type":"CDM"},{"code":"320","type":"RC"},{"code":"75774","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"discounted_cash":1537.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1464.0,"discounted_cash":1229.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Venogram Unilateral","code_information":[{"code":"32000127","type":"CDM"},{"code":"320","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2575.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1686.0,"discounted_cash":1416.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vein X-Ray Trunk","code_information":[{"code":"32000128","type":"CDM"},{"code":"320","type":"RC"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":9560.0,"discounted_cash":8030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8671.0,"discounted_cash":7283.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Venogram Jugular","code_information":[{"code":"32000129","type":"CDM"},{"code":"320","type":"RC"},{"code":"75860","type":"HCPCS"}],"standard_charges":[{"gross_charge":8436.0,"discounted_cash":7086.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3374.0,"discounted_cash":2834.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Hepat Venogram W/O Pres","code_information":[{"code":"32000130","type":"CDM"},{"code":"320","type":"RC"},{"code":"75891","type":"HCPCS"}],"standard_charges":[{"gross_charge":9560.0,"discounted_cash":8030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7396.0,"discounted_cash":6212.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Embolization","code_information":[{"code":"32000131","type":"CDM"},{"code":"320","type":"RC"},{"code":"75894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4912.0,"discounted_cash":4126.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2365.0,"discounted_cash":1986.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Angio/Exist Cath F/U Rx","code_information":[{"code":"32000132","type":"CDM"},{"code":"320","type":"RC"},{"code":"75898","type":"HCPCS"}],"standard_charges":[{"gross_charge":8436.0,"discounted_cash":7086.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3400.0,"discounted_cash":2856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Rvl Fbrn Sh Sep V Acc","code_information":[{"code":"32000133","type":"CDM"},{"code":"320","type":"RC"},{"code":"75901","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":545.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":502.0,"discounted_cash":421.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Rvl Fbrn Sh Via Dv Lmn","code_information":[{"code":"32000134","type":"CDM"},{"code":"320","type":"RC"},{"code":"75902","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":368.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":339.0,"discounted_cash":284.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Transcatheter Biopsy","code_information":[{"code":"32000139","type":"CDM"},{"code":"320","type":"RC"},{"code":"75970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2335.0,"discounted_cash":1961.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1552.0,"discounted_cash":1303.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Plmt Biliary Drainage Cath External","code_information":[{"code":"32000141","type":"CDM"},{"code":"320","type":"RC"},{"code":"47533","type":"HCPCS"}],"standard_charges":[{"gross_charge":13110.0,"discounted_cash":11012.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":10143.0,"discounted_cash":8520.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Plmt Biliary Drainage Cath Internal-External","code_information":[{"code":"32000142","type":"CDM"},{"code":"320","type":"RC"},{"code":"47534","type":"HCPCS"}],"standard_charges":[{"gross_charge":13110.0,"discounted_cash":11012.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":10143.0,"discounted_cash":8520.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Perc Tube Change","code_information":[{"code":"32000143","type":"CDM"},{"code":"320","type":"RC"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":944.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":787.0,"discounted_cash":661.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Guide Drainage Abscess","code_information":[{"code":"32000144","type":"CDM"},{"code":"320","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":2457.0,"discounted_cash":2063.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1633.0,"discounted_cash":1371.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fluoroscopy 1 Hour","code_information":[{"code":"32000145","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":531.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Peds Nose/ Rectum Fb","code_information":[{"code":"32000147","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":227.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":189.0,"discounted_cash":158.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc S&I Absc Fistula/Sinus","code_information":[{"code":"32000148","type":"CDM"},{"code":"320","type":"RC"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"discounted_cash":1253.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1044.0,"discounted_cash":876.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Surgical Specimen","code_information":[{"code":"32000149","type":"CDM"},{"code":"320","type":"RC"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":1425.0,"discounted_cash":1197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1043.0,"discounted_cash":876.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc 3D Render W/Intrp Postproces","code_information":[{"code":"32000150","type":"CDM"},{"code":"320","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.0,"discounted_cash":565.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":217.0,"discounted_cash":182.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc 3D Recon Wrkstatn","code_information":[{"code":"32000151","type":"CDM"},{"code":"320","type":"RC"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":217.0,"discounted_cash":182.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ob Fetal, Limited","code_information":[{"code":"32000152","type":"CDM"},{"code":"320","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":607.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":434.0,"discounted_cash":364.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fluoro Guide Cvc","code_information":[{"code":"32000153","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":392.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":374.0,"discounted_cash":314.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Flouro Joint Inj/Asp","code_information":[{"code":"32000154","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":250.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":230.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fluoro Needle Spine","code_information":[{"code":"32000155","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":661.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":292.0,"discounted_cash":245.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Stress Joints Views","code_information":[{"code":"32000156","type":"CDM"},{"code":"320","type":"RC"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":367.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":279.0,"discounted_cash":234.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":186.0,"discounted_cash":156.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Bone Age Study","code_information":[{"code":"32000157","type":"CDM"},{"code":"320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":272.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":207.0,"discounted_cash":173.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Length Study","code_information":[{"code":"32000158","type":"CDM"},{"code":"320","type":"RC"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":263.0,"discounted_cash":220.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Survey Renal Limited","code_information":[{"code":"32000159","type":"CDM"},{"code":"320","type":"RC"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":351.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":268.0,"discounted_cash":225.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Survey Metastases","code_information":[{"code":"32000160","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1622.0,"discounted_cash":1362.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1040.0,"discounted_cash":873.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Series, Infant","code_information":[{"code":"32000161","type":"CDM"},{"code":"320","type":"RC"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":298.0,"discounted_cash":250.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Joint Survey 1 View","code_information":[{"code":"32000162","type":"CDM"},{"code":"320","type":"RC"},{"code":"77077","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":279.0,"discounted_cash":234.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Density Axial","code_information":[{"code":"32000163","type":"CDM"},{"code":"320","type":"RC"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":423.0,"discounted_cash":355.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Denisity-Periphral","code_information":[{"code":"32000164","type":"CDM"},{"code":"320","type":"RC"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":219.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Parathyrd Planar W/Wo Subtrj","code_information":[{"code":"32000165","type":"CDM"},{"code":"320","type":"RC"},{"code":"78071","type":"HCPCS"}],"standard_charges":[{"gross_charge":4178.0,"discounted_cash":3509.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2852.0,"discounted_cash":2395.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cerebral Select Cca","code_information":[{"code":"32000168","type":"CDM"},{"code":"320","type":"RC"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":12475.0,"discounted_cash":10479.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9653.0,"discounted_cash":8108.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cerebral Select Ica Left","code_information":[{"code":"32000169","type":"CDM"},{"code":"320","type":"RC"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":17002.0,"discounted_cash":14281.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":13155.0,"discounted_cash":11050.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Select Vertebral Left","code_information":[{"code":"32000170","type":"CDM"},{"code":"320","type":"RC"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":20402.0,"discounted_cash":17137.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":15786.0,"discounted_cash":13260.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Superselect Cerebral Each","code_information":[{"code":"32000171","type":"CDM"},{"code":"320","type":"RC"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":5425.0,"discounted_cash":4557.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1006.0,"discounted_cash":845.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Thombolysis Venous","code_information":[{"code":"32000172","type":"CDM"},{"code":"320","type":"RC"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":3883.0,"discounted_cash":3261.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3400.0,"discounted_cash":2856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Thrombolysis Day 2","code_information":[{"code":"32000173","type":"CDM"},{"code":"320","type":"RC"},{"code":"37213","type":"HCPCS"}],"standard_charges":[{"gross_charge":9858.0,"discounted_cash":8280.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7626.0,"discounted_cash":6405.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Thrombolysis Final Day","code_information":[{"code":"32000174","type":"CDM"},{"code":"320","type":"RC"},{"code":"37214","type":"HCPCS"}],"standard_charges":[{"gross_charge":9858.0,"discounted_cash":8280.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7626.0,"discounted_cash":6405.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Nerve Injection Intercostal","code_information":[{"code":"32000175","type":"CDM"},{"code":"320","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2138.0,"discounted_cash":1795.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1597.0,"discounted_cash":1341.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Nerve Intercostal Multiple","code_information":[{"code":"32000176","type":"CDM"},{"code":"320","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":4102.0,"discounted_cash":3445.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3066.0,"discounted_cash":2575.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Xr Spine Thoracic Complete 4+ Vw","code_information":[{"code":"32000177","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Xr  Bend Only L-S Spine 2-3 View","code_information":[{"code":"32000178","type":"CDM"},{"code":"320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":298.0,"discounted_cash":250.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Discography Cerv/Thor Spine","code_information":[{"code":"32000179","type":"CDM"},{"code":"320","type":"RC"},{"code":"72285","type":"HCPCS"}],"standard_charges":[{"gross_charge":13965.0,"discounted_cash":11730.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8524.0,"discounted_cash":7160.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fl Discogram Lumbar","code_information":[{"code":"32000180","type":"CDM"},{"code":"320","type":"RC"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":14113.0,"discounted_cash":11854.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8524.0,"discounted_cash":7160.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Xr Arthrogram Ankle","code_information":[{"code":"32000181","type":"CDM"},{"code":"320","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":711.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":605.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Of Peritoneum","code_information":[{"code":"32000182","type":"CDM"},{"code":"320","type":"RC"},{"code":"74190","type":"HCPCS"}],"standard_charges":[{"gross_charge":3191.0,"discounted_cash":2680.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2121.0,"discounted_cash":1781.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fl Small Bowel Enteroclysis","code_information":[{"code":"32000183","type":"CDM"},{"code":"320","type":"RC"},{"code":"74251","type":"HCPCS"}],"standard_charges":[{"gross_charge":1319.0,"discounted_cash":1107.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":876.0,"discounted_cash":735.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Xr Cholangiogram Intraoperative Additional","code_information":[{"code":"32000184","type":"CDM"},{"code":"320","type":"RC"},{"code":"74301","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":738.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":583.0,"discounted_cash":489.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biliary Stone Removal","code_information":[{"code":"32000185","type":"CDM"},{"code":"320","type":"RC"},{"code":"47544","type":"HCPCS"}],"standard_charges":[{"gross_charge":6902.0,"discounted_cash":5797.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5340.0,"discounted_cash":4485.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray For Pancreas Endoscopy","code_information":[{"code":"32000186","type":"CDM"},{"code":"320","type":"RC"},{"code":"74329","type":"HCPCS"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":1011.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":800.0,"discounted_cash":672.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Guide Gu Dilation","code_information":[{"code":"32000187","type":"CDM"},{"code":"320","type":"RC"},{"code":"74485","type":"HCPCS"}],"standard_charges":[{"gross_charge":4721.0,"discounted_cash":3965.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3140.0,"discounted_cash":2637.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Artery X-Rays Spine","code_information":[{"code":"32000189","type":"CDM"},{"code":"320","type":"RC"},{"code":"75705","type":"HCPCS"}],"standard_charges":[{"gross_charge":20268.0,"discounted_cash":17025.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":13620.0,"discounted_cash":11440.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Angiogram Pulmonary Unilateral; Selective","code_information":[{"code":"32000190","type":"CDM"},{"code":"320","type":"RC"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":4586.0,"discounted_cash":3852.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3549.0,"discounted_cash":2981.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Angiogram Pulmonary Bilateral; Selective","code_information":[{"code":"32000191","type":"CDM"},{"code":"320","type":"RC"},{"code":"75743","type":"HCPCS"}],"standard_charges":[{"gross_charge":4955.0,"discounted_cash":4162.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3836.0,"discounted_cash":3222.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pulmonary Angiography By Selective Cath Or Venous Inj","code_information":[{"code":"32000192","type":"CDM"},{"code":"320","type":"RC"},{"code":"75746","type":"HCPCS"}],"standard_charges":[{"gross_charge":8436.0,"discounted_cash":7086.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3400.0,"discounted_cash":2856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vein X-Ray Arms/Legs","code_information":[{"code":"32000194","type":"CDM"},{"code":"320","type":"RC"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":4323.0,"discounted_cash":3631.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2349.0,"discounted_cash":1973.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Venogram Renal , Unilateral; Selective","code_information":[{"code":"32000195","type":"CDM"},{"code":"320","type":"RC"},{"code":"75831","type":"HCPCS"}],"standard_charges":[{"gross_charge":4586.0,"discounted_cash":3852.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3549.0,"discounted_cash":2981.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Venogram Renal , Bilateral; Selective","code_information":[{"code":"32000196","type":"CDM"},{"code":"320","type":"RC"},{"code":"75833","type":"HCPCS"}],"standard_charges":[{"gross_charge":4586.0,"discounted_cash":3852.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3549.0,"discounted_cash":2981.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vein X-Ray Liver W/Hemodynamic Evaluation","code_information":[{"code":"32000197","type":"CDM"},{"code":"320","type":"RC"},{"code":"75885","type":"HCPCS"}],"standard_charges":[{"gross_charge":4719.0,"discounted_cash":3963.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3651.0,"discounted_cash":3066.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vein X-Ray Liver W/O Hemodynamic Evaluation","code_information":[{"code":"32000198","type":"CDM"},{"code":"320","type":"RC"},{"code":"75887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3614.0,"discounted_cash":3035.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3400.0,"discounted_cash":2856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Venogram Hepatic W Hemodynamic Evaluation","code_information":[{"code":"32000199","type":"CDM"},{"code":"320","type":"RC"},{"code":"75889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9560.0,"discounted_cash":8030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7396.0,"discounted_cash":6212.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fluoroscopic Procedure","code_information":[{"code":"32000202","type":"CDM"},{"code":"320","type":"RC"},{"code":"76496","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":271.0,"discounted_cash":227.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Entire Spine 4/5 Views","code_information":[{"code":"32000203","type":"CDM"},{"code":"320","type":"RC"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.0,"discounted_cash":976.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":746.0,"discounted_cash":626.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Entire Spine 6/> Views","code_information":[{"code":"32000204","type":"CDM"},{"code":"320","type":"RC"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.0,"discounted_cash":976.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":746.0,"discounted_cash":626.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Hip Uni 4/> Views","code_information":[{"code":"32000205","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":512.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":392.0,"discounted_cash":329.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Hips Bi 3-4 Views","code_information":[{"code":"32000206","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":512.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":392.0,"discounted_cash":329.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Hips Bi 5/> Views","code_information":[{"code":"32000207","type":"CDM"},{"code":"320","type":"RC"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.0,"discounted_cash":976.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":746.0,"discounted_cash":626.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Of Femur 1 View","code_information":[{"code":"32000208","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":309.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":235.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc  Ir Intravascular Retrieval Of Fb","code_information":[{"code":"32000209","type":"CDM"},{"code":"320","type":"RC"},{"code":"37197","type":"HCPCS"}],"standard_charges":[{"gross_charge":10435.0,"discounted_cash":8765.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8348.0,"discounted_cash":7012.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection Ileal Loop","code_information":[{"code":"32000210","type":"CDM"},{"code":"320","type":"RC"},{"code":"50690","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":240.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":221.0,"discounted_cash":185.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Extremity Non-Vasc Real-Time Img Compl","code_information":[{"code":"32000211","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":897.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1015.0,"discounted_cash":852.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":225.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc X-Ray Exam Abdomen 1 View","code_information":[{"code":"32000214","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":318.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":265.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Abdomen 2 Views","code_information":[{"code":"32000215","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":407.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":338.0,"discounted_cash":283.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Abdomen 3+ Views","code_information":[{"code":"32000216","type":"CDM"},{"code":"320","type":"RC"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":399.0,"discounted_cash":335.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Air Injection Into Abdomen","code_information":[{"code":"32000217","type":"CDM"},{"code":"320","type":"RC"},{"code":"49400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1233.0,"discounted_cash":1035.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":954.0,"discounted_cash":801.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Lymphangiography Pelvic/Abdominal Unilat Rs&I","code_information":[{"code":"32000218","type":"CDM"},{"code":"320","type":"RC"},{"code":"75805","type":"HCPCS"}],"standard_charges":[{"gross_charge":5112.0,"discounted_cash":4294.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3785.0,"discounted_cash":3179.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Lymphangiography Pelvic/Abdominal Bilateral Rs&I","code_information":[{"code":"32000219","type":"CDM"},{"code":"320","type":"RC"},{"code":"75807","type":"HCPCS"}],"standard_charges":[{"gross_charge":12347.0,"discounted_cash":10371.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9142.0,"discounted_cash":7679.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Angiography Internal Mammary Rs&I","code_information":[{"code":"32000220","type":"CDM"},{"code":"320","type":"RC"},{"code":"75756","type":"HCPCS"}],"standard_charges":[{"gross_charge":12347.0,"discounted_cash":10371.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9142.0,"discounted_cash":7679.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Contrst X-Ray Uppr Gi Tract","code_information":[{"code":"32000226","type":"CDM"},{"code":"320","type":"RC"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.0,"discounted_cash":666.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":634.0,"discounted_cash":532.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc  X-Ray Xm Esophagus 2Cntrst","code_information":[{"code":"32000227","type":"CDM"},{"code":"320","type":"RC"},{"code":"74221","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.0,"discounted_cash":666.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":634.0,"discounted_cash":532.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Sm Int F-Thru Std","code_information":[{"code":"32000228","type":"CDM"},{"code":"320","type":"RC"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":941.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":785.0,"discounted_cash":659.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Angiography Spinal Selective Rs&I","code_information":[{"code":"32000230","type":"CDM"},{"code":"320","type":"RC"},{"code":"75705","type":"HCPCS"}],"standard_charges":[{"gross_charge":20268.0,"discounted_cash":17025.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Core Needle Bx Lung/Mediastinum Perq W/Img","code_information":[{"code":"32000232","type":"CDM"},{"code":"320","type":"RC"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":7435.0,"discounted_cash":6245.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5765.0,"discounted_cash":4842.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Radiologic Examination Sacroiliac Jnts <3 Views","code_information":[{"code":"32000233","type":"CDM"},{"code":"320","type":"RC"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":409.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":463.0,"discounted_cash":388.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc  X-Ray Exam Of Eye Sockets","code_information":[{"code":"32000234","type":"CDM"},{"code":"320","type":"RC"},{"code":"70190","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":303.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":343.0,"discounted_cash":288.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Unlisted Diagnostic Radiographic Procedure","code_information":[{"code":"32000236","type":"CDM"},{"code":"320","type":"RC"},{"code":"76499","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":317.0,"discounted_cash":266.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Intraluminal Dilation Strictures&/Obstrcjs Rs&I","code_information":[{"code":"32000237","type":"CDM"},{"code":"320","type":"RC"},{"code":"74360","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.0,"discounted_cash":660.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":511.0,"discounted_cash":429.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection Extremity Venography","code_information":[{"code":"32100000","type":"CDM"},{"code":"321","type":"RC"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":1092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":866.0,"discounted_cash":727.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Venography Caval Inferior Serialography Rs&I","code_information":[{"code":"32100001","type":"CDM"},{"code":"321","type":"RC"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":9560.0,"discounted_cash":8030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9082.0,"discounted_cash":7628.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Abdominal Aortogram","code_information":[{"code":"32300000","type":"CDM"},{"code":"323","type":"RC"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":5872.0,"discounted_cash":4932.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Select Extremity Carotid Left","code_information":[{"code":"32300001","type":"CDM"},{"code":"323","type":"RC"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":8112.0,"discounted_cash":6814.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":6275.0,"discounted_cash":5271.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ribs Bilat 3 Views","code_information":[{"code":"32400005","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ribs Bilat W/Pa Chest","code_information":[{"code":"32400006","type":"CDM"},{"code":"324","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":574.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":441.0,"discounted_cash":370.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Chest 1 View","code_information":[{"code":"32400010","type":"CDM"},{"code":"324","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":261.0,"discounted_cash":219.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Chest 2 Views","code_information":[{"code":"32400011","type":"CDM"},{"code":"324","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":390.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Chest 3 Views","code_information":[{"code":"32400012","type":"CDM"},{"code":"324","type":"RC"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":261.0,"discounted_cash":219.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Chest 4+ Views","code_information":[{"code":"32400013","type":"CDM"},{"code":"324","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":524.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":482.0,"discounted_cash":404.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Hdr Rdncl Intrs/Icav Brtx 1 C","code_information":[{"code":"33000000","type":"CDM"},{"code":"333","type":"RC"},{"code":"77770","type":"HCPCS"}],"standard_charges":[{"gross_charge":4261.0,"discounted_cash":3579.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hdr Rdncl Intrs/Icav Brtx 2-12 C","code_information":[{"code":"33000001","type":"CDM"},{"code":"330","type":"RC"},{"code":"77771","type":"HCPCS"}],"standard_charges":[{"gross_charge":4261.0,"discounted_cash":3579.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hdr Rdncl Intrs/Icav Brtx +12 C","code_information":[{"code":"33000002","type":"CDM"},{"code":"330","type":"RC"},{"code":"77772","type":"HCPCS"}],"standard_charges":[{"gross_charge":4261.0,"discounted_cash":3579.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bladder Instillation Anticarcinogenic Agent","code_information":[{"code":"33000003","type":"CDM"},{"code":"330","type":"RC"},{"code":"51720","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":661.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chemo Adm Im/Sub Non Horm Ant-Neo","code_information":[{"code":"33100000","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":336.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Simulation Simple","code_information":[{"code":"33300000","type":"CDM"},{"code":"333","type":"RC"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.0,"discounted_cash":761.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Simulation-Complex","code_information":[{"code":"33300001","type":"CDM"},{"code":"333","type":"RC"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2037.0,"discounted_cash":1711.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Resp Motion Management Simulation","code_information":[{"code":"33300002","type":"CDM"},{"code":"333","type":"RC"},{"code":"77293","type":"HCPCS"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":1164.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Simulation, 3D Reconstruct","code_information":[{"code":"33300003","type":"CDM"},{"code":"333","type":"RC"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":7628.0,"discounted_cash":6407.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Radiation Therapy Dose Plan","code_information":[{"code":"33300004","type":"CDM"},{"code":"333","type":"RC"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":771.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Radiotherapy Dose Plan Imrt","code_information":[{"code":"33300005","type":"CDM"},{"code":"333","type":"RC"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":8797.0,"discounted_cash":7389.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Teletx Iso Plan Complex","code_information":[{"code":"33300006","type":"CDM"},{"code":"333","type":"RC"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.0,"discounted_cash":1738.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Brachytx Iso Plan Simple","code_information":[{"code":"33300007","type":"CDM"},{"code":"333","type":"RC"},{"code":"77316","type":"HCPCS"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":1696.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Brachytx Iso Plan Intermediate","code_information":[{"code":"33300008","type":"CDM"},{"code":"333","type":"RC"},{"code":"77317","type":"HCPCS"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":1696.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Special Teletx Port Plan","code_information":[{"code":"33300009","type":"CDM"},{"code":"333","type":"RC"},{"code":"77321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1912.0,"discounted_cash":1606.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Special Radiation Dosimetry","code_information":[{"code":"33300010","type":"CDM"},{"code":"333","type":"RC"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":771.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Radiation Treatment Aid(S) - Simple","code_information":[{"code":"33300011","type":"CDM"},{"code":"333","type":"RC"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.0,"discounted_cash":1349.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Radiation Treatment Aid(S) - Intermediate","code_information":[{"code":"33300012","type":"CDM"},{"code":"333","type":"RC"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.0,"discounted_cash":1349.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Radiation Treatment Aid(S) - Complex","code_information":[{"code":"33300013","type":"CDM"},{"code":"333","type":"RC"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1869.0,"discounted_cash":1569.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Radiation Physics Consult","code_information":[{"code":"33300014","type":"CDM"},{"code":"333","type":"RC"},{"code":"77336","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":758.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Design Mlc Device For Imrt","code_information":[{"code":"33300015","type":"CDM"},{"code":"333","type":"RC"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":1176.0,"discounted_cash":987.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Special Meidcal Radiation Physics Consultation","code_information":[{"code":"33300016","type":"CDM"},{"code":"333","type":"RC"},{"code":"77370","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1705.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Srs Tx Del Sgl Session Cranial Cs","code_information":[{"code":"33300017","type":"CDM"},{"code":"333","type":"RC"},{"code":"77372","type":"HCPCS"}],"standard_charges":[{"gross_charge":24486.0,"discounted_cash":20568.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Srs Fractionated Tx Delivery","code_information":[{"code":"33300018","type":"CDM"},{"code":"333","type":"RC"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":13097.0,"discounted_cash":11001.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Imrt Daily Tx - Simple","code_information":[{"code":"33300019","type":"CDM"},{"code":"333","type":"RC"},{"code":"77385","type":"HCPCS"}],"standard_charges":[{"gross_charge":4344.0,"discounted_cash":3648.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Imrt Daily Tx - Complex","code_information":[{"code":"33300020","type":"CDM"},{"code":"333","type":"RC"},{"code":"77386","type":"HCPCS"}],"standard_charges":[{"gross_charge":4344.0,"discounted_cash":3648.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Image Guidance Radiation For Tx Delivery","code_information":[{"code":"33300021","type":"CDM"},{"code":"333","type":"RC"},{"code":"77387","type":"HCPCS"}],"standard_charges":[{"gross_charge":848.0,"discounted_cash":712.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Daily Rt Simple","code_information":[{"code":"33300022","type":"CDM"},{"code":"333","type":"RC"},{"code":"77402","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":739.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Daily Rt Complex","code_information":[{"code":"33300023","type":"CDM"},{"code":"333","type":"RC"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":1845.0,"discounted_cash":1549.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Radiology Port Film(S)","code_information":[{"code":"33300024","type":"CDM"},{"code":"333","type":"RC"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":367.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Special Radiation Treatment","code_information":[{"code":"33300025","type":"CDM"},{"code":"333","type":"RC"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":3386.0,"discounted_cash":2844.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hdr Rdncl Intrs/Icav Brtx 1 C","code_information":[{"code":"33300026","type":"CDM"},{"code":"333","type":"RC"},{"code":"77770","type":"HCPCS"}],"standard_charges":[{"gross_charge":4261.0,"discounted_cash":3579.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hdr Rdncl Intrs/Icav Brtx 2-12 Channel","code_information":[{"code":"33300027","type":"CDM"},{"code":"333","type":"RC"},{"code":"77771","type":"HCPCS"}],"standard_charges":[{"gross_charge":4261.0,"discounted_cash":3579.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Simulation-Intermediate","code_information":[{"code":"33300028","type":"CDM"},{"code":"333","type":"RC"},{"code":"77285","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1499.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intracavitary Implant","code_information":[{"code":"33300029","type":"CDM"},{"code":"333","type":"RC"},{"code":"77761","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1725.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intracavitary Implant Intermediate","code_information":[{"code":"33300030","type":"CDM"},{"code":"333","type":"RC"},{"code":"77762","type":"HCPCS"}],"standard_charges":[{"gross_charge":2292.0,"discounted_cash":1925.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intracavitary Implant Complex","code_information":[{"code":"33300031","type":"CDM"},{"code":"333","type":"RC"},{"code":"77763","type":"HCPCS"}],"standard_charges":[{"gross_charge":2848.0,"discounted_cash":2392.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Teletx Iso Plan Simple","code_information":[{"code":"33300032","type":"CDM"},{"code":"333","type":"RC"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.0,"discounted_cash":1122.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Brachytx Iso Plan Complex","code_information":[{"code":"33300033","type":"CDM"},{"code":"333","type":"RC"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":1696.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Daily Rt Intermediate","code_information":[{"code":"33300034","type":"CDM"},{"code":"333","type":"RC"},{"code":"77407","type":"HCPCS"}],"standard_charges":[{"gross_charge":1155.0,"discounted_cash":970.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Interstitial Application Complex","code_information":[{"code":"33300035","type":"CDM"},{"code":"333","type":"RC"},{"code":"77778","type":"HCPCS"}],"standard_charges":[{"gross_charge":5528.0,"discounted_cash":4643.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Handling Of Radioelement","code_information":[{"code":"33300036","type":"CDM"},{"code":"333","type":"RC"},{"code":"77790","type":"HCPCS"}],"standard_charges":[{"gross_charge":841.0,"discounted_cash":706.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inst/Infusion Radioelemnt","code_information":[{"code":"33300038","type":"CDM"},{"code":"333","type":"RC"},{"code":"77750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1904.0,"discounted_cash":1599.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hdr Rdncl Intrs/Icav Brtx +12 C","code_information":[{"code":"33300039","type":"CDM"},{"code":"333","type":"RC"},{"code":"77772","type":"HCPCS"}],"standard_charges":[{"gross_charge":4261.0,"discounted_cash":3579.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Brachytx, Non-Str,Hdr Ir-192","code_information":[{"code":"33300041","type":"CDM"},{"code":"333","type":"RC"},{"code":"C1717","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":1149.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hdr Rdncl Skn Surf Brachytx Les </2Cm/1 Chan","code_information":[{"code":"33300042","type":"CDM"},{"code":"333","type":"RC"},{"code":"77767","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.0,"discounted_cash":1071.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Unlistd Px Med Radj Physic Dosim&Tx Dev&Spec Svc","code_information":[{"code":"33300043","type":"CDM"},{"code":"333","type":"RC"},{"code":"77399","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":544.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hdr Rdncl Sk Srf Brchytx Les >2Cm&2Chan/Mlt Les","code_information":[{"code":"33300044","type":"CDM"},{"code":"333","type":"RC"},{"code":"77768","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.0,"discounted_cash":1071.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chemo Admin Iv Push Sngl Drug Initial","code_information":[{"code":"33500000","type":"CDM"},{"code":"335","type":"RC"},{"code":"96409","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chemo Admin Iv Push Add'l Drug","code_information":[{"code":"33500001","type":"CDM"},{"code":"335","type":"RC"},{"code":"96411","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chemo Iv Infusion 1 Hr","code_information":[{"code":"33500002","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":1026.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chemo Iv Infusion Addl Hr","code_information":[{"code":"33500003","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":777.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chemo Iv Infus Each Addl Seq","code_information":[{"code":"33500004","type":"CDM"},{"code":"335","type":"RC"},{"code":"96417","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":777.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thyroid Uptake/Multiple","code_information":[{"code":"34000000","type":"CDM"},{"code":"340","type":"RC"},{"code":"78012","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":753.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":583.0,"discounted_cash":489.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Thyroid Imaging W/Blood Flow","code_information":[{"code":"34000001","type":"CDM"},{"code":"340","type":"RC"},{"code":"78013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.0,"discounted_cash":1618.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1255.0,"discounted_cash":1054.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Thyroid Scan/Multiple Uptake","code_information":[{"code":"34000002","type":"CDM"},{"code":"340","type":"RC"},{"code":"78014","type":"HCPCS"}],"standard_charges":[{"gross_charge":2789.0,"discounted_cash":2342.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1906.0,"discounted_cash":1601.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Thyroid Met Imaging Body","code_information":[{"code":"34000003","type":"CDM"},{"code":"340","type":"RC"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":3875.0,"discounted_cash":3255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2648.0,"discounted_cash":2224.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Parathyroid Planar Imaging","code_information":[{"code":"34000004","type":"CDM"},{"code":"340","type":"RC"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":2489.0,"discounted_cash":2090.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1699.0,"discounted_cash":1427.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Marrow Ltd","code_information":[{"code":"34000005","type":"CDM"},{"code":"340","type":"RC"},{"code":"78102","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1864.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1517.0,"discounted_cash":1274.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Marrow Whole Body","code_information":[{"code":"34000006","type":"CDM"},{"code":"340","type":"RC"},{"code":"78104","type":"HCPCS"}],"standard_charges":[{"gross_charge":2318.0,"discounted_cash":1947.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1507.0,"discounted_cash":1265.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Lymph System Imaging","code_information":[{"code":"34000007","type":"CDM"},{"code":"340","type":"RC"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2910.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2366.0,"discounted_cash":1987.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Hepatobiliary System Imaging","code_information":[{"code":"34000008","type":"CDM"},{"code":"340","type":"RC"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2297.0,"discounted_cash":1929.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1567.0,"discounted_cash":1316.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Hepatobil Syst Image W/Drug","code_information":[{"code":"34000009","type":"CDM"},{"code":"340","type":"RC"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":2297.0,"discounted_cash":1929.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1567.0,"discounted_cash":1316.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Salivary Gland Imaging","code_information":[{"code":"34000010","type":"CDM"},{"code":"340","type":"RC"},{"code":"78230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1832.0,"discounted_cash":1538.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":523.0,"discounted_cash":439.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Gastroesophageal Reflux Exam","code_information":[{"code":"34000011","type":"CDM"},{"code":"340","type":"RC"},{"code":"78262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1832.0,"discounted_cash":1538.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1062.0,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Gastric Emptying Study","code_information":[{"code":"34000012","type":"CDM"},{"code":"340","type":"RC"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":2906.0,"discounted_cash":2441.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1982.0,"discounted_cash":1664.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Acute Gi Blood Loss Imaging","code_information":[{"code":"34000013","type":"CDM"},{"code":"340","type":"RC"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":2906.0,"discounted_cash":2441.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1982.0,"discounted_cash":1664.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Meckels Divert Exam","code_information":[{"code":"34000014","type":"CDM"},{"code":"340","type":"RC"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.0,"discounted_cash":1809.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1473.0,"discounted_cash":1237.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Imaging Limited Area","code_information":[{"code":"34000015","type":"CDM"},{"code":"340","type":"RC"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2040.0,"discounted_cash":1713.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1392.0,"discounted_cash":1169.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Scan /Whole Body","code_information":[{"code":"34000016","type":"CDM"},{"code":"340","type":"RC"},{"code":"78306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2906.0,"discounted_cash":2441.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1982.0,"discounted_cash":1664.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Scan 3 Phase","code_information":[{"code":"34000017","type":"CDM"},{"code":"340","type":"RC"},{"code":"78315","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":2919.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2373.0,"discounted_cash":1993.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ht Muscle Image Spect Sing","code_information":[{"code":"34000019","type":"CDM"},{"code":"340","type":"RC"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":6003.0,"discounted_cash":5042.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2521.0,"discounted_cash":2117.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ht Muscle Image Spect Mult","code_information":[{"code":"34000020","type":"CDM"},{"code":"340","type":"RC"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":6524.0,"discounted_cash":5480.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3503.0,"discounted_cash":2942.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Gated Heart Planar Single","code_information":[{"code":"34000021","type":"CDM"},{"code":"340","type":"RC"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":3265.0,"discounted_cash":2742.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2271.0,"discounted_cash":1907.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Lung Scan Perfusion","code_information":[{"code":"34000022","type":"CDM"},{"code":"340","type":"RC"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":2899.0,"discounted_cash":2435.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1979.0,"discounted_cash":1662.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Lung Vent/Perfusion","code_information":[{"code":"34000023","type":"CDM"},{"code":"340","type":"RC"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":4552.0,"discounted_cash":3823.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3109.0,"discounted_cash":2611.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Lung Quantitative Diff Vent/Perfusion","code_information":[{"code":"34000024","type":"CDM"},{"code":"340","type":"RC"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":4552.0,"discounted_cash":3823.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3109.0,"discounted_cash":2611.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Brain Image W/Flow < 4 Views","code_information":[{"code":"34000025","type":"CDM"},{"code":"340","type":"RC"},{"code":"78601","type":"HCPCS"}],"standard_charges":[{"gross_charge":3016.0,"discounted_cash":2533.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2059.0,"discounted_cash":1729.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cerebrospinal Fluid Scan","code_information":[{"code":"34000027","type":"CDM"},{"code":"340","type":"RC"},{"code":"78630","type":"HCPCS"}],"standard_charges":[{"gross_charge":4801.0,"discounted_cash":4032.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3119.0,"discounted_cash":2619.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Csf Shunt Evaluation","code_information":[{"code":"34000028","type":"CDM"},{"code":"340","type":"RC"},{"code":"78645","type":"HCPCS"}],"standard_charges":[{"gross_charge":3016.0,"discounted_cash":2533.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1961.0,"discounted_cash":1647.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Kidney Flow/Funct Image W/O Drug","code_information":[{"code":"34000029","type":"CDM"},{"code":"340","type":"RC"},{"code":"78707","type":"HCPCS"}],"standard_charges":[{"gross_charge":4945.0,"discounted_cash":4153.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3379.0,"discounted_cash":2838.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Kidney Flow/Funct Image W/Drug","code_information":[{"code":"34000030","type":"CDM"},{"code":"340","type":"RC"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":6233.0,"discounted_cash":5235.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4256.0,"discounted_cash":3575.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Tumor Imaging Whole Body","code_information":[{"code":"34000032","type":"CDM"},{"code":"340","type":"RC"},{"code":"78802","type":"HCPCS"}],"standard_charges":[{"gross_charge":4220.0,"discounted_cash":3544.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2878.0,"discounted_cash":2417.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Tumr Localization Spect","code_information":[{"code":"34000033","type":"CDM"},{"code":"340","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":5748.0,"discounted_cash":4828.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3919.0,"discounted_cash":3291.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Tumor Imaging Loc Whole Body Multiple","code_information":[{"code":"34000034","type":"CDM"},{"code":"340","type":"RC"},{"code":"78804","type":"HCPCS"}],"standard_charges":[{"gross_charge":5325.0,"discounted_cash":4473.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3632.0,"discounted_cash":3050.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Nuclear Rx Oral Admin","code_information":[{"code":"34000037","type":"CDM"},{"code":"340","type":"RC"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":1775.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1374.0,"discounted_cash":1154.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Iodine I-123 Iobenguane","code_information":[{"code":"34000038","type":"CDM"},{"code":"340","type":"RC"},{"code":"A9582","type":"HCPCS"}],"standard_charges":[{"gross_charge":9837.0,"discounted_cash":8263.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7611.0,"discounted_cash":6393.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Adrenal Cortex & Medulla Img","code_information":[{"code":"34000039","type":"CDM"},{"code":"340","type":"RC"},{"code":"78075","type":"HCPCS"}],"standard_charges":[{"gross_charge":7093.0,"discounted_cash":5958.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4843.0,"discounted_cash":4068.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Red Cell Sequestration","code_information":[{"code":"34000040","type":"CDM"},{"code":"340","type":"RC"},{"code":"78140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1583.0,"discounted_cash":1329.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1030.0,"discounted_cash":865.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spleen Scan Only","code_information":[{"code":"34000041","type":"CDM"},{"code":"340","type":"RC"},{"code":"78185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1709.0,"discounted_cash":1435.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1114.0,"discounted_cash":935.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Liver Scan W Vascular Flow","code_information":[{"code":"34000042","type":"CDM"},{"code":"340","type":"RC"},{"code":"78202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2906.0,"discounted_cash":2441.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1982.0,"discounted_cash":1664.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Liver Spleen Scan","code_information":[{"code":"34000045","type":"CDM"},{"code":"340","type":"RC"},{"code":"78215","type":"HCPCS"}],"standard_charges":[{"gross_charge":2432.0,"discounted_cash":2042.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1581.0,"discounted_cash":1328.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Liver Spleen Scan W Vascular Flow","code_information":[{"code":"34000046","type":"CDM"},{"code":"340","type":"RC"},{"code":"78216","type":"HCPCS"}],"standard_charges":[{"gross_charge":3488.0,"discounted_cash":2929.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2268.0,"discounted_cash":1905.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Leveen/Shunt Patency Exam","code_information":[{"code":"34000047","type":"CDM"},{"code":"340","type":"RC"},{"code":"78291","type":"HCPCS"}],"standard_charges":[{"gross_charge":2326.0,"discounted_cash":1953.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1513.0,"discounted_cash":1270.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Imaging Multiple Areas","code_information":[{"code":"34000048","type":"CDM"},{"code":"340","type":"RC"},{"code":"78305","type":"HCPCS"}],"standard_charges":[{"gross_charge":2318.0,"discounted_cash":1947.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1507.0,"discounted_cash":1265.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vascular Flow Imaging","code_information":[{"code":"34000049","type":"CDM"},{"code":"340","type":"RC"},{"code":"78445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1308.0,"discounted_cash":1098.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":851.0,"discounted_cash":714.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Lung Perfusion Differential","code_information":[{"code":"34000050","type":"CDM"},{"code":"340","type":"RC"},{"code":"78597","type":"HCPCS"}],"standard_charges":[{"gross_charge":2318.0,"discounted_cash":1947.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1507.0,"discounted_cash":1265.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Brain Image 4+ Views","code_information":[{"code":"34000051","type":"CDM"},{"code":"340","type":"RC"},{"code":"78605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":2633.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2038.0,"discounted_cash":1711.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Csf Leak Detection","code_information":[{"code":"34000052","type":"CDM"},{"code":"340","type":"RC"},{"code":"78650","type":"HCPCS"}],"standard_charges":[{"gross_charge":3389.0,"discounted_cash":2846.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2204.0,"discounted_cash":1851.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Kidney Imaging Morphol","code_information":[{"code":"34000053","type":"CDM"},{"code":"340","type":"RC"},{"code":"78700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2318.0,"discounted_cash":1947.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1507.0,"discounted_cash":1265.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Kidney W Vascular Flow","code_information":[{"code":"34000054","type":"CDM"},{"code":"340","type":"RC"},{"code":"78701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.0,"discounted_cash":2120.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1642.0,"discounted_cash":1379.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ureteral Reflux Study","code_information":[{"code":"34000055","type":"CDM"},{"code":"340","type":"RC"},{"code":"78740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1725.0,"discounted_cash":1449.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1120.0,"discounted_cash":940.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Testicular W Vascular Flow","code_information":[{"code":"34000056","type":"CDM"},{"code":"340","type":"RC"},{"code":"78761","type":"HCPCS"}],"standard_charges":[{"gross_charge":1810.0,"discounted_cash":1520.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1178.0,"discounted_cash":989.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Tumor Localization Limited","code_information":[{"code":"34000057","type":"CDM"},{"code":"340","type":"RC"},{"code":"78800","type":"HCPCS"}],"standard_charges":[{"gross_charge":3375.0,"discounted_cash":2835.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2303.0,"discounted_cash":1934.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Gastric Empty Single Day","code_information":[{"code":"34000059","type":"CDM"},{"code":"340","type":"RC"},{"code":"78265","type":"HCPCS"}],"standard_charges":[{"gross_charge":3606.0,"discounted_cash":3029.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2343.0,"discounted_cash":1968.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Gastric Empty Mult Day","code_information":[{"code":"34000060","type":"CDM"},{"code":"340","type":"RC"},{"code":"78266","type":"HCPCS"}],"standard_charges":[{"gross_charge":3974.0,"discounted_cash":3338.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2582.0,"discounted_cash":2168.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Rp Therapy Intravenous Administration","code_information":[{"code":"34000061","type":"CDM"},{"code":"340","type":"RC"},{"code":"79101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1229.0,"discounted_cash":1032.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":772.0,"discounted_cash":648.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Gastrointestinal Protein Loss","code_information":[{"code":"34000062","type":"CDM"},{"code":"340","type":"RC"},{"code":"78282","type":"HCPCS"}],"standard_charges":[{"gross_charge":2148.0,"discounted_cash":1804.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1396.0,"discounted_cash":1172.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cardiac Shunt Detection","code_information":[{"code":"34000063","type":"CDM"},{"code":"340","type":"RC"},{"code":"78428","type":"HCPCS"}],"standard_charges":[{"gross_charge":2050.0,"discounted_cash":1722.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1400.0,"discounted_cash":1176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pulmonary Ventilation Imaging","code_information":[{"code":"34000064","type":"CDM"},{"code":"340","type":"RC"},{"code":"78579","type":"HCPCS"}],"standard_charges":[{"gross_charge":2281.0,"discounted_cash":1916.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1433.0,"discounted_cash":1203.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Rp Loclzj Tum Spect W/Ct 1","code_information":[{"code":"34000065","type":"CDM"},{"code":"340","type":"RC"},{"code":"78830","type":"HCPCS"}],"standard_charges":[{"gross_charge":7855.0,"discounted_cash":6598.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7463.0,"discounted_cash":6268.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Rp Loclzj Tum Spect W/Ct 2","code_information":[{"code":"34000067","type":"CDM"},{"code":"340","type":"RC"},{"code":"78832","type":"HCPCS"}],"standard_charges":[{"gross_charge":6926.0,"discounted_cash":5817.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Parathyrd Planar W/Spect&Ct","code_information":[{"code":"34000166","type":"CDM"},{"code":"340","type":"RC"},{"code":"78072","type":"HCPCS"}],"standard_charges":[{"gross_charge":4178.0,"discounted_cash":3509.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2852.0,"discounted_cash":2395.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Kidney Img Morphology Vascular Flow Multiple","code_information":[{"code":"34000191","type":"CDM"},{"code":"340","type":"RC"},{"code":"78709","type":"HCPCS"}],"standard_charges":[{"gross_charge":2476.0,"discounted_cash":2079.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2246.0,"discounted_cash":1886.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inj Radioactive Tracer For Id Of Sentinel Node","code_information":[{"code":"34000192","type":"CDM"},{"code":"340","type":"RC"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":1549.0,"discounted_cash":1301.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1472.0,"discounted_cash":1236.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Iv Inj Ra Drug Dx Study","code_information":[{"code":"34100000","type":"CDM"},{"code":"341","type":"RC"},{"code":"78808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1855.0,"discounted_cash":1558.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1683.0,"discounted_cash":1413.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"NDC Description Not Available","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00000000123","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9509","type":"HCPCS"},{"code":"00000000123","type":"NDC"}],"standard_charges":[{"gross_charge":219.38,"discounted_cash":184.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"NDC Description Not Available","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019086207","type":"CDM"},{"code":"343","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00019086207","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"NDC Description Not Available","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019095313","type":"CDM"},{"code":"343","type":"RC"},{"code":"Q9961","type":"HCPCS"},{"code":"00019095313","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"NDC Description Not Available","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019095315","type":"CDM"},{"code":"343","type":"RC"},{"code":"Q9961","type":"HCPCS"},{"code":"00019095315","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Conray 43: 12 BOTTLE, GLASS in 1 BOX (0019-3183-09)  / 250 mL in 1 BOTTLE, GLASS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019318309","type":"CDM"},{"code":"343","type":"RC"},{"code":"Q9960","type":"HCPCS"},{"code":"00019318309","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"OCTREOSCAN: 1 KIT in 1 BOX (0019-9050-40)  *  1 mL in 1 VIAL, GLASS *  1 mL in 1 VIAL, GLASS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019905040","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9572","type":"HCPCS"},{"code":"00019905040","type":"NDC"}],"standard_charges":[{"gross_charge":7416.88,"discounted_cash":6230.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"TechneScan HDP: 30 VIAL in 1 CARTON (0019-9091-40)  / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019909140","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9561","type":"HCPCS"},{"code":"00019909140","type":"NDC"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":95.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"TechneScan MAG3: 5 VIAL in 1 CELLO PACK (0019-9096-20)  / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019909620","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9562","type":"HCPCS"},{"code":"00019909620","type":"NDC"}],"standard_charges":[{"gross_charge":516.57,"discounted_cash":433.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"GALLIUM CITRATE GA-67: 1 VIAL in 1 CAN (0019-9180-06)  / 3.3 mL in 1 VIAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019918006","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9556","type":"HCPCS"},{"code":"00019918006","type":"NDC"}],"standard_charges":[{"gross_charge":146.2,"discounted_cash":122.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Sodium Iodide I-131: 1 VIAL in 1 CAN (0019-9450-01)  / 1 mL in 1 VIAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019945001","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9528","type":"HCPCS"},{"code":"00019945001","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Sodium Iodide I-131: 1 VIAL in 1 CAN (0019-9450-02)  / 2 mL in 1 VIAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019945002","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9517","type":"HCPCS"},{"code":"00019945002","type":"NDC"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Sodium Iodide I-131: 1 VIAL in 1 CAN (0019-9450-03)  / 3 mL in 1 VIAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00019945003","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9517","type":"HCPCS"},{"code":"00019945003","type":"NDC"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Choletec: 10 Vial In 1 Carton (0270-0083-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_00270008320","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9537","type":"HCPCS"},{"code":"00270008320","type":"NDC"}],"standard_charges":[{"gross_charge":197.79,"discounted_cash":166.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Neurolite: 2 Kit In 1 Package, Combination (11994-006-02)  / 1 Kit In 1 Kit *  1 Injection In 1 Vial (11994-002-01)  *  1 Ml In 1 Vial (11994-004-01)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_11994000602","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9557","type":"HCPCS"},{"code":"11994000602","type":"NDC"}],"standard_charges":[{"gross_charge":4487.0,"discounted_cash":3769.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Indium In 111 Oxyquinoline: 1 Vial In 1 Box (17156-021-01)  / 1 Ml In 1 Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_17156002101","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9570","type":"HCPCS"},{"code":"17156002101","type":"NDC"}],"standard_charges":[{"gross_charge":1804.19,"discounted_cash":1515.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Ceretec: 5 Vial In 1 Tray (17156-022-05)  / 5 Ml In 1 Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_17156002205","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9569","type":"HCPCS"},{"code":"17156002205","type":"NDC"}],"standard_charges":[{"gross_charge":2022.94,"discounted_cash":1699.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Ceretec: 1 Kit In 1 Carton (17156-025-05)  *  5 Ml In 1 Vial, Glass (17156-022-05)  *  2.5 Ml In 1 Vial, Glass (17156-027-01)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_17156002505","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9569","type":"HCPCS"},{"code":"17156002505","type":"NDC"}],"standard_charges":[{"gross_charge":3487.26,"discounted_cash":2929.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Adreview: 1 Vial, Glass In 1 Container (17156-235-01)  / 5 Ml In 1 Vial, Glass","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_17156023501","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9582","type":"HCPCS"},{"code":"17156023501","type":"NDC"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":2923.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Kit for the Preparation of Technetium Tc 99m Pentetate Injection: 30 VIAL in 1 KIT (45567-0010-2)  / 10 mL in 1 VIAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_45567001002","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9567","type":"HCPCS"},{"code":"45567001002","type":"NDC"}],"standard_charges":[{"gross_charge":407.54,"discounted_cash":342.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Kit For The Prepartion Of Technetium Tc99M Sulfur Colloid: 1 Kit In 1 Package (45567-0030-1)  *  3 Ml In 1 Vial *  3 Ml In 1 Vial *  10 Ml In 1 Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_45567003001","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9541","type":"HCPCS"},{"code":"45567003001","type":"NDC"}],"standard_charges":[{"gross_charge":651.47,"discounted_cash":547.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Kit For The Preparation Of Technetium Tc 99M Medronate: 5 Vial, Multi-Dose In 1 Kit (45567-0040-1)  / 10 Ml In 1 Vial, Multi-Dose","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_45567004001","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9503","type":"HCPCS"},{"code":"45567004001","type":"NDC"}],"standard_charges":[{"gross_charge":199.63,"discounted_cash":167.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Kit For The Preparation Of Technetium Tc99M Pyrophosphate: 5 Vial, Multi-Dose In 1 Kit (45567-0060-1)  / 10 Ml In 1 Vial, Multi-Dose","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_45567006001","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9538","type":"HCPCS"},{"code":"45567006001","type":"NDC"}],"standard_charges":[{"gross_charge":269.78,"discounted_cash":226.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Sodium Iodide I 123: 1 Vial, Plastic In 1 Can (48815-1002-1)  / 1 Capsule, Gelatin Coated In 1 Vial, Plastic","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_48815100201","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9516","type":"HCPCS"},{"code":"48815100201","type":"NDC"}],"standard_charges":[{"gross_charge":156.5,"discounted_cash":131.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"NDC Description Not Available","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_65174027000","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9560","type":"HCPCS"},{"code":"65174027000","type":"NDC"}],"standard_charges":[{"gross_charge":286.94,"discounted_cash":241.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Draximage Maa: 30 Injection, Powder, For Solution In 1 Kit (65174-270-30)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_65174027030","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9540","type":"HCPCS"},{"code":"65174027030","type":"NDC"}],"standard_charges":[{"gross_charge":860.74,"discounted_cash":723.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Sodium Fluoride F18: 30 Ml In 1 Vial, Glass (65857-300-30)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_65857030030","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9552","type":"HCPCS"},{"code":"65857030030","type":"NDC"}],"standard_charges":[{"gross_charge":1553.0,"discounted_cash":1304.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"NDC Description Not Available","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_65857050030","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9500","type":"HCPCS"},{"code":"65857050030","type":"NDC"}],"standard_charges":[{"gross_charge":263.25,"discounted_cash":221.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Netspot: 1 Kit In 1 Kit (69488-001-40)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_69488000140","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9587","type":"HCPCS"},{"code":"69488000140","type":"NDC"}],"standard_charges":[{"gross_charge":63.41,"discounted_cash":53.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"NDC Description Not Available","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"34300051_99999408400","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9512","type":"HCPCS"},{"code":"99999408400","type":"NDC"}],"standard_charges":[{"gross_charge":213.55,"discounted_cash":179.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364 | NDC EA = 1 EA"}]},{"description":"Hc Abd/Pel W/O Contrast","code_information":[{"code":"35000000","type":"CDM"},{"code":"350","type":"RC"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":3883.0,"discounted_cash":3261.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3106.0,"discounted_cash":2609.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Abd/Pel W Contrast","code_information":[{"code":"35000001","type":"CDM"},{"code":"350","type":"RC"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":6000.0,"discounted_cash":5040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4800.0,"discounted_cash":4032.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Abd/Pel W&W/O Contrast","code_information":[{"code":"35000002","type":"CDM"},{"code":"350","type":"RC"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":6689.0,"discounted_cash":5618.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5351.0,"discounted_cash":4494.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Colonography W/O Contrast","code_information":[{"code":"35000003","type":"CDM"},{"code":"350","type":"RC"},{"code":"74261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":1102.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1012.0,"discounted_cash":850.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Colonography Screening","code_information":[{"code":"35000004","type":"CDM"},{"code":"350","type":"RC"},{"code":"74263","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.0,"discounted_cash":1171.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":274.0,"discounted_cash":230.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Guide Drainage Abscess","code_information":[{"code":"35000005","type":"CDM"},{"code":"350","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":2457.0,"discounted_cash":2063.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1633.0,"discounted_cash":1371.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Guided Needle Placement","code_information":[{"code":"35000006","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2942.0,"discounted_cash":2471.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2501.0,"discounted_cash":2100.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Guidance For Rt Fields","code_information":[{"code":"35000007","type":"CDM"},{"code":"350","type":"RC"},{"code":"77014","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.0,"discounted_cash":752.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":660.0,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Cervical Spine W Wo Contrast","code_information":[{"code":"35000008","type":"CDM"},{"code":"350","type":"RC"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":5668.0,"discounted_cash":4761.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2501.0,"discounted_cash":2100.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Colon W Wo Contrast","code_information":[{"code":"35000009","type":"CDM"},{"code":"350","type":"RC"},{"code":"74262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1404.0,"discounted_cash":1179.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1084.0,"discounted_cash":910.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Heart W/3D Image","code_information":[{"code":"35000010","type":"CDM"},{"code":"350","type":"RC"},{"code":"75572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1404.0,"discounted_cash":1179.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1054.0,"discounted_cash":885.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Heart No Contrast Quant Eval Coronry Calcium","code_information":[{"code":"35000011","type":"CDM"},{"code":"350","type":"RC"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":167.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":199.0,"discounted_cash":167.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Limited/Localized Follow Up Study","code_information":[{"code":"35000036","type":"CDM"},{"code":"350","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":296.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":335.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Head W/O Contrast","code_information":[{"code":"35100000","type":"CDM"},{"code":"351","type":"RC"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2136.0,"discounted_cash":1794.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1588.0,"discounted_cash":1333.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Head W/Contrast","code_information":[{"code":"35100001","type":"CDM"},{"code":"351","type":"RC"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":2840.0,"discounted_cash":2385.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2414.0,"discounted_cash":2027.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Head W/Wo Contrast","code_information":[{"code":"35100002","type":"CDM"},{"code":"351","type":"RC"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":5929.0,"discounted_cash":4980.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4526.0,"discounted_cash":3801.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Orbit/Ear/Fossa W/O Contrast","code_information":[{"code":"35100003","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":2356.0,"discounted_cash":1979.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1478.0,"discounted_cash":1241.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Orbit/Ear/Fossa W/Contrast","code_information":[{"code":"35100004","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":3578.0,"discounted_cash":3005.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2326.0,"discounted_cash":1953.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Orbit/Ear/Fossa W/Wo Contrast","code_information":[{"code":"35100005","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":4527.0,"discounted_cash":3802.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2490.0,"discounted_cash":2091.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Maxillofacial W/O Cont","code_information":[{"code":"35100006","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":3756.0,"discounted_cash":3155.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1478.0,"discounted_cash":1241.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Maxillofacial W/Contrast","code_information":[{"code":"35100007","type":"CDM"},{"code":"351","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":4069.0,"discounted_cash":3417.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2238.0,"discounted_cash":1879.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Maxillofacial W/Wo Contrast","code_information":[{"code":"35100008","type":"CDM"},{"code":"351","type":"RC"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":4527.0,"discounted_cash":3802.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2490.0,"discounted_cash":2091.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Soft Tissue Neck W/O Contrast","code_information":[{"code":"35100009","type":"CDM"},{"code":"351","type":"RC"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2055.0,"discounted_cash":1726.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1492.0,"discounted_cash":1253.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Soft Tissue Neck W/Contrast","code_information":[{"code":"35100010","type":"CDM"},{"code":"351","type":"RC"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":5000.0,"discounted_cash":4200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3817.0,"discounted_cash":3206.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Soft Tissue Neck W/Wo Contrast","code_information":[{"code":"35100011","type":"CDM"},{"code":"351","type":"RC"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":5835.0,"discounted_cash":4901.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2602.0,"discounted_cash":2185.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Angiography Head","code_information":[{"code":"35100012","type":"CDM"},{"code":"351","type":"RC"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":3163.0,"discounted_cash":2656.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2689.0,"discounted_cash":2258.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Perfusion W/Contrast Cbf","code_information":[{"code":"35100100","type":"CDM"},{"code":"351","type":"RC"},{"code":"0042T","type":"HCPCS"}],"standard_charges":[{"gross_charge":2150.0,"discounted_cash":1806.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1505.0,"discounted_cash":1264.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Angiography Neck","code_information":[{"code":"35200000","type":"CDM"},{"code":"352","type":"RC"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":3158.0,"discounted_cash":2652.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2684.0,"discounted_cash":2254.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Thorax W/O Contrast","code_information":[{"code":"35200001","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":3214.0,"discounted_cash":2699.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2628.0,"discounted_cash":2207.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Thorax W/Contrast","code_information":[{"code":"35200002","type":"CDM"},{"code":"352","type":"RC"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":4973.0,"discounted_cash":4177.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4065.0,"discounted_cash":3414.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Thorax W/Wo Contrast","code_information":[{"code":"35200003","type":"CDM"},{"code":"352","type":"RC"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":5850.0,"discounted_cash":4914.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2633.0,"discounted_cash":2211.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Angiography Chest","code_information":[{"code":"35200004","type":"CDM"},{"code":"352","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":5615.0,"discounted_cash":4716.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4590.0,"discounted_cash":3855.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Spine Cervical W/O Contrast","code_information":[{"code":"35200005","type":"CDM"},{"code":"352","type":"RC"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":3463.0,"discounted_cash":2908.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1558.0,"discounted_cash":1308.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Spine Cervical W/Cont","code_information":[{"code":"35200006","type":"CDM"},{"code":"352","type":"RC"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":5110.0,"discounted_cash":4292.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2501.0,"discounted_cash":2100.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Spine Thoracic W/O Cont","code_information":[{"code":"35200007","type":"CDM"},{"code":"352","type":"RC"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":3744.0,"discounted_cash":3144.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1572.0,"discounted_cash":1320.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Spine Thoracic W/Cont","code_information":[{"code":"35200008","type":"CDM"},{"code":"352","type":"RC"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":4533.0,"discounted_cash":3807.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2249.0,"discounted_cash":1889.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Spine Thoracic W/Wo Contrast","code_information":[{"code":"35200009","type":"CDM"},{"code":"352","type":"RC"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":5598.0,"discounted_cash":4702.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2641.0,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Spine Lumbar W/O Contrast","code_information":[{"code":"35200010","type":"CDM"},{"code":"352","type":"RC"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":3179.0,"discounted_cash":2670.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1431.0,"discounted_cash":1202.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Spine Lumbar W/Cont","code_information":[{"code":"35200011","type":"CDM"},{"code":"352","type":"RC"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":4374.0,"discounted_cash":3674.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2187.0,"discounted_cash":1837.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Spine Lumbar W/Wo Contrast","code_information":[{"code":"35200012","type":"CDM"},{"code":"352","type":"RC"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":4953.0,"discounted_cash":4160.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2477.0,"discounted_cash":2080.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Angiograph Pelvis W/O & W Contrast","code_information":[{"code":"35200013","type":"CDM"},{"code":"352","type":"RC"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":6233.0,"discounted_cash":5235.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2493.0,"discounted_cash":2094.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Pelvis W/O Contrast","code_information":[{"code":"35200014","type":"CDM"},{"code":"352","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":2076.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1112.0,"discounted_cash":934.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Pelvis W/Contrast","code_information":[{"code":"35200015","type":"CDM"},{"code":"352","type":"RC"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":3177.0,"discounted_cash":2668.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1747.0,"discounted_cash":1467.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Pelvis W/Wo Contrast","code_information":[{"code":"35200016","type":"CDM"},{"code":"352","type":"RC"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":4458.0,"discounted_cash":3744.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1994.0,"discounted_cash":1674.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Upper Extremity W/O Cont","code_information":[{"code":"35200017","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":2797.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1508.0,"discounted_cash":1266.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Upper Extremity W/Cont","code_information":[{"code":"35200018","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":3726.0,"discounted_cash":3129.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2494.0,"discounted_cash":2094.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Angiograph Upper Extremity W/O & W Cont","code_information":[{"code":"35200019","type":"CDM"},{"code":"352","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3354.0,"discounted_cash":2817.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2851.0,"discounted_cash":2394.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Lower Extremity Wo Cont","code_information":[{"code":"35200020","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3024.0,"discounted_cash":2540.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1591.0,"discounted_cash":1336.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Lower Extremity W/Cont","code_information":[{"code":"35200021","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":3419.0,"discounted_cash":2871.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2501.0,"discounted_cash":2100.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Angiograph Lwr Extremity W/O & W Cont","code_information":[{"code":"35200022","type":"CDM"},{"code":"352","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":3153.0,"discounted_cash":2648.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2680.0,"discounted_cash":2251.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Abdomen W/O Contrast","code_information":[{"code":"35200023","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":3802.0,"discounted_cash":3193.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1589.0,"discounted_cash":1334.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Abdomen W/Contrast","code_information":[{"code":"35200024","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":4518.0,"discounted_cash":3795.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2485.0,"discounted_cash":2087.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Abdomen W/Wo Contrast","code_information":[{"code":"35200025","type":"CDM"},{"code":"352","type":"RC"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":5108.0,"discounted_cash":4290.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2771.0,"discounted_cash":2327.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Angiograph Abd/Pelvis W/O & W Cont","code_information":[{"code":"35200026","type":"CDM"},{"code":"352","type":"RC"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":8264.0,"discounted_cash":6941.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5678.0,"discounted_cash":4769.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Angiograph Abdomen W/O & W Cont","code_information":[{"code":"35200027","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":5825.0,"discounted_cash":4893.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2860.0,"discounted_cash":2402.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Coronary Arteries W 3D Image","code_information":[{"code":"35200028","type":"CDM"},{"code":"352","type":"RC"},{"code":"75574","type":"HCPCS"}],"standard_charges":[{"gross_charge":3333.0,"discounted_cash":2799.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2297.0,"discounted_cash":1929.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Angiograph Abdominal Aorta W/Runoff","code_information":[{"code":"35200029","type":"CDM"},{"code":"352","type":"RC"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":5893.0,"discounted_cash":4950.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4814.0,"discounted_cash":4043.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Upper Extremity W/Wo Contrast","code_information":[{"code":"35200030","type":"CDM"},{"code":"352","type":"RC"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":4138.0,"discounted_cash":3475.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2690.0,"discounted_cash":2259.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Lower Extremity W/Wo Contrast","code_information":[{"code":"35200031","type":"CDM"},{"code":"352","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":3861.0,"discounted_cash":3243.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2641.0,"discounted_cash":2218.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Heart W/3D Image Congen","code_information":[{"code":"35200032","type":"CDM"},{"code":"352","type":"RC"},{"code":"75573","type":"HCPCS"}],"standard_charges":[{"gross_charge":1766.0,"discounted_cash":1483.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1413.0,"discounted_cash":1186.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Procedure","code_information":[{"code":"35200033","type":"CDM"},{"code":"352","type":"RC"},{"code":"76497","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":388.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":358.0,"discounted_cash":300.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc  Computed Tomography Thorax Lw Dose Lng Ca Scr C-","code_information":[{"code":"35200056","type":"CDM"},{"code":"352","type":"RC"},{"code":"71271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1218.0,"discounted_cash":1023.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1021.0,"discounted_cash":857.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Chest Tube Insertion","code_information":[{"code":"36000000","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":540.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cv Fresen Intra-Aortic Pump/Hr","code_information":[{"code":"36000001","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":577.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cv Perfusion Service Lev 1","code_information":[{"code":"36000002","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2682.0,"discounted_cash":2252.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cv Perfusion Service Lev 2","code_information":[{"code":"36000003","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":16979.0,"discounted_cash":14262.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cv Perfusion Service Lev 3","code_information":[{"code":"36000004","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":37757.0,"discounted_cash":31715.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cvor Base Complex Case","code_information":[{"code":"36000005","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":5472.0,"discounted_cash":4596.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cvor Base Complex Pr Minute","code_information":[{"code":"36000006","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cvor Base Heart Per Case","code_information":[{"code":"36000007","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":7122.0,"discounted_cash":5982.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cvor Base Moderate Case","code_information":[{"code":"36000008","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":3910.0,"discounted_cash":3284.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cvor Base Moderate Per Minute","code_information":[{"code":"36000009","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":118.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cvor Base Simple Case","code_information":[{"code":"36000010","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":1066.0,"discounted_cash":895.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cvor Base Simple Per Minute","code_information":[{"code":"36000011","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":81.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cvor Heart Case Per Minute","code_information":[{"code":"36000012","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":149.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Or Advanced Case Per Minute","code_information":[{"code":"36000013","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Or Base Advanced Case","code_information":[{"code":"36000014","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":6225.0,"discounted_cash":5229.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Or Base Complex Case","code_information":[{"code":"36000015","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":5983.0,"discounted_cash":5025.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Or Base Moderate Case","code_information":[{"code":"36000016","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":4615.0,"discounted_cash":3876.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Or Base Simple Case","code_information":[{"code":"36000017","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":1283.0,"discounted_cash":1077.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Or Complex Case Per Minute","code_information":[{"code":"36000018","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Or Moderate Case Per Minute","code_information":[{"code":"36000019","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Or Simple Case Per Minute","code_information":[{"code":"36000021","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perfusion Service Lev 1","code_information":[{"code":"36000022","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2164.0,"discounted_cash":1817.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perfusion Service Lev 2","code_information":[{"code":"36000023","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":3292.0,"discounted_cash":2765.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perfusion Service Lev 3","code_information":[{"code":"36000024","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":4458.0,"discounted_cash":3744.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perfusion Service Lev 4","code_information":[{"code":"36000025","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":4602.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surgical Proc 1-30 Min","code_information":[{"code":"36000026","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2794.0,"discounted_cash":2346.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surgical Proc 31-60 Min","code_information":[{"code":"36000027","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":5026.0,"discounted_cash":4221.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surgical Proc 61-90 Min","code_information":[{"code":"36000028","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":7550.0,"discounted_cash":6342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surgical Proc 91-120 Min","code_information":[{"code":"36000029","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":12214.0,"discounted_cash":10259.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Endotracheal Intubation","code_information":[{"code":"36000030","type":"CDM"},{"code":"360","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":516.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thorocentesis W Cath /Guidance","code_information":[{"code":"36000031","type":"CDM"},{"code":"360","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":10551.0,"discounted_cash":8862.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1910.0,"discounted_cash":1604.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bl Exchange/Transfuse Non-Nb","code_information":[{"code":"36000032","type":"CDM"},{"code":"360","type":"RC"},{"code":"36455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1943.0,"discounted_cash":1632.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Non-Tunnel Cv Cath => 5 Years Old","code_information":[{"code":"36000033","type":"CDM"},{"code":"360","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":5160.0,"discounted_cash":4334.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mech Remov Tunneled Cv Cath, Separate Access","code_information":[{"code":"36000034","type":"CDM"},{"code":"360","type":"RC"},{"code":"36595","type":"HCPCS"}],"standard_charges":[{"gross_charge":9170.0,"discounted_cash":7702.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":6963.0,"discounted_cash":5848.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inj W/Fluor Eval Cv Device","code_information":[{"code":"36000035","type":"CDM"},{"code":"360","type":"RC"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.0,"discounted_cash":634.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":573.0,"discounted_cash":481.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Remove Renal Tube W/Fluoro","code_information":[{"code":"36000036","type":"CDM"},{"code":"360","type":"RC"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":2214.0,"discounted_cash":1859.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1681.0,"discounted_cash":1412.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cath Placement Prostate Seeds","code_information":[{"code":"36000037","type":"CDM"},{"code":"360","type":"RC"},{"code":"55875","type":"HCPCS"}],"standard_charges":[{"gross_charge":8512.0,"discounted_cash":7150.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ecmo Initiation Veno-Arterial","code_information":[{"code":"36000038","type":"CDM"},{"code":"360","type":"RC"},{"code":"33947","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":356.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ecmo Initiation Veno-Venous","code_information":[{"code":"36000039","type":"CDM"},{"code":"360","type":"RC"},{"code":"33946","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":356.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ecmo Monitoring Veno-Arterial","code_information":[{"code":"36000040","type":"CDM"},{"code":"360","type":"RC"},{"code":"33949","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":356.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ecmo Monitoring Veno-Venous","code_information":[{"code":"36000041","type":"CDM"},{"code":"360","type":"RC"},{"code":"33948","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":356.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove Int Dwell Ureteral Stent Transurethral","code_information":[{"code":"36000042","type":"CDM"},{"code":"360","type":"RC"},{"code":"50386","type":"HCPCS"}],"standard_charges":[{"gross_charge":8188.0,"discounted_cash":6877.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5852.0,"discounted_cash":4915.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Rmvl & Rplcmt Xtrnl Accessible Nephrourtrl Cath","code_information":[{"code":"36000043","type":"CDM"},{"code":"360","type":"RC"},{"code":"50387","type":"HCPCS"}],"standard_charges":[{"gross_charge":2970.77,"discounted_cash":2495.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2311.0,"discounted_cash":1941.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Insj Non-Biodegradable Drug Delivery Implant","code_information":[{"code":"36000044","type":"CDM"},{"code":"360","type":"RC"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":622.0,"discounted_cash":522.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Intrauterine Device Iud","code_information":[{"code":"36000045","type":"CDM"},{"code":"360","type":"RC"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":4498.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Revise Leg Vein","code_information":[{"code":"36000046","type":"CDM"},{"code":"360","type":"RC"},{"code":"37700","type":"HCPCS"}],"standard_charges":[{"gross_charge":15398.0,"discounted_cash":12934.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Stab Phlebt Varicose Veins 1 Xtr > 20 Incs","code_information":[{"code":"36000047","type":"CDM"},{"code":"360","type":"RC"},{"code":"37766","type":"HCPCS"}],"standard_charges":[{"gross_charge":15398.0,"discounted_cash":12934.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Guide Cath Drain Abs/Hem/Ser/Cyst","code_information":[{"code":"36100001","type":"CDM"},{"code":"361","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":3609.0,"discounted_cash":3031.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2888.0,"discounted_cash":2425.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc I&D Skin Abcess Simple","code_information":[{"code":"36100002","type":"CDM"},{"code":"361","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":632.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Puncture Drainage Of Lesion","code_information":[{"code":"36100003","type":"CDM"},{"code":"361","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":5273.0,"discounted_cash":4429.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4219.0,"discounted_cash":3543.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Debridement Subq 1St 20 Sq Cm Or Less","code_information":[{"code":"36100004","type":"CDM"},{"code":"361","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":1245.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Musc/Fasci 1St 20Sqcm","code_information":[{"code":"36100005","type":"CDM"},{"code":"361","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":1245.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Bone 1St 20 Sq Cm","code_information":[{"code":"36100006","type":"CDM"},{"code":"361","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":4626.0,"discounted_cash":3885.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Debridement Subq Add 20 Sq Cm Or Prt Of","code_information":[{"code":"36100007","type":"CDM"},{"code":"361","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":1245.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Mus/Fascia Add 20 Sqcm Or Prt","code_information":[{"code":"36100008","type":"CDM"},{"code":"361","type":"RC"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":1245.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Bone Add 20 Sqcm Or Prt Of","code_information":[{"code":"36100009","type":"CDM"},{"code":"361","type":"RC"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":4626.0,"discounted_cash":3885.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Nail 6 Or More","code_information":[{"code":"36100012","type":"CDM"},{"code":"361","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.0,"discounted_cash":396.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Splt-Thck Autograft, Trnk,Arm,Leg","code_information":[{"code":"36100013","type":"CDM"},{"code":"361","type":"RC"},{"code":"15100","type":"HCPCS"}],"standard_charges":[{"gross_charge":14654.0,"discounted_cash":12309.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Trnk Etc<=100Sqcm 1St 25","code_information":[{"code":"36100014","type":"CDM"},{"code":"361","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":5036.0,"discounted_cash":4230.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Graft T/A/L Add-On 25 Sqcm","code_information":[{"code":"36100015","type":"CDM"},{"code":"361","type":"RC"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":1071.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Grft T/Arm/Lg Child > 100 1St 100","code_information":[{"code":"36100016","type":"CDM"},{"code":"361","type":"RC"},{"code":"15273","type":"HCPCS"}],"standard_charges":[{"gross_charge":8306.0,"discounted_cash":6977.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skn Sub Grft T/A/L Child Add > 100","code_information":[{"code":"36100017","type":"CDM"},{"code":"361","type":"RC"},{"code":"15274","type":"HCPCS"}],"standard_charges":[{"gross_charge":1896.0,"discounted_cash":1592.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Graft Face/Nk/Hf/G <=100Sqcm 1St 25","code_information":[{"code":"36100018","type":"CDM"},{"code":"361","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":5036.0,"discounted_cash":4230.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Graft F/N/Hf/G Addl <=100Sqcm 1St 25","code_information":[{"code":"36100019","type":"CDM"},{"code":"361","type":"RC"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":1414.0,"discounted_cash":1187.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dress/Debride P Thick Burn S <5% Total Body Area","code_information":[{"code":"36100020","type":"CDM"},{"code":"361","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":735.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chemical Cauterization","code_information":[{"code":"36100021","type":"CDM"},{"code":"361","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":493.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Breast Cyst Asp","code_information":[{"code":"36100022","type":"CDM"},{"code":"361","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2089.0,"discounted_cash":1754.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1671.0,"discounted_cash":1403.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Breast Cyst Asp Add-On","code_information":[{"code":"36100023","type":"CDM"},{"code":"361","type":"RC"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":367.0,"discounted_cash":308.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":309.0,"discounted_cash":259.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Bx Breast 1St Lesion Strtctc","code_information":[{"code":"36100024","type":"CDM"},{"code":"361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":4445.0,"discounted_cash":3733.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3556.0,"discounted_cash":2987.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bx Breast Add Lesion Strtctc","code_information":[{"code":"36100025","type":"CDM"},{"code":"361","type":"RC"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":4445.0,"discounted_cash":3733.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3556.0,"discounted_cash":2987.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Breast Bx 1St Lesion","code_information":[{"code":"36100026","type":"CDM"},{"code":"361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":4445.0,"discounted_cash":3733.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3556.0,"discounted_cash":2987.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Breast Bx Addt Lesion","code_information":[{"code":"36100027","type":"CDM"},{"code":"361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":4445.0,"discounted_cash":3733.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3556.0,"discounted_cash":2987.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bx Breast 1St Lesion Mr Imag","code_information":[{"code":"36100028","type":"CDM"},{"code":"361","type":"RC"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":4445.0,"discounted_cash":3733.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3556.0,"discounted_cash":2987.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bx Breast Add Lesion Mr Imag","code_information":[{"code":"36100029","type":"CDM"},{"code":"361","type":"RC"},{"code":"19086","type":"HCPCS"}],"standard_charges":[{"gross_charge":4445.0,"discounted_cash":3733.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3556.0,"discounted_cash":2987.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Breast Wire Loc 1St","code_information":[{"code":"36100030","type":"CDM"},{"code":"361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":1833.0,"discounted_cash":1539.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1741.0,"discounted_cash":1462.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Breast Wire Loc Addt","code_information":[{"code":"36100031","type":"CDM"},{"code":"361","type":"RC"},{"code":"19282","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":1016.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":806.0,"discounted_cash":677.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Breast Wire Loc 1St Us Imag","code_information":[{"code":"36100032","type":"CDM"},{"code":"361","type":"RC"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":1833.0,"discounted_cash":1539.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":788.0,"discounted_cash":661.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Breast Wire Loc Addt Us Image","code_information":[{"code":"36100033","type":"CDM"},{"code":"361","type":"RC"},{"code":"19286","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":1173.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":978.0,"discounted_cash":821.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Needle Biopsy Muscle","code_information":[{"code":"36100034","type":"CDM"},{"code":"361","type":"RC"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3571.0,"discounted_cash":2999.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2856.0,"discounted_cash":2399.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Biopsy Trocar/Needle, Superficial","code_information":[{"code":"36100035","type":"CDM"},{"code":"361","type":"RC"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4299.0,"discounted_cash":3611.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3439.0,"discounted_cash":2888.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Biopsy Trocar/Needle, Deep","code_information":[{"code":"36100036","type":"CDM"},{"code":"361","type":"RC"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5828.0,"discounted_cash":4895.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4662.0,"discounted_cash":3916.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inject Sinus Tract For X-Ray","code_information":[{"code":"36100037","type":"CDM"},{"code":"361","type":"RC"},{"code":"20501","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.0,"discounted_cash":626.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":497.0,"discounted_cash":417.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inj Tendon Sheath/Ligament","code_information":[{"code":"36100038","type":"CDM"},{"code":"361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1039.0,"discounted_cash":872.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":942.0,"discounted_cash":791.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Drain/Inj Intermediate Joint/Bursa W/O Us","code_information":[{"code":"36100039","type":"CDM"},{"code":"361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":1042.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":835.0,"discounted_cash":701.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Drain/Inj Major Joint/Bursa W/O Us","code_information":[{"code":"36100040","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1441.0,"discounted_cash":1210.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":821.0,"discounted_cash":689.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Drain/Inj Major Joint/Bursa W/Us","code_information":[{"code":"36100041","type":"CDM"},{"code":"402","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":2007.0,"discounted_cash":1685.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1251.0,"discounted_cash":1050.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Biopsy Of Neck/Chest","code_information":[{"code":"36100043","type":"CDM"},{"code":"361","type":"RC"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":5828.0,"discounted_cash":4895.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4508.0,"discounted_cash":3786.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inject Shoulder Arthrography","code_information":[{"code":"36100044","type":"CDM"},{"code":"361","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":527.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":440.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Treat Shoulder Disl W Manipulation","code_information":[{"code":"36100045","type":"CDM"},{"code":"361","type":"RC"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":6018.0,"discounted_cash":5055.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj, Elbow Arthrography","code_information":[{"code":"36100046","type":"CDM"},{"code":"361","type":"RC"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":357.0,"discounted_cash":299.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection For Wrist X-Ray","code_information":[{"code":"36100047","type":"CDM"},{"code":"361","type":"RC"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":514.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":428.0,"discounted_cash":359.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inject, Hip Arthrography","code_information":[{"code":"36100048","type":"CDM"},{"code":"361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":603.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":503.0,"discounted_cash":422.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Apply Rigid Leg Cast","code_information":[{"code":"36100050","type":"CDM"},{"code":"361","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.0,"discounted_cash":1084.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Apply Unna Boot","code_information":[{"code":"36100051","type":"CDM"},{"code":"361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.28,"discounted_cash":791.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Apply Multilayer Comp Lower Leg","code_information":[{"code":"36100052","type":"CDM"},{"code":"361","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":704.88,"discounted_cash":592.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Of Chest Tube","code_information":[{"code":"36100054","type":"CDM"},{"code":"361","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2034.0,"discounted_cash":1708.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1830.0,"discounted_cash":1537.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Thoracentesis W/Guidance","code_information":[{"code":"36100055","type":"CDM"},{"code":"361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2468.0,"discounted_cash":2073.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1974.0,"discounted_cash":1658.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Thorocentesis W Cath /Guidance","code_information":[{"code":"36100056","type":"CDM"},{"code":"361","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":10551.0,"discounted_cash":8862.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1910.0,"discounted_cash":1604.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Msp Sc Extremity Vein 36000","code_information":[{"code":"36100059","type":"CDM"},{"code":"361","type":"RC"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":160.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":127.0,"discounted_cash":106.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pseudoaneurysm Injection Trt","code_information":[{"code":"36100060","type":"CDM"},{"code":"361","type":"RC"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":885.0,"discounted_cash":743.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":664.0,"discounted_cash":557.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection, Ext Venography","code_information":[{"code":"36100061","type":"CDM"},{"code":"361","type":"RC"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":1092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":866.0,"discounted_cash":727.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Place Catheter In Vein","code_information":[{"code":"36100062","type":"CDM"},{"code":"361","type":"RC"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2645.0,"discounted_cash":2221.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1764.0,"discounted_cash":1481.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Place Catheter In Vein Selective","code_information":[{"code":"36100063","type":"CDM"},{"code":"361","type":"RC"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2500.0,"discounted_cash":2100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1750.0,"discounted_cash":1470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Establish Access To Artery","code_information":[{"code":"36100064","type":"CDM"},{"code":"361","type":"RC"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"discounted_cash":1994.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1662.0,"discounted_cash":1396.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cath Access-Aorta","code_information":[{"code":"36100066","type":"CDM"},{"code":"361","type":"RC"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2541.0,"discounted_cash":2134.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1779.0,"discounted_cash":1494.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ins Cath Abd/L-Ext Art 1St","code_information":[{"code":"36100067","type":"CDM"},{"code":"361","type":"RC"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":3541.0,"discounted_cash":2974.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2479.0,"discounted_cash":2082.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ins Cath Abd/L-Extremity Artery 2Nd","code_information":[{"code":"36100068","type":"CDM"},{"code":"361","type":"RC"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":3486.0,"discounted_cash":2928.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2440.0,"discounted_cash":2049.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ins Cath Abd/L-Extremity Artery 3Rd","code_information":[{"code":"36100069","type":"CDM"},{"code":"361","type":"RC"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":4282.0,"discounted_cash":3596.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2997.0,"discounted_cash":2517.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ins Cath Abd/L-Extremity Artery Addl","code_information":[{"code":"36100070","type":"CDM"},{"code":"361","type":"RC"},{"code":"36248","type":"HCPCS"}],"standard_charges":[{"gross_charge":2103.0,"discounted_cash":1766.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1402.0,"discounted_cash":1177.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ins Cath Renal Artery 1St Unilateral","code_information":[{"code":"36100071","type":"CDM"},{"code":"361","type":"RC"},{"code":"36251","type":"HCPCS"}],"standard_charges":[{"gross_charge":9560.0,"discounted_cash":8030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4015.0,"discounted_cash":3372.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Umbilical Catheter Insertion","code_information":[{"code":"36100073","type":"CDM"},{"code":"361","type":"RC"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":569.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Non-Tunnel Cv Cath => 5 Years Old","code_information":[{"code":"36100074","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":5160.0,"discounted_cash":4334.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4386.0,"discounted_cash":3684.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":4386.0,"discounted_cash":3684.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Insert Tunneled Cv Cath Wo Port => 5 Years Old","code_information":[{"code":"36100075","type":"CDM"},{"code":"361","type":"RC"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":8997.0,"discounted_cash":7557.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7198.0,"discounted_cash":6046.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Insert Tunneled Cv Cath W Port => 5 Years Old","code_information":[{"code":"36100076","type":"CDM"},{"code":"361","type":"RC"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":16097.0,"discounted_cash":13521.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":12877.0,"discounted_cash":10816.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Picc Insertion<5Yrs","code_information":[{"code":"36100077","type":"CDM"},{"code":"361","type":"RC"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":4321.0,"discounted_cash":3629.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3341.0,"discounted_cash":2806.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Picc Line Insertion => 5 Years Old","code_information":[{"code":"36100078","type":"CDM"},{"code":"361","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":4517.0,"discounted_cash":3794.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3614.0,"discounted_cash":3035.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Repair Tunneled Cv Cath","code_information":[{"code":"36100079","type":"CDM"},{"code":"361","type":"RC"},{"code":"36575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1990.0,"discounted_cash":1671.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1539.0,"discounted_cash":1292.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Replace Cvad Cath","code_information":[{"code":"36100080","type":"CDM"},{"code":"361","type":"RC"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":4321.0,"discounted_cash":3629.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3456.0,"discounted_cash":2903.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Replace Tunneled Cv Cath","code_information":[{"code":"36100081","type":"CDM"},{"code":"361","type":"RC"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":8997.0,"discounted_cash":7557.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7198.0,"discounted_cash":6046.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Replace Picc Cath","code_information":[{"code":"36100082","type":"CDM"},{"code":"361","type":"RC"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":4472.0,"discounted_cash":3756.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3354.0,"discounted_cash":2817.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Removal Tunneled Cv Cath Wo Subct Port Or Pump","code_information":[{"code":"36100083","type":"CDM"},{"code":"361","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":2372.0,"discounted_cash":1992.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1897.0,"discounted_cash":1593.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Removal Tunneled Cv Cath W Subct Port Or Pump","code_information":[{"code":"36100084","type":"CDM"},{"code":"361","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":5567.0,"discounted_cash":4676.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4453.0,"discounted_cash":3740.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":3439.0,"discounted_cash":2888.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Declot Vad","code_information":[{"code":"36100085","type":"CDM"},{"code":"361","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"discounted_cash":588.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":666.0,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mech Remov Tunneled Cv Cath","code_information":[{"code":"36100086","type":"CDM"},{"code":"361","type":"RC"},{"code":"36596","type":"HCPCS"}],"standard_charges":[{"gross_charge":4321.0,"discounted_cash":3629.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3341.0,"discounted_cash":2806.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Reposition Venous Catheter","code_information":[{"code":"36100087","type":"CDM"},{"code":"361","type":"RC"},{"code":"36597","type":"HCPCS"}],"standard_charges":[{"gross_charge":4321.0,"discounted_cash":3629.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3456.0,"discounted_cash":2903.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ins Endovas Vena Cava Filtr","code_information":[{"code":"36100089","type":"CDM"},{"code":"361","type":"RC"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":10561.0,"discounted_cash":8871.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8449.0,"discounted_cash":7097.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Transcatheter Biopsy","code_information":[{"code":"36100090","type":"CDM"},{"code":"361","type":"RC"},{"code":"37200","type":"HCPCS"}],"standard_charges":[{"gross_charge":8706.0,"discounted_cash":7313.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":6736.0,"discounted_cash":5658.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vasc Embolize/Occlude Artery","code_information":[{"code":"36100091","type":"CDM"},{"code":"361","type":"RC"},{"code":"37242","type":"HCPCS"}],"standard_charges":[{"gross_charge":35438.0,"discounted_cash":29767.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":33666.0,"discounted_cash":28279.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vasc Embolize/Occlude Organ","code_information":[{"code":"36100092","type":"CDM"},{"code":"361","type":"RC"},{"code":"37243","type":"HCPCS"}],"standard_charges":[{"gross_charge":55961.0,"discounted_cash":47007.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":44769.0,"discounted_cash":37605.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vasc Embolize/Occlude Bleed","code_information":[{"code":"36100093","type":"CDM"},{"code":"361","type":"RC"},{"code":"37244","type":"HCPCS"}],"standard_charges":[{"gross_charge":55961.0,"discounted_cash":47007.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":44769.0,"discounted_cash":37605.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bone Marrow Aspiration","code_information":[{"code":"36100094","type":"CDM"},{"code":"361","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3445.0,"discounted_cash":2893.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2666.0,"discounted_cash":2239.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":2666.0,"discounted_cash":2239.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Bone Marrow Biopsy","code_information":[{"code":"36100095","type":"CDM"},{"code":"361","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3445.0,"discounted_cash":2893.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2755.0,"discounted_cash":2314.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Needle Biopsy Lymph Nodes","code_information":[{"code":"36100096","type":"CDM"},{"code":"361","type":"RC"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3571.0,"discounted_cash":2999.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2856.0,"discounted_cash":2399.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection For Salivary X-Ray","code_information":[{"code":"36100097","type":"CDM"},{"code":"361","type":"RC"},{"code":"42550","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":548.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Nasal/Orogastric W/Tube Plmt","code_information":[{"code":"36100098","type":"CDM"},{"code":"361","type":"RC"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":647.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":596.0,"discounted_cash":500.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Reposition Gastrostomy Tube","code_information":[{"code":"36100099","type":"CDM"},{"code":"361","type":"RC"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":3407.0,"discounted_cash":2861.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1524.0,"discounted_cash":1280.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Needle Biopsy Of Liver","code_information":[{"code":"36100100","type":"CDM"},{"code":"361","type":"RC"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3852.0,"discounted_cash":3235.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3082.0,"discounted_cash":2588.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Incision Of Gallbladder","code_information":[{"code":"36100101","type":"CDM"},{"code":"361","type":"RC"},{"code":"47490","type":"HCPCS"}],"standard_charges":[{"gross_charge":7212.0,"discounted_cash":6058.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5770.0,"discounted_cash":4846.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ptc Image/Inject","code_information":[{"code":"36100102","type":"CDM"},{"code":"361","type":"RC"},{"code":"47532","type":"HCPCS"}],"standard_charges":[{"gross_charge":10400.0,"discounted_cash":8736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8046.0,"discounted_cash":6758.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc T Tube Cholangiogram Image/Inj","code_information":[{"code":"36100103","type":"CDM"},{"code":"361","type":"RC"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":9385.0,"discounted_cash":7883.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3800.0,"discounted_cash":3192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bilary Drain Ext Comp","code_information":[{"code":"36100104","type":"CDM"},{"code":"361","type":"RC"},{"code":"47533","type":"HCPCS"}],"standard_charges":[{"gross_charge":13110.0,"discounted_cash":11012.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":10143.0,"discounted_cash":8520.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biliary Drain Int/Ext Comp","code_information":[{"code":"36100105","type":"CDM"},{"code":"361","type":"RC"},{"code":"47534","type":"HCPCS"}],"standard_charges":[{"gross_charge":13110.0,"discounted_cash":11012.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":10143.0,"discounted_cash":8520.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Abd Paracentesis W/Imaging","code_information":[{"code":"36100106","type":"CDM"},{"code":"361","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1958.0,"discounted_cash":1644.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1566.0,"discounted_cash":1315.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biopsy Abdominal Mass","code_information":[{"code":"36100107","type":"CDM"},{"code":"361","type":"RC"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":3852.0,"discounted_cash":3235.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3082.0,"discounted_cash":2588.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Image Cath Fluid Colxn Visc","code_information":[{"code":"36100108","type":"CDM"},{"code":"361","type":"RC"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":7740.0,"discounted_cash":6501.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":6192.0,"discounted_cash":5201.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Image Cath Fluid Peri/Retro","code_information":[{"code":"36100109","type":"CDM"},{"code":"361","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":7740.0,"discounted_cash":6501.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":6192.0,"discounted_cash":5201.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Assess Cyst Contrast Inject","code_information":[{"code":"36100110","type":"CDM"},{"code":"361","type":"RC"},{"code":"49424","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":665.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":554.0,"discounted_cash":465.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Place Gastrostomy Tube Perc","code_information":[{"code":"36100111","type":"CDM"},{"code":"361","type":"RC"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":5152.0,"discounted_cash":4327.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4121.0,"discounted_cash":3461.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Change G-Tube To G-J Perc","code_information":[{"code":"36100112","type":"CDM"},{"code":"361","type":"RC"},{"code":"49446","type":"HCPCS"}],"standard_charges":[{"gross_charge":4741.0,"discounted_cash":3982.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3792.0,"discounted_cash":3185.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Replace G/C Tube Perc","code_information":[{"code":"36100113","type":"CDM"},{"code":"361","type":"RC"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2372.0,"discounted_cash":1992.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1897.0,"discounted_cash":1593.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Replace Duod/Jej Tube Perc","code_information":[{"code":"36100114","type":"CDM"},{"code":"361","type":"RC"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2372.0,"discounted_cash":1992.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1897.0,"discounted_cash":1593.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Replace G-J Tube Perc","code_information":[{"code":"36100115","type":"CDM"},{"code":"361","type":"RC"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":2372.0,"discounted_cash":1992.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1897.0,"discounted_cash":1593.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fix G/Colon Tube W/Device","code_information":[{"code":"36100116","type":"CDM"},{"code":"361","type":"RC"},{"code":"49460","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.0,"discounted_cash":1580.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1505.0,"discounted_cash":1264.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fluoro Exam Of G/Colon Tube","code_information":[{"code":"36100117","type":"CDM"},{"code":"361","type":"RC"},{"code":"49465","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":647.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":596.0,"discounted_cash":500.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Renal Biopsy Percutaneous","code_information":[{"code":"36100118","type":"CDM"},{"code":"361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3852.0,"discounted_cash":3235.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3082.0,"discounted_cash":2588.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Drainage Of Kidney Lesion","code_information":[{"code":"36100119","type":"CDM"},{"code":"361","type":"RC"},{"code":"50390","type":"HCPCS"}],"standard_charges":[{"gross_charge":4610.0,"discounted_cash":3872.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3687.0,"discounted_cash":3097.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Plmt Nephrostomy Catheter","code_information":[{"code":"36100120","type":"CDM"},{"code":"361","type":"RC"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":7196.0,"discounted_cash":6044.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5757.0,"discounted_cash":4835.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Perc Cryo Ablate Renal Tum","code_information":[{"code":"36100124","type":"CDM"},{"code":"361","type":"RC"},{"code":"50593","type":"HCPCS"}],"standard_charges":[{"gross_charge":37293.0,"discounted_cash":31326.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":26611.0,"discounted_cash":22353.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Change Of Ureter Tube/Stent","code_information":[{"code":"36100125","type":"CDM"},{"code":"361","type":"RC"},{"code":"50688","type":"HCPCS"}],"standard_charges":[{"gross_charge":6109.62,"discounted_cash":5132.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4887.91,"discounted_cash":4105.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection For Bladder X-Ray; Cystography Or Voiding","code_information":[{"code":"36100126","type":"CDM"},{"code":"361","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":647.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":514.0,"discounted_cash":431.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection For Bladder X-Ray; Retrograde","code_information":[{"code":"36100127","type":"CDM"},{"code":"361","type":"RC"},{"code":"51610","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":645.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":511.0,"discounted_cash":429.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Circumcision Using Clamp Or Other W Regional Block","code_information":[{"code":"36100128","type":"CDM"},{"code":"723","type":"RC"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":5553.0,"discounted_cash":4664.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4442.0,"discounted_cash":3731.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Catheter For Hysterography","code_information":[{"code":"36100129","type":"CDM"},{"code":"361","type":"RC"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":541.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":516.0,"discounted_cash":433.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Delivery Of Placenta","code_information":[{"code":"36100130","type":"CDM"},{"code":"361","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":8302.0,"discounted_cash":6973.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Biopsy Of Thyroid","code_information":[{"code":"36100131","type":"CDM"},{"code":"361","type":"RC"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2089.0,"discounted_cash":1754.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":814.0,"discounted_cash":683.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":814.0,"discounted_cash":683.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Aspir/Inj Thyroid Cyst","code_information":[{"code":"36100132","type":"CDM"},{"code":"361","type":"RC"},{"code":"60300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2089.0,"discounted_cash":1754.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1617.0,"discounted_cash":1358.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection Into Brain Canal","code_information":[{"code":"36100133","type":"CDM"},{"code":"361","type":"RC"},{"code":"61055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1949.0,"discounted_cash":1637.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1507.0,"discounted_cash":1265.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spinal Fluid Tap Diagnostic","code_information":[{"code":"36100134","type":"CDM"},{"code":"361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.0,"discounted_cash":1107.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":989.0,"discounted_cash":830.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inject Epidural Patch","code_information":[{"code":"36100135","type":"CDM"},{"code":"361","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.0,"discounted_cash":2860.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2724.0,"discounted_cash":2288.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection For Myelogram","code_information":[{"code":"36100136","type":"CDM"},{"code":"361","type":"RC"},{"code":"62284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1474.0,"discounted_cash":1238.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1141.0,"discounted_cash":958.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Myelography Lumbar Injection, Thoracic","code_information":[{"code":"36100137","type":"CDM"},{"code":"361","type":"RC"},{"code":"62303","type":"HCPCS"}],"standard_charges":[{"gross_charge":4479.0,"discounted_cash":3762.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3583.0,"discounted_cash":3009.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Myelography Lumbar Injection, Lumbosacral","code_information":[{"code":"36100138","type":"CDM"},{"code":"361","type":"RC"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":4479.0,"discounted_cash":3762.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3583.0,"discounted_cash":3009.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Myelography Lumbar Injection, 2 Or More Regions","code_information":[{"code":"36100139","type":"CDM"},{"code":"361","type":"RC"},{"code":"62305","type":"HCPCS"}],"standard_charges":[{"gross_charge":4479.0,"discounted_cash":3762.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3583.0,"discounted_cash":3009.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inject Spine Cerv/Thoracic","code_information":[{"code":"36100140","type":"CDM"},{"code":"361","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.0,"discounted_cash":2860.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2637.0,"discounted_cash":2215.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inject Spine Lumbar/Sacral","code_information":[{"code":"36100141","type":"CDM"},{"code":"361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":3524.0,"discounted_cash":2960.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2637.0,"discounted_cash":2215.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc N Block Supraclavicular Inj","code_information":[{"code":"36100144","type":"CDM"},{"code":"361","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1309.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Cont Infuse Brachial Plex / Supraclavicular","code_information":[{"code":"36100145","type":"CDM"},{"code":"361","type":"RC"},{"code":"64416","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Axillary","code_information":[{"code":"36100146","type":"CDM"},{"code":"361","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1309.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Sciatic Single / Popliteal Single","code_information":[{"code":"36100147","type":"CDM"},{"code":"361","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Femoral Single","code_information":[{"code":"36100148","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1309.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Femoral Cont Infusion","code_information":[{"code":"36100149","type":"CDM"},{"code":"361","type":"RC"},{"code":"64448","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Other Peripheral /Ankle/Wrist","code_information":[{"code":"36100150","type":"CDM"},{"code":"361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.0,"discounted_cash":1580.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Foramen Epidural C/T","code_information":[{"code":"36100151","type":"CDM"},{"code":"361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":4441.0,"discounted_cash":3730.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2637.0,"discounted_cash":2215.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inj Foramen Epidural L/S","code_information":[{"code":"36100152","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":4595.0,"discounted_cash":3859.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2637.0,"discounted_cash":2215.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inj Paravertebral Facet Jnt C/T 1 Lev","code_information":[{"code":"36100153","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2863.0,"discounted_cash":2404.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2568.0,"discounted_cash":2157.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inj Paravert F Jnt L/S 1 Lev","code_information":[{"code":"36100154","type":"CDM"},{"code":"361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":4595.0,"discounted_cash":3859.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2637.0,"discounted_cash":2215.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Inj Paravert F Jnt L/S 2 Lev","code_information":[{"code":"36100155","type":"CDM"},{"code":"361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":2691.0,"discounted_cash":2260.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1972.0,"discounted_cash":1656.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Guide For Tissue Ablation","code_information":[{"code":"36100156","type":"CDM"},{"code":"350","type":"RC"},{"code":"77013","type":"HCPCS"}],"standard_charges":[{"gross_charge":2886.0,"discounted_cash":2424.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2597.0,"discounted_cash":2181.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Debridement Selective ,<20 Sq Cm","code_information":[{"code":"36100157","type":"CDM"},{"code":"361","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.0,"discounted_cash":710.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Opn Wnd Ea Add 20Sqcm","code_information":[{"code":"36100158","type":"CDM"},{"code":"361","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":685.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Trnk Etc 1St 25 Low Mcr","code_information":[{"code":"36100159","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5271","type":"HCPCS"}],"standard_charges":[{"gross_charge":2388.0,"discounted_cash":2005.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Trnk Etc +25 Low Mcr","code_information":[{"code":"36100160","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1897.0,"discounted_cash":1593.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Trnk Etc 1St 100 Low Mcr","code_information":[{"code":"36100161","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5273","type":"HCPCS"}],"standard_charges":[{"gross_charge":8002.0,"discounted_cash":6721.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Trnk Etc +100 Low Mcr","code_information":[{"code":"36100162","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5274","type":"HCPCS"}],"standard_charges":[{"gross_charge":5114.0,"discounted_cash":4295.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Feet Etc 1St 25 Low Mcr","code_information":[{"code":"36100163","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"gross_charge":2786.0,"discounted_cash":2340.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Skin Sub Feet Etc +25 Low Mcr","code_information":[{"code":"36100164","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5276","type":"HCPCS"}],"standard_charges":[{"gross_charge":1732.0,"discounted_cash":1454.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj For Sacroiliac Jt Anesth","code_information":[{"code":"36100165","type":"CDM"},{"code":"361","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2392.0,"discounted_cash":2009.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bi Stereotactic Needle Localization","code_information":[{"code":"36100167","type":"CDM"},{"code":"361","type":"RC"},{"code":"19283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1833.0,"discounted_cash":1539.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":775.0,"discounted_cash":651.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Bi Stereo Wire Loc Additional","code_information":[{"code":"36100168","type":"CDM"},{"code":"361","type":"RC"},{"code":"19284","type":"HCPCS"}],"standard_charges":[{"gross_charge":2270.0,"discounted_cash":1906.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1513.0,"discounted_cash":1270.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Inject Tendon","code_information":[{"code":"36100169","type":"CDM"},{"code":"361","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1541.0,"discounted_cash":1294.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1191.0,"discounted_cash":1000.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Us Guide Small Joint Injection","code_information":[{"code":"36100170","type":"CDM"},{"code":"361","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1625.0,"discounted_cash":1365.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1219.0,"discounted_cash":1023.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Us Guide Medium Joint Injection","code_information":[{"code":"36100171","type":"CDM"},{"code":"361","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1825.0,"discounted_cash":1533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1251.0,"discounted_cash":1050.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":1251.0,"discounted_cash":1050.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Us Asp/Inj Ganglion Cyst","code_information":[{"code":"36100172","type":"CDM"},{"code":"361","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":863.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":823.0,"discounted_cash":691.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Ct Nl Unlisted Spine","code_information":[{"code":"36100173","type":"CDM"},{"code":"361","type":"RC"},{"code":"22899","type":"HCPCS"}],"standard_charges":[{"gross_charge":12675.0,"discounted_cash":10647.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9807.0,"discounted_cash":8237.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fl Inject Ankle Arthrogram","code_information":[{"code":"36100174","type":"CDM"},{"code":"361","type":"RC"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"discounted_cash":588.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":467.0,"discounted_cash":392.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Rf Ablation Tumor Lung","code_information":[{"code":"36100175","type":"CDM"},{"code":"361","type":"RC"},{"code":"32998","type":"HCPCS"}],"standard_charges":[{"gross_charge":25984.0,"discounted_cash":21826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":20105.0,"discounted_cash":16888.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sc Select Venous 2Nd","code_information":[{"code":"36100177","type":"CDM"},{"code":"361","type":"RC"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2100.0,"discounted_cash":1764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Place Catheter In Artery 3Rd Order","code_information":[{"code":"36100178","type":"CDM"},{"code":"361","type":"RC"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":3877.0,"discounted_cash":3256.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2584.0,"discounted_cash":2170.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Place Catheter In Artery Additional","code_information":[{"code":"36100179","type":"CDM"},{"code":"361","type":"RC"},{"code":"36218","type":"HCPCS"}],"standard_charges":[{"gross_charge":2318.0,"discounted_cash":1947.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1546.0,"discounted_cash":1298.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ins Cath Ren Art 2Nd+ Unilat","code_information":[{"code":"36100180","type":"CDM"},{"code":"361","type":"RC"},{"code":"36253","type":"HCPCS"}],"standard_charges":[{"gross_charge":9560.0,"discounted_cash":8030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7396.0,"discounted_cash":6212.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sc Portal Vein","code_information":[{"code":"36100181","type":"CDM"},{"code":"361","type":"RC"},{"code":"36481","type":"HCPCS"}],"standard_charges":[{"gross_charge":3834.0,"discounted_cash":3220.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2864.0,"discounted_cash":2405.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sel Organ Blood Sample","code_information":[{"code":"36100182","type":"CDM"},{"code":"361","type":"RC"},{"code":"36500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2556.0,"discounted_cash":2147.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1704.0,"discounted_cash":1431.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Replace Tunnel Cvc Port","code_information":[{"code":"36100183","type":"CDM"},{"code":"361","type":"RC"},{"code":"36582","type":"HCPCS"}],"standard_charges":[{"gross_charge":17536.0,"discounted_cash":14730.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":13569.0,"discounted_cash":11397.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ivc Filter Reposition","code_information":[{"code":"36100184","type":"CDM"},{"code":"361","type":"RC"},{"code":"37192","type":"HCPCS"}],"standard_charges":[{"gross_charge":9809.0,"discounted_cash":8239.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7333.0,"discounted_cash":6159.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ivc Filter Retrieval","code_information":[{"code":"36100185","type":"CDM"},{"code":"361","type":"RC"},{"code":"37193","type":"HCPCS"}],"standard_charges":[{"gross_charge":10896.0,"discounted_cash":9152.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8172.0,"discounted_cash":6864.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pta Iliac Art Additional Ipsi","code_information":[{"code":"36100186","type":"CDM"},{"code":"361","type":"RC"},{"code":"37222","type":"HCPCS"}],"standard_charges":[{"gross_charge":15164.0,"discounted_cash":12737.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":11335.0,"discounted_cash":9521.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pta/Atherec Fem-Pop","code_information":[{"code":"36100187","type":"CDM"},{"code":"361","type":"RC"},{"code":"37225","type":"HCPCS"}],"standard_charges":[{"gross_charge":32202.0,"discounted_cash":27049.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":24072.0,"discounted_cash":20220.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pta/St/Ath Fem/Pop","code_information":[{"code":"36100188","type":"CDM"},{"code":"361","type":"RC"},{"code":"37227","type":"HCPCS"}],"standard_charges":[{"gross_charge":55768.0,"discounted_cash":46845.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":41686.0,"discounted_cash":35016.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pta/Ather Tib/Per Initial","code_information":[{"code":"36100189","type":"CDM"},{"code":"361","type":"RC"},{"code":"37229","type":"HCPCS"}],"standard_charges":[{"gross_charge":40915.0,"discounted_cash":34368.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":27295.0,"discounted_cash":22927.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pta/Stent/Ath Tib/Per","code_information":[{"code":"36100190","type":"CDM"},{"code":"361","type":"RC"},{"code":"37231","type":"HCPCS"}],"standard_charges":[{"gross_charge":43731.0,"discounted_cash":36734.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":39666.0,"discounted_cash":33319.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pta/Ath Additional Tib/Peroneal","code_information":[{"code":"36100191","type":"CDM"},{"code":"361","type":"RC"},{"code":"37233","type":"HCPCS"}],"standard_charges":[{"gross_charge":31157.0,"discounted_cash":26171.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":23291.0,"discounted_cash":19564.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pta/Stent Additional Tib","code_information":[{"code":"36100192","type":"CDM"},{"code":"361","type":"RC"},{"code":"37234","type":"HCPCS"}],"standard_charges":[{"gross_charge":19769.0,"discounted_cash":16605.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":13180.0,"discounted_cash":11071.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Open/Perq Place Stent Same","code_information":[{"code":"36100193","type":"CDM"},{"code":"361","type":"RC"},{"code":"37238","type":"HCPCS"}],"standard_charges":[{"gross_charge":66450.0,"discounted_cash":55818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":49673.0,"discounted_cash":41725.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Open/Perq Place Stent Ea Add","code_information":[{"code":"36100194","type":"CDM"},{"code":"361","type":"RC"},{"code":"37239","type":"HCPCS"}],"standard_charges":[{"gross_charge":32135.0,"discounted_cash":26993.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":24022.0,"discounted_cash":20178.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vasc Embolize/Occlude Venous","code_information":[{"code":"36100195","type":"CDM"},{"code":"361","type":"RC"},{"code":"37241","type":"HCPCS"}],"standard_charges":[{"gross_charge":55961.0,"discounted_cash":47007.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":43296.0,"discounted_cash":36368.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Unlisted Procedure Lymph","code_information":[{"code":"36100196","type":"CDM"},{"code":"361","type":"RC"},{"code":"38999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1626.0,"discounted_cash":1365.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1258.0,"discounted_cash":1056.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sc Intro Long Gi Tube","code_information":[{"code":"36100197","type":"CDM"},{"code":"361","type":"RC"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2372.0,"discounted_cash":1992.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1834.0,"discounted_cash":1540.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Rf Ablation Tumor Liver","code_information":[{"code":"36100198","type":"CDM"},{"code":"361","type":"RC"},{"code":"47382","type":"HCPCS"}],"standard_charges":[{"gross_charge":25984.0,"discounted_cash":21826.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":20105.0,"discounted_cash":16888.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biliary Tube Chg Comp","code_information":[{"code":"36100199","type":"CDM"},{"code":"361","type":"RC"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":10400.0,"discounted_cash":8736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8320.0,"discounted_cash":6988.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Needle Biopsy Pancreas","code_information":[{"code":"36100200","type":"CDM"},{"code":"361","type":"RC"},{"code":"48102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1757.0,"discounted_cash":1475.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1800.0,"discounted_cash":1512.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sc Abscess Tube Change","code_information":[{"code":"36100201","type":"CDM"},{"code":"361","type":"RC"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":4847.0,"discounted_cash":4071.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3878.0,"discounted_cash":3257.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Place Duod/Jej Tube Perc","code_information":[{"code":"36100202","type":"CDM"},{"code":"361","type":"RC"},{"code":"49441","type":"HCPCS"}],"standard_charges":[{"gross_charge":5152.0,"discounted_cash":4327.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3434.0,"discounted_cash":2884.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Cecostomy Tube","code_information":[{"code":"36100203","type":"CDM"},{"code":"361","type":"RC"},{"code":"49442","type":"HCPCS"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":3356.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3094.0,"discounted_cash":2598.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Pre-Op Wire Abdomen","code_information":[{"code":"36100204","type":"CDM"},{"code":"361","type":"RC"},{"code":"49999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2491.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2690.0,"discounted_cash":2259.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ureter Stent Remove/Replace","code_information":[{"code":"36100205","type":"CDM"},{"code":"361","type":"RC"},{"code":"50384","type":"HCPCS"}],"standard_charges":[{"gross_charge":6166.0,"discounted_cash":5179.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4772.0,"discounted_cash":4008.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Rf Ablate Tumor Renal","code_information":[{"code":"36100206","type":"CDM"},{"code":"361","type":"RC"},{"code":"50592","type":"HCPCS"}],"standard_charges":[{"gross_charge":32756.0,"discounted_cash":27515.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":25344.0,"discounted_cash":21288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biopsy Of Prostate","code_information":[{"code":"36100207","type":"CDM"},{"code":"361","type":"RC"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":6093.0,"discounted_cash":5118.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4717.0,"discounted_cash":3962.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Nl Cyst Aspiration Spine","code_information":[{"code":"36100208","type":"CDM"},{"code":"361","type":"RC"},{"code":"62268","type":"HCPCS"}],"standard_charges":[{"gross_charge":4184.0,"discounted_cash":3514.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3347.0,"discounted_cash":2811.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Needle Biopsy Spinal Cord","code_information":[{"code":"36100209","type":"CDM"},{"code":"361","type":"RC"},{"code":"62269","type":"HCPCS"}],"standard_charges":[{"gross_charge":3057.0,"discounted_cash":2567.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2365.0,"discounted_cash":1986.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sc Discogram Lumbar","code_information":[{"code":"36100210","type":"CDM"},{"code":"361","type":"RC"},{"code":"62290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2839.0,"discounted_cash":2384.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1987.0,"discounted_cash":1669.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sc Discogram Cerv/Thor","code_information":[{"code":"36100211","type":"CDM"},{"code":"361","type":"RC"},{"code":"62291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1710.0,"discounted_cash":1436.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1325.0,"discounted_cash":1113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fl Myelogram Cervical","code_information":[{"code":"36100212","type":"CDM"},{"code":"361","type":"RC"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":4479.0,"discounted_cash":3762.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3463.0,"discounted_cash":2908.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Facet Inj 2Nd Cerv/Thor","code_information":[{"code":"36100213","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1766.0,"discounted_cash":1483.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1602.0,"discounted_cash":1345.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ct Facet Inj 3Rd Cerv/Thor","code_information":[{"code":"36100214","type":"CDM"},{"code":"361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1262.0,"discounted_cash":1060.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":842.0,"discounted_cash":707.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Clip Placement Soft Tissue Initial","code_information":[{"code":"36100215","type":"CDM"},{"code":"361","type":"RC"},{"code":"10035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2297.0,"discounted_cash":1929.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1776.0,"discounted_cash":1491.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Clip Placement Soft Tissue Addtional","code_information":[{"code":"36100216","type":"CDM"},{"code":"361","type":"RC"},{"code":"10036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1151.0,"discounted_cash":966.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":890.0,"discounted_cash":747.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Conversion Ext Bil Drg Cath","code_information":[{"code":"36100217","type":"CDM"},{"code":"361","type":"RC"},{"code":"47535","type":"HCPCS"}],"standard_charges":[{"gross_charge":10400.0,"discounted_cash":8736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8046.0,"discounted_cash":6758.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Removal Biliary Drg Cath","code_information":[{"code":"36100218","type":"CDM"},{"code":"361","type":"RC"},{"code":"47537","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1938.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1846.0,"discounted_cash":1550.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biliary Stent Each Exist Acc","code_information":[{"code":"36100219","type":"CDM"},{"code":"361","type":"RC"},{"code":"47538","type":"HCPCS"}],"standard_charges":[{"gross_charge":24801.0,"discounted_cash":20832.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":19188.0,"discounted_cash":16117.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biliary Stent New Acc Wo Cath","code_information":[{"code":"36100220","type":"CDM"},{"code":"361","type":"RC"},{"code":"47539","type":"HCPCS"}],"standard_charges":[{"gross_charge":19674.0,"discounted_cash":16526.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":15221.0,"discounted_cash":12785.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biliary Stent New Acc W Cath","code_information":[{"code":"36100221","type":"CDM"},{"code":"361","type":"RC"},{"code":"47540","type":"HCPCS"}],"standard_charges":[{"gross_charge":19674.0,"discounted_cash":16526.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":15221.0,"discounted_cash":12785.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biliary Access To Sm Bw","code_information":[{"code":"36100222","type":"CDM"},{"code":"361","type":"RC"},{"code":"47541","type":"HCPCS"}],"standard_charges":[{"gross_charge":10400.0,"discounted_cash":8736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":8046.0,"discounted_cash":6758.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biliary Duct Dilation","code_information":[{"code":"36100223","type":"CDM"},{"code":"361","type":"RC"},{"code":"47542","type":"HCPCS"}],"standard_charges":[{"gross_charge":6902.0,"discounted_cash":5797.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5340.0,"discounted_cash":4485.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biliary Duct Biopsy","code_information":[{"code":"36100224","type":"CDM"},{"code":"361","type":"RC"},{"code":"47543","type":"HCPCS"}],"standard_charges":[{"gross_charge":7919.0,"discounted_cash":6651.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":6128.0,"discounted_cash":5147.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sclerotx Fluid Collection","code_information":[{"code":"36100225","type":"CDM"},{"code":"361","type":"RC"},{"code":"49185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5672.0,"discounted_cash":4764.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4537.0,"discounted_cash":3811.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Neprostogram New Acc","code_information":[{"code":"36100226","type":"CDM"},{"code":"361","type":"RC"},{"code":"50430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2505.0,"discounted_cash":2104.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1939.0,"discounted_cash":1628.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Nephrostogram","code_information":[{"code":"36100227","type":"CDM"},{"code":"361","type":"RC"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":2505.0,"discounted_cash":2104.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2004.0,"discounted_cash":1683.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Convert Nephrostomy Catheter","code_information":[{"code":"36100228","type":"CDM"},{"code":"361","type":"RC"},{"code":"50434","type":"HCPCS"}],"standard_charges":[{"gross_charge":2505.0,"discounted_cash":2104.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2200.0,"discounted_cash":1848.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Perc Neph Tube Change","code_information":[{"code":"36100229","type":"CDM"},{"code":"361","type":"RC"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":3158.0,"discounted_cash":2652.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2526.0,"discounted_cash":2121.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Endoluminal Bx Urtr Rnl Plvs","code_information":[{"code":"36100230","type":"CDM"},{"code":"361","type":"RC"},{"code":"50606","type":"HCPCS"}],"standard_charges":[{"gross_charge":6902.0,"discounted_cash":5797.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5340.0,"discounted_cash":4485.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ureter Stent Via Exist Acc","code_information":[{"code":"36100231","type":"CDM"},{"code":"361","type":"RC"},{"code":"50693","type":"HCPCS"}],"standard_charges":[{"gross_charge":13512.0,"discounted_cash":11350.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":10809.0,"discounted_cash":9079.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ureter Stent New Acc W/O Cath","code_information":[{"code":"36100232","type":"CDM"},{"code":"361","type":"RC"},{"code":"50694","type":"HCPCS"}],"standard_charges":[{"gross_charge":13512.0,"discounted_cash":11350.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":10454.0,"discounted_cash":8781.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ureter Stent New Acc W Cath","code_information":[{"code":"36100233","type":"CDM"},{"code":"361","type":"RC"},{"code":"50695","type":"HCPCS"}],"standard_charges":[{"gross_charge":13512.0,"discounted_cash":11350.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":10809.0,"discounted_cash":9079.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Balloon Dilate Urtrl Strix","code_information":[{"code":"36100234","type":"CDM"},{"code":"361","type":"RC"},{"code":"50706","type":"HCPCS"}],"standard_charges":[{"gross_charge":6902.0,"discounted_cash":5797.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5340.0,"discounted_cash":4485.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc N Blk Supraclavicular Cont Infuse","code_information":[{"code":"36100235","type":"CDM"},{"code":"361","type":"RC"},{"code":"64416","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Sciatic Cont / Popliteal Infusion","code_information":[{"code":"36100236","type":"CDM"},{"code":"361","type":"RC"},{"code":"64446","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Cont Foramen / Lumbar Plexus","code_information":[{"code":"36100237","type":"CDM"},{"code":"361","type":"RC"},{"code":"64449","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Foramen / Lumbar Plexus Epidural L/S","code_information":[{"code":"36100238","type":"CDM"},{"code":"361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":4595.0,"discounted_cash":3859.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Lmbr/Thor/Paraverebral","code_information":[{"code":"36100239","type":"CDM"},{"code":"361","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2344.0,"discounted_cash":1968.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2344.0,"discounted_cash":1968.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc N Block Inj Ilio-Ing/Hypogi","code_information":[{"code":"36100242","type":"CDM"},{"code":"361","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1611.0,"discounted_cash":1353.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Intercostal","code_information":[{"code":"36100244","type":"CDM"},{"code":"361","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2138.0,"discounted_cash":1795.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Intercostal Cont Infuse","code_information":[{"code":"36100245","type":"CDM"},{"code":"361","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":4102.0,"discounted_cash":3445.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Fascia Iliaca Single","code_information":[{"code":"36100246","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1309.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Adductor Femoral Cont Infuse","code_information":[{"code":"36100247","type":"CDM"},{"code":"361","type":"RC"},{"code":"64448","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Abdomen(Tap)","code_information":[{"code":"36100248","type":"CDM"},{"code":"361","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1309.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Rectus Sheath","code_information":[{"code":"36100249","type":"CDM"},{"code":"361","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1309.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Abdomen (Tap) Cont Infuse","code_information":[{"code":"36100250","type":"CDM"},{"code":"361","type":"RC"},{"code":"64487","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Rectus Sheath Cont Infuse","code_information":[{"code":"36100251","type":"CDM"},{"code":"361","type":"RC"},{"code":"64487","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Bilat (Tap)Abdomen","code_information":[{"code":"36100252","type":"CDM"},{"code":"361","type":"RC"},{"code":"64488","type":"HCPCS"}],"standard_charges":[{"gross_charge":3117.0,"discounted_cash":2618.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Rectus Sheath- Bilat","code_information":[{"code":"36100253","type":"CDM"},{"code":"361","type":"RC"},{"code":"64488","type":"HCPCS"}],"standard_charges":[{"gross_charge":3117.0,"discounted_cash":2618.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Abd Tap Bilat Cont Infuse","code_information":[{"code":"36100254","type":"CDM"},{"code":"361","type":"RC"},{"code":"64489","type":"HCPCS"}],"standard_charges":[{"gross_charge":5960.0,"discounted_cash":5006.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Blk Rect Shth Bilat Cont Infuse","code_information":[{"code":"36100255","type":"CDM"},{"code":"361","type":"RC"},{"code":"64489","type":"HCPCS"}],"standard_charges":[{"gross_charge":5960.0,"discounted_cash":5006.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Adductor","code_information":[{"code":"36100256","type":"CDM"},{"code":"361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1309.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj(S), Anes Agent(S) A/O Steroid; Brachial Plexus","code_information":[{"code":"36100257","type":"CDM"},{"code":"361","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1309.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Interscale, Cont Infuse","code_information":[{"code":"36100258","type":"CDM"},{"code":"361","type":"RC"},{"code":"64416","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Axillary Cont Infuse","code_information":[{"code":"36100259","type":"CDM"},{"code":"361","type":"RC"},{"code":"64416","type":"HCPCS"}],"standard_charges":[{"gross_charge":2980.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Plmt Nephroureteral Catheter","code_information":[{"code":"36100260","type":"CDM"},{"code":"361","type":"RC"},{"code":"50433","type":"HCPCS"}],"standard_charges":[{"gross_charge":8101.0,"discounted_cash":6804.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":6481.0,"discounted_cash":5444.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Endometrial Biopsy","code_information":[{"code":"36100261","type":"CDM"},{"code":"361","type":"RC"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":809.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":746.0,"discounted_cash":626.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dialysis Av Shunt With Angioplasty","code_information":[{"code":"36100262","type":"CDM"},{"code":"361","type":"RC"},{"code":"36902","type":"HCPCS"}],"standard_charges":[{"gross_charge":25538.0,"discounted_cash":21451.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":19154.0,"discounted_cash":16089.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dialysis Av Shunt With Stent","code_information":[{"code":"36100263","type":"CDM"},{"code":"361","type":"RC"},{"code":"36903","type":"HCPCS"}],"standard_charges":[{"gross_charge":51622.0,"discounted_cash":43362.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":38586.0,"discounted_cash":32412.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dialysis Av Shunt Declot","code_information":[{"code":"36100264","type":"CDM"},{"code":"361","type":"RC"},{"code":"36904","type":"HCPCS"}],"standard_charges":[{"gross_charge":25538.0,"discounted_cash":21451.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":19154.0,"discounted_cash":16089.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dialysis Av Shunt Declotwith Angioplasty","code_information":[{"code":"36100265","type":"CDM"},{"code":"361","type":"RC"},{"code":"36905","type":"HCPCS"}],"standard_charges":[{"gross_charge":51622.0,"discounted_cash":43362.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":38717.0,"discounted_cash":32522.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dialysis Av Shunt Declot/Stent","code_information":[{"code":"36100266","type":"CDM"},{"code":"361","type":"RC"},{"code":"36906","type":"HCPCS"}],"standard_charges":[{"gross_charge":78241.0,"discounted_cash":65722.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":58487.0,"discounted_cash":49129.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dialysis Av Central Segment Pta","code_information":[{"code":"36100267","type":"CDM"},{"code":"361","type":"RC"},{"code":"36907","type":"HCPCS"}],"standard_charges":[{"gross_charge":39122.0,"discounted_cash":32862.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":29342.0,"discounted_cash":24647.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dialysis Av Central Segment Stent","code_information":[{"code":"36100268","type":"CDM"},{"code":"361","type":"RC"},{"code":"36908","type":"HCPCS"}],"standard_charges":[{"gross_charge":39122.0,"discounted_cash":32862.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":29245.0,"discounted_cash":24565.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dialysis Av Shunt Embolization","code_information":[{"code":"36100269","type":"CDM"},{"code":"361","type":"RC"},{"code":"36909","type":"HCPCS"}],"standard_charges":[{"gross_charge":39122.0,"discounted_cash":32862.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":29245.0,"discounted_cash":24565.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Percutaneous Angioplasty Initial Artery","code_information":[{"code":"36100270","type":"CDM"},{"code":"361","type":"RC"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":25538.0,"discounted_cash":21451.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":19092.0,"discounted_cash":16037.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Percutaneous Angioplasty Addit Artery","code_information":[{"code":"36100271","type":"CDM"},{"code":"361","type":"RC"},{"code":"37247","type":"HCPCS"}],"standard_charges":[{"gross_charge":12771.0,"discounted_cash":10727.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9547.0,"discounted_cash":8019.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Percutaneous Angioplasty Initial Vein","code_information":[{"code":"36100272","type":"CDM"},{"code":"361","type":"RC"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":25538.0,"discounted_cash":21451.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":19154.0,"discounted_cash":16089.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Percutaneous Angioplasty Additvein","code_information":[{"code":"36100273","type":"CDM"},{"code":"361","type":"RC"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":12771.0,"discounted_cash":10727.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9547.0,"discounted_cash":8019.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/O Img Gdn","code_information":[{"code":"36100274","type":"CDM"},{"code":"361","type":"RC"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":3219.0,"discounted_cash":2703.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3058.0,"discounted_cash":2568.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn","code_information":[{"code":"36100275","type":"CDM"},{"code":"361","type":"RC"},{"code":"62326","type":"HCPCS"}],"standard_charges":[{"gross_charge":3219.0,"discounted_cash":2703.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2919.0,"discounted_cash":2451.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Midline Insertion","code_information":[{"code":"36100276","type":"CDM"},{"code":"361","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":4517.0,"discounted_cash":3794.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3614.0,"discounted_cash":3035.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc  Ir Tunnel Peritoneal Catheter","code_information":[{"code":"36100277","type":"CDM"},{"code":"361","type":"RC"},{"code":"49418","type":"HCPCS"}],"standard_charges":[{"gross_charge":16598.0,"discounted_cash":13942.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":12841.0,"discounted_cash":10786.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Prq Aspir Pulposus/Intervertebral Disc/Pvrt Tiss","code_information":[{"code":"36100278","type":"CDM"},{"code":"361","type":"RC"},{"code":"62267","type":"HCPCS"}],"standard_charges":[{"gross_charge":3124.0,"discounted_cash":2624.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2499.0,"discounted_cash":2099.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Biopsy Salivary Gland Needle","code_information":[{"code":"36100279","type":"CDM"},{"code":"361","type":"RC"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":5672.0,"discounted_cash":4764.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4537.0,"discounted_cash":3811.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Tenotomy Percutaneous Toe Single Tendon","code_information":[{"code":"36100280","type":"CDM"},{"code":"361","type":"RC"},{"code":"28010","type":"HCPCS"}],"standard_charges":[{"gross_charge":6137.0,"discounted_cash":5155.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ct Drain Peritoneal/Retroperitoneal Trans Vaginal Or Rectum","code_information":[{"code":"36100282","type":"CDM"},{"code":"361","type":"RC"},{"code":"49407","type":"HCPCS"}],"standard_charges":[{"gross_charge":6637.0,"discounted_cash":5575.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5133.0,"discounted_cash":4311.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dstrj Neurolytic W/Wo Rad Monitor Celiac Plexus","code_information":[{"code":"36100283","type":"CDM"},{"code":"361","type":"RC"},{"code":"64680","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"discounted_cash":3630.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3343.0,"discounted_cash":2808.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Neg Pressure Wound Therapy Non Dme &Lt;/= 50 Sq Cm","code_information":[{"code":"36100284","type":"CDM"},{"code":"361","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1409.0,"discounted_cash":1183.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Neg Pressure Wound Therapy Non Dme >50 Sq Cm","code_information":[{"code":"36100285","type":"CDM"},{"code":"361","type":"RC"},{"code":"97608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1409.0,"discounted_cash":1183.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Diagnostic Bone Marrow Biopsies & Aspirations","code_information":[{"code":"36100286","type":"CDM"},{"code":"361","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":8915.0,"discounted_cash":7488.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7133.0,"discounted_cash":5991.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":6396.0,"discounted_cash":5372.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Rpr Ctr Vad W/Subq Port/Pmp Ctr/Prph Insj Sit","code_information":[{"code":"36100287","type":"CDM"},{"code":"361","type":"RC"},{"code":"36576","type":"HCPCS"}],"standard_charges":[{"gross_charge":5981.0,"discounted_cash":5024.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4310.0,"discounted_cash":3620.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Remove Int Dwell Ureteral Stent Transurethral","code_information":[{"code":"36100288","type":"CDM"},{"code":"361","type":"RC"},{"code":"50386","type":"HCPCS"}],"standard_charges":[{"gross_charge":8188.0,"discounted_cash":6877.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5852.0,"discounted_cash":4915.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Incision & Removal Foreign Body Subq Tiss Simple","code_information":[{"code":"36100289","type":"CDM"},{"code":"361","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":624.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ct Guided Breast Biopsy","code_information":[{"code":"36100290","type":"CDM"},{"code":"361","type":"RC"},{"code":"19499","type":"HCPCS"}],"standard_charges":[{"gross_charge":12696.0,"discounted_cash":10664.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9491.0,"discounted_cash":7972.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Rplcmt Compl Prph Cvc W/O Subq Port/Pmp","code_information":[{"code":"36100291","type":"CDM"},{"code":"361","type":"RC"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":4472.0,"discounted_cash":3756.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3354.0,"discounted_cash":2817.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fine Needle Aspiration Bx W/O Img Gdn Ea Addl","code_information":[{"code":"36100292","type":"CDM"},{"code":"361","type":"RC"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1189.0,"discounted_cash":998.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":888.0,"discounted_cash":745.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fine Needle Aspiration Bx W/Us Gdn 1St Lesion","code_information":[{"code":"36100293","type":"CDM"},{"code":"361","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":3380.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2536.0,"discounted_cash":2130.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Fine Needle Aspiration Bx W/Us Gdn Ea Addl","code_information":[{"code":"36100294","type":"CDM"},{"code":"361","type":"RC"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":2164.0,"discounted_cash":1817.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1623.0,"discounted_cash":1363.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fine Needle Aspiration Bx W/Fluor Gdn 1St Lesion","code_information":[{"code":"36100295","type":"CDM"},{"code":"361","type":"RC"},{"code":"10007","type":"HCPCS"}],"standard_charges":[{"gross_charge":3380.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2536.0,"discounted_cash":2130.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fine Needle Aspiration Bx W/Fluor Gdn Ea Addl","code_information":[{"code":"36100296","type":"CDM"},{"code":"361","type":"RC"},{"code":"10008","type":"HCPCS"}],"standard_charges":[{"gross_charge":3380.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2536.0,"discounted_cash":2130.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fine Needle Aspiration Bx W/Ct Gdn 1St Lesion","code_information":[{"code":"36100297","type":"CDM"},{"code":"361","type":"RC"},{"code":"10009","type":"HCPCS"}],"standard_charges":[{"gross_charge":3380.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2536.0,"discounted_cash":2130.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fine Needle Aspiration Bx W/Ct Gdn Ea Addl","code_information":[{"code":"36100298","type":"CDM"},{"code":"361","type":"RC"},{"code":"10010","type":"HCPCS"}],"standard_charges":[{"gross_charge":3380.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2529.0,"discounted_cash":2124.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fine Needle Aspiration Bx W/Mr Gdn 1St Lesion","code_information":[{"code":"36100299","type":"CDM"},{"code":"361","type":"RC"},{"code":"10011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3380.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2529.0,"discounted_cash":2124.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fine Needle Aspiration Bx W/Mr Gdn Ea Addl","code_information":[{"code":"36100300","type":"CDM"},{"code":"361","type":"RC"},{"code":"10012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2199.0,"discounted_cash":1847.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1642.0,"discounted_cash":1379.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Njx Px Cntrst Kne Arthg Cntrst Enhncd Ct/Mri Kne","code_information":[{"code":"36100301","type":"CDM"},{"code":"361","type":"RC"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":530.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":442.0,"discounted_cash":371.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Perq Dilation Xst Trc Endourologic Px W/Img","code_information":[{"code":"36100302","type":"CDM"},{"code":"361","type":"RC"},{"code":"50436","type":"HCPCS"}],"standard_charges":[{"gross_charge":9663.0,"discounted_cash":8116.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7224.0,"discounted_cash":6068.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Perq Dilation Xst Trc New Access Renal Coltj Sys","code_information":[{"code":"36100303","type":"CDM"},{"code":"361","type":"RC"},{"code":"50437","type":"HCPCS"}],"standard_charges":[{"gross_charge":16259.0,"discounted_cash":13657.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":12155.0,"discounted_cash":10210.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Tangential Biopsy Skin Single Lesion","code_information":[{"code":"36100304","type":"CDM"},{"code":"361","type":"RC"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":753.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tangential Biopsy Skin Ea Sep/Additional Lesion","code_information":[{"code":"36100305","type":"CDM"},{"code":"361","type":"RC"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":374.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Punch Biopsy Skin Single Lesion","code_information":[{"code":"36100306","type":"CDM"},{"code":"361","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":753.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Punch Biopsy Skin Ea Sep/Additional Lesion","code_information":[{"code":"36100307","type":"CDM"},{"code":"361","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":374.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Incisional Biopsy Skin Single Lesion","code_information":[{"code":"36100308","type":"CDM"},{"code":"361","type":"RC"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":1594.0,"discounted_cash":1338.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Incisional Biopsy Skin Ea Sep/Additional Lesion","code_information":[{"code":"36100309","type":"CDM"},{"code":"361","type":"RC"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":926.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Picc W/Rs&I < 5 Yr","code_information":[{"code":"36100310","type":"CDM"},{"code":"361","type":"RC"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":3619.0,"discounted_cash":3039.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2714.0,"discounted_cash":2279.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Insertion Picc W/Rs&I 5 Yr/>","code_information":[{"code":"36100311","type":"CDM"},{"code":"361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":6383.0,"discounted_cash":5361.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4787.0,"discounted_cash":4021.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection Procedure Lymphangiography","code_information":[{"code":"36100312","type":"CDM"},{"code":"361","type":"RC"},{"code":"38790","type":"HCPCS"}],"standard_charges":[{"gross_charge":2314.0,"discounted_cash":1943.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1730.0,"discounted_cash":1453.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Njx Anes Stellate Ganglion Crv Sympathetic","code_information":[{"code":"36100313","type":"CDM"},{"code":"361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":4464.0,"discounted_cash":3749.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3335.0,"discounted_cash":2801.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Rmvl & Rplcmt Intly Dwelling Ureteral Stent Prq","code_information":[{"code":"36100314","type":"CDM"},{"code":"361","type":"RC"},{"code":"50382","type":"HCPCS"}],"standard_charges":[{"gross_charge":10151.0,"discounted_cash":8526.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7613.0,"discounted_cash":6394.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Drs&/Dbrdmt Prtl-Thkns Burns 1St/Sbsq Medium","code_information":[{"code":"36100315","type":"CDM"},{"code":"361","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.0,"discounted_cash":1045.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closure Intestinal Cutaneous Fistula","code_information":[{"code":"36100316","type":"CDM"},{"code":"361","type":"RC"},{"code":"44640","type":"HCPCS"}],"standard_charges":[{"gross_charge":6297.0,"discounted_cash":5289.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Foramen Epidural Add-On","code_information":[{"code":"36100317","type":"CDM"},{"code":"361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":2197.0,"discounted_cash":1845.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1992.0,"discounted_cash":1673.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc  Grafix Stravix Prime Pl Sqcm","code_information":[{"code":"36100318","type":"CDM"},{"code":"361","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":2603.12,"discounted_cash":2186.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Nushield 1 Square Cm","code_information":[{"code":"36100319","type":"CDM"},{"code":"361","type":"RC"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3421.6,"discounted_cash":2874.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Foramen Epidural Add-On","code_information":[{"code":"36100320","type":"CDM"},{"code":"361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":6649.0,"discounted_cash":5585.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2111.0,"discounted_cash":1773.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 3+ Level","code_information":[{"code":"36100321","type":"CDM"},{"code":"361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":6455.0,"discounted_cash":5422.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5854.0,"discounted_cash":4917.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Evasc Rpr Dplmnt Aorto-Aortic Ndgft","code_information":[{"code":"36100401","type":"CDM"},{"code":"361","type":"RC"},{"code":"34701","type":"HCPCS"}],"standard_charges":[{"gross_charge":18083.0,"discounted_cash":15189.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Biopsy Pleura Percutaneous Needle","code_information":[{"code":"36100402","type":"CDM"},{"code":"361","type":"RC"},{"code":"32400","type":"HCPCS"}],"standard_charges":[{"gross_charge":4148.0,"discounted_cash":3484.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3762.0,"discounted_cash":3160.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc N Block Inj Cervical Plexus","code_information":[{"code":"36100404","type":"CDM"},{"code":"361","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":356.0,"discounted_cash":299.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Change Cystostomy Tube","code_information":[{"code":"36100410","type":"CDM"},{"code":"361","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":430.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":486.0,"discounted_cash":408.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Diagnostic Lumbar Spinal Puncture W/Fluor Or Ct","code_information":[{"code":"36100411","type":"CDM"},{"code":"361","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":3993.0,"discounted_cash":3354.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3195.0,"discounted_cash":2683.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection Aa&/Strd Greater Occipital Nerve","code_information":[{"code":"36100412","type":"CDM"},{"code":"361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1435.0,"discounted_cash":1205.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove & Replace Indwell Ureteral Stent Trurthrl","code_information":[{"code":"36100413","type":"CDM"},{"code":"361","type":"RC"},{"code":"50385","type":"HCPCS"}],"standard_charges":[{"gross_charge":8984.0,"discounted_cash":7546.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7187.0,"discounted_cash":6037.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ir Transcerv Fallopian Tube Cath W/Wo Hystosalping","code_information":[{"code":"36100414","type":"CDM"},{"code":"361","type":"RC"},{"code":"58345","type":"HCPCS"}],"standard_charges":[{"gross_charge":15969.0,"discounted_cash":13413.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":12356.0,"discounted_cash":10379.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ir Transcervical Cathj Fallopian Tube Rs&I","code_information":[{"code":"36100415","type":"CDM"},{"code":"361","type":"RC"},{"code":"74742","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":174.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Debridement Nail Any Method 1-5","code_information":[{"code":"36100416","type":"CDM"},{"code":"361","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":257.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":132.0,"discounted_cash":110.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Drs&/Dbrdmt Prtl-Thkns Burns 1St/Sbsq Large","code_information":[{"code":"36100418","type":"CDM"},{"code":"361","type":"RC"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1109.0,"discounted_cash":931.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Intrauterine Device Iud (Us)","code_information":[{"code":"36100419","type":"CDM"},{"code":"361","type":"RC"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":4498.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4857.0,"discounted_cash":4079.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Core Needle Bx Lung/Mediastinum Perq W/Img","code_information":[{"code":"36100420","type":"CDM"},{"code":"361","type":"RC"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":7435.0,"discounted_cash":6245.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5948.0,"discounted_cash":4996.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Low Cost Skin Substitute App","code_information":[{"code":"36100421","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5277","type":"HCPCS"}],"standard_charges":[{"gross_charge":2728.0,"discounted_cash":2291.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Low Cost Skin Substitute App","code_information":[{"code":"36100422","type":"CDM"},{"code":"361","type":"RC"},{"code":"C5278","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":423.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Injection Anes Superior Hypogastric Plexus","code_information":[{"code":"36100423","type":"CDM"},{"code":"361","type":"RC"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":4279.0,"discounted_cash":3594.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3239.0,"discounted_cash":2720.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulation Thoracic","code_information":[{"code":"36100424","type":"CDM"},{"code":"361","type":"RC"},{"code":"22513","type":"HCPCS"}],"standard_charges":[{"gross_charge":25856.0,"discounted_cash":21719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":19566.0,"discounted_cash":16435.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulj Lmbr","code_information":[{"code":"36100425","type":"CDM"},{"code":"361","type":"RC"},{"code":"22514","type":"HCPCS"}],"standard_charges":[{"gross_charge":25856.0,"discounted_cash":21719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":19566.0,"discounted_cash":16435.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc  Perq Vert Agmntj Cavity Crtj Uni/Bi Cannulj Each Additional","code_information":[{"code":"36100426","type":"CDM"},{"code":"361","type":"RC"},{"code":"22515","type":"HCPCS"}],"standard_charges":[{"gross_charge":6705.0,"discounted_cash":5632.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4694.0,"discounted_cash":3942.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc  Chemotx Admn Cns Req Spinal Puncture","code_information":[{"code":"36100427","type":"CDM"},{"code":"331","type":"RC"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1282.0,"discounted_cash":1076.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":970.0,"discounted_cash":814.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc  Aspiration Bladder Insert Suprapubic Catheter","code_information":[{"code":"36100428","type":"CDM"},{"code":"361","type":"RC"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":7731.0,"discounted_cash":6494.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7344.0,"discounted_cash":6168.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc  Biopsy Bone Open Superficial","code_information":[{"code":"36100429","type":"CDM"},{"code":"361","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":10684.0,"discounted_cash":8974.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perq Sac Agmntj Uni W/Wo Balo/Mchnl Dev 1/> Ndl","code_information":[{"code":"36100430","type":"CDM"},{"code":"361","type":"RC"},{"code":"0200T","type":"HCPCS"}],"standard_charges":[{"gross_charge":28245.0,"discounted_cash":23725.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perq Sac Agmntj Bi W/Wo Balo/Mchnl Dev 2/> Ndls","code_information":[{"code":"36100431","type":"CDM"},{"code":"361","type":"RC"},{"code":"0201T","type":"HCPCS"}],"standard_charges":[{"gross_charge":28245.0,"discounted_cash":23725.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Exc Lesion Tendon Sheath/Capsule W/Synvct Foot","code_information":[{"code":"36100432","type":"CDM"},{"code":"361","type":"RC"},{"code":"28090","type":"HCPCS"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":5274.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Puncture Aspiration Abscess Hematoma Bulla/Cyst","code_information":[{"code":"36100433","type":"CDM"},{"code":"361","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":5273.0,"discounted_cash":4429.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4219.0,"discounted_cash":3543.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Incision & Drainage Leg/Ankle Abscess/Hematoma","code_information":[{"code":"36100434","type":"CDM"},{"code":"361","type":"RC"},{"code":"27603","type":"HCPCS"}],"standard_charges":[{"gross_charge":10749.0,"discounted_cash":9029.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":6102.0,"discounted_cash":5125.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Back Les Sc < 3 Cm","code_information":[{"code":"36100435","type":"CDM"},{"code":"361","type":"RC"},{"code":"21930","type":"HCPCS"}],"standard_charges":[{"gross_charge":6074.0,"discounted_cash":5102.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Transcath Stent Cca W/Eps","code_information":[{"code":"36100436","type":"CDM"},{"code":"361","type":"RC"},{"code":"37215","type":"HCPCS"}],"standard_charges":[{"gross_charge":12949.0,"discounted_cash":10877.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Secondary Closure Surg Wound/Dehsn Extsv/Complic","code_information":[{"code":"36100437","type":"CDM"},{"code":"361","type":"RC"},{"code":"13160","type":"HCPCS"}],"standard_charges":[{"gross_charge":7394.0,"discounted_cash":6210.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3916.0,"discounted_cash":3289.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Injx Anes Celiac Plexus W/Wo Radiologic Monitrng","code_information":[{"code":"36100438","type":"CDM"},{"code":"361","type":"RC"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":3554.0,"discounted_cash":2985.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Incision Lingual Frenum Frenotomy","code_information":[{"code":"36100439","type":"CDM"},{"code":"361","type":"RC"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":5841.0,"discounted_cash":4906.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx Superficial Wound Dehiscence Simple Closure","code_information":[{"code":"36100440","type":"CDM"},{"code":"361","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2262.0,"discounted_cash":1900.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1349.0,"discounted_cash":1133.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Excision Tumor Soft Tis Foot/Toe Subq 1.5 Cm/>","code_information":[{"code":"36100441","type":"CDM"},{"code":"361","type":"RC"},{"code":"28039","type":"HCPCS"}],"standard_charges":[{"gross_charge":10237.0,"discounted_cash":8599.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Of  Breast Catheter (Unlst Proc Breast)","code_information":[{"code":"36100442","type":"CDM"},{"code":"361","type":"RC"},{"code":"19499","type":"HCPCS"}],"standard_charges":[{"gross_charge":6615.0,"discounted_cash":5556.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tenotomy Open Extensor Foot/Toe Each Tendon","code_information":[{"code":"36100443","type":"CDM"},{"code":"361","type":"RC"},{"code":"28234","type":"HCPCS"}],"standard_charges":[{"gross_charge":6124.0,"discounted_cash":5144.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Release Of Foot Contracture","code_information":[{"code":"36100444","type":"CDM"},{"code":"361","type":"RC"},{"code":"28270","type":"HCPCS"}],"standard_charges":[{"gross_charge":12709.0,"discounted_cash":10675.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Implant Deep","code_information":[{"code":"36100445","type":"CDM"},{"code":"361","type":"RC"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":11029.0,"discounted_cash":9264.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Unlisted Procedure Vascular Surgery","code_information":[{"code":"36100446","type":"CDM"},{"code":"361","type":"RC"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2352.0,"discounted_cash":1975.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1529.0,"discounted_cash":1284.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Partial Removal Foot Fascia","code_information":[{"code":"36100447","type":"CDM"},{"code":"361","type":"RC"},{"code":"28060","type":"HCPCS"}],"standard_charges":[{"gross_charge":12709.0,"discounted_cash":10675.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mastotomy W/Exploration/Drainage Abscess Deep","code_information":[{"code":"36100448","type":"CDM"},{"code":"361","type":"RC"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6399.0,"discounted_cash":5375.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Laryngoscopy Flexible Diagnostic","code_information":[{"code":"36100449","type":"CDM"},{"code":"361","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":624.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx Opn Tendon Flexor Foot Single/Mult Tendon Spx","code_information":[{"code":"36100450","type":"CDM"},{"code":"361","type":"RC"},{"code":"28230","type":"HCPCS"}],"standard_charges":[{"gross_charge":6342.0,"discounted_cash":5327.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther Injection Carp Tunnel","code_information":[{"code":"36120000","type":"CDM"},{"code":"361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Removal Implant Superficial","code_information":[{"code":"36120002","type":"CDM"},{"code":"361","type":"RC"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Tr-Ext B9+Marg 1.1-2 Cm","code_information":[{"code":"36120003","type":"CDM"},{"code":"361","type":"RC"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Njx Sclrsnt Mlt Incmptnt Vn","code_information":[{"code":"36120004","type":"CDM"},{"code":"361","type":"RC"},{"code":"36471","type":"HCPCS"}],"standard_charges":[{"gross_charge":856.15,"discounted_cash":719.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Tr-Ext B9+Marg 2.1-3Cm","code_information":[{"code":"36120005","type":"CDM"},{"code":"361","type":"RC"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Tr-Ext B9+Marg 0.6-1 Cm","code_information":[{"code":"36120006","type":"CDM"},{"code":"361","type":"RC"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Tr-Ext B9+Marg 0.5 Cm<","code_information":[{"code":"36120007","type":"CDM"},{"code":"361","type":"RC"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc H-F-Nk-Sp B9+Marg 0.5/<","code_information":[{"code":"36120008","type":"CDM"},{"code":"361","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Apply Short Leg Cast","code_information":[{"code":"36120009","type":"CDM"},{"code":"361","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":484.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Tr-Ext B9+Marg 3.1-4 Cm","code_information":[{"code":"36120010","type":"CDM"},{"code":"361","type":"RC"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc H-F-Nk-Sp B9+Marg 1.1-2","code_information":[{"code":"36120011","type":"CDM"},{"code":"361","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Application Of Long Arm Cast","code_information":[{"code":"36120012","type":"CDM"},{"code":"361","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":484.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Release Palm Contracture","code_information":[{"code":"36120013","type":"CDM"},{"code":"361","type":"RC"},{"code":"26040","type":"HCPCS"}],"standard_charges":[{"gross_charge":3452.0,"discounted_cash":2899.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Treatment Of Thigh Fracture","code_information":[{"code":"36120014","type":"CDM"},{"code":"361","type":"RC"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Treatment Of Fibula Fracture","code_information":[{"code":"36120015","type":"CDM"},{"code":"361","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":744.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Treat Wrist Bone Fracture","code_information":[{"code":"36120016","type":"CDM"},{"code":"361","type":"RC"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc H-F-Nk-Sp B9+Marg 2.1-3","code_information":[{"code":"36120017","type":"CDM"},{"code":"361","type":"RC"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Clsd Tx Pelvic Ring Fx","code_information":[{"code":"36120018","type":"CDM"},{"code":"361","type":"RC"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Manipulat Palm Cord Post Inj","code_information":[{"code":"36120019","type":"CDM"},{"code":"361","type":"RC"},{"code":"26341","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Back Tum Deep < 5 Cm","code_information":[{"code":"36120020","type":"CDM"},{"code":"361","type":"RC"},{"code":"21932","type":"HCPCS"}],"standard_charges":[{"gross_charge":5809.0,"discounted_cash":4879.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Removal Of Breast Lesion","code_information":[{"code":"36120021","type":"CDM"},{"code":"361","type":"RC"},{"code":"19120","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":6876.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Repair Finger Tendon","code_information":[{"code":"36120022","type":"CDM"},{"code":"361","type":"RC"},{"code":"26432","type":"HCPCS"}],"standard_charges":[{"gross_charge":3452.0,"discounted_cash":2899.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Arm/Elbow Les Sc < 3 Cm","code_information":[{"code":"36120023","type":"CDM"},{"code":"361","type":"RC"},{"code":"24075","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Neck Les Sc 3 Cm/>","code_information":[{"code":"36120024","type":"CDM"},{"code":"361","type":"RC"},{"code":"21552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6102.0,"discounted_cash":5125.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc F/E/E/N/L Mal+Mrg 0.6-1","code_information":[{"code":"36120025","type":"CDM"},{"code":"361","type":"RC"},{"code":"11641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc H-F-Nk-Sp B9+Marg 3.1-4","code_information":[{"code":"36120026","type":"CDM"},{"code":"361","type":"RC"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Removal Of Foreign Body","code_information":[{"code":"36120027","type":"CDM"},{"code":"361","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":4570.0,"discounted_cash":3838.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Face-Mm B9+Marg 1.1-2 Cm","code_information":[{"code":"36120028","type":"CDM"},{"code":"361","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc H-F-Nk-Sp B9+Marg 0.6-1","code_information":[{"code":"36120029","type":"CDM"},{"code":"361","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Face-Mm B9+Marg 0.5 Cm/<","code_information":[{"code":"36120030","type":"CDM"},{"code":"361","type":"RC"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Endovenous Laser 1St Vein","code_information":[{"code":"36120031","type":"CDM"},{"code":"361","type":"RC"},{"code":"36478","type":"HCPCS"}],"standard_charges":[{"gross_charge":6517.0,"discounted_cash":5474.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Deb Skin Bone At Fx Site","code_information":[{"code":"36120032","type":"CDM"},{"code":"361","type":"RC"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":6102.0,"discounted_cash":5125.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Decompression Of Thigh/Knee","code_information":[{"code":"36120033","type":"CDM"},{"code":"361","type":"RC"},{"code":"27498","type":"HCPCS"}],"standard_charges":[{"gross_charge":3286.0,"discounted_cash":2760.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Remove Pilonidal Cyst Exten","code_information":[{"code":"36120034","type":"CDM"},{"code":"361","type":"RC"},{"code":"11771","type":"HCPCS"}],"standard_charges":[{"gross_charge":6102.0,"discounted_cash":5125.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Ex Arm/Elbow Tum Deep < 5 Cm","code_information":[{"code":"36120035","type":"CDM"},{"code":"361","type":"RC"},{"code":"24076","type":"HCPCS"}],"standard_charges":[{"gross_charge":6102.0,"discounted_cash":5125.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Face Tum Deep 2 Cm/>","code_information":[{"code":"36120036","type":"CDM"},{"code":"361","type":"RC"},{"code":"21014","type":"HCPCS"}],"standard_charges":[{"gross_charge":6102.0,"discounted_cash":5125.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Back Les Sc 3 Cm/>","code_information":[{"code":"36120037","type":"CDM"},{"code":"361","type":"RC"},{"code":"21931","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Treat Thigh Fracture","code_information":[{"code":"36120038","type":"CDM"},{"code":"361","type":"RC"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Thigh/Knee Les Sc < 3 Cm","code_information":[{"code":"36120039","type":"CDM"},{"code":"361","type":"RC"},{"code":"27327","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Abd Les Sc 3 Cm/>","code_information":[{"code":"36120040","type":"CDM"},{"code":"361","type":"RC"},{"code":"22903","type":"HCPCS"}],"standard_charges":[{"gross_charge":6102.0,"discounted_cash":5125.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Treat Thigh Fracture","code_information":[{"code":"36120041","type":"CDM"},{"code":"361","type":"RC"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Skn Hdrdnt Ing Smpl/Ntrm","code_information":[{"code":"36120042","type":"CDM"},{"code":"361","type":"RC"},{"code":"11462","type":"HCPCS"}],"standard_charges":[{"gross_charge":6102.0,"discounted_cash":5125.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Removal Of Implant From Hand","code_information":[{"code":"36120043","type":"CDM"},{"code":"361","type":"RC"},{"code":"26320","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Face Les Sc <2 Cm","code_information":[{"code":"36120044","type":"CDM"},{"code":"361","type":"RC"},{"code":"21011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Biopsy/Removal Lymph Nodes","code_information":[{"code":"36120045","type":"CDM"},{"code":"361","type":"RC"},{"code":"38500","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":6876.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Tr-Ext B9+Marg >4.0 Cm","code_information":[{"code":"36120046","type":"CDM"},{"code":"361","type":"RC"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Tr-Ext Mal+Marg 2.1-3 Cm","code_information":[{"code":"36120047","type":"CDM"},{"code":"361","type":"RC"},{"code":"11603","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc F/E/E/N/L Mal+Mrg 1.1-2","code_information":[{"code":"36120048","type":"CDM"},{"code":"361","type":"RC"},{"code":"11642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Tr-Ext Mal+Marg 1.1-2 Cm","code_information":[{"code":"36120049","type":"CDM"},{"code":"361","type":"RC"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Biopsy Of Tongue","code_information":[{"code":"36120050","type":"CDM"},{"code":"361","type":"RC"},{"code":"41100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1182.0,"discounted_cash":992.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Bx Breast Percut W/O Image","code_information":[{"code":"36120051","type":"CDM"},{"code":"361","type":"RC"},{"code":"19100","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Application Of Long Leg Cast","code_information":[{"code":"36120052","type":"CDM"},{"code":"361","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":484.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Destruct B9 Lesion 1-14","code_information":[{"code":"36120053","type":"CDM"},{"code":"361","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Inj Dupuytren Cord W/Enzyme","code_information":[{"code":"36120054","type":"CDM"},{"code":"361","type":"RC"},{"code":"20527","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Inject Skin Lesions </W 7","code_information":[{"code":"36120055","type":"CDM"},{"code":"361","type":"RC"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Rmvl Ndwellg Tunneled Pleural Catheter W/Cuff","code_information":[{"code":"36120056","type":"CDM"},{"code":"361","type":"RC"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":1133.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Excision Malignant Lesion F/E/E/N/L 2.1-3.0 Cm","code_information":[{"code":"36120057","type":"CDM"},{"code":"361","type":"RC"},{"code":"11643","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Excision Malignant Lesion F/E/E/N/L 3.1-4.0 Cm","code_information":[{"code":"36120058","type":"CDM"},{"code":"361","type":"RC"},{"code":"11644","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Excision Malignant Lesion S/N/H/F/G 3.1-4.0 Cm","code_information":[{"code":"36120059","type":"CDM"},{"code":"361","type":"RC"},{"code":"11624","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Nasopharyngoscopy W/Endoscope Spx","code_information":[{"code":"36120060","type":"CDM"},{"code":"361","type":"RC"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.0,"discounted_cash":509.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":405.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Excision Malignant Lesion Trunk/Arm/Leg > 4.0 Cm","code_information":[{"code":"36120061","type":"CDM"},{"code":"361","type":"RC"},{"code":"11606","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Cltx Tibial Shaft Fx W/O Manipulation","code_information":[{"code":"36120062","type":"CDM"},{"code":"361","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Cltx Sprcndylr/Trnscndylr Fem Fx W/O Manj","code_information":[{"code":"36120063","type":"CDM"},{"code":"361","type":"RC"},{"code":"27501","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":404.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 0.6-1.0Cm","code_information":[{"code":"36120065","type":"CDM"},{"code":"361","type":"RC"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Chemodervate Facial/Trigem/Cerv Musc Migraine","code_information":[{"code":"36120066","type":"CDM"},{"code":"361","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":890.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Cltx Acetabulum Hip/Sockt Fx W/O Manj","code_information":[{"code":"36120067","type":"CDM"},{"code":"361","type":"RC"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":404.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 2.1-3.0Cm","code_information":[{"code":"36120068","type":"CDM"},{"code":"361","type":"RC"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Tumor Soft Tiss Forearm And/Wrist Subq 3Cm/>","code_information":[{"code":"36120069","type":"CDM"},{"code":"361","type":"RC"},{"code":"25071","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Njx Aa&/Strd Plantar Common Digital Nerves","code_information":[{"code":"36120070","type":"CDM"},{"code":"361","type":"RC"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G > 4.0Cm","code_information":[{"code":"36120071","type":"CDM"},{"code":"361","type":"RC"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":7629.0,"discounted_cash":6408.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc \tExc Tumor Soft Tiss Neck/Thorax Subfascial <5Cm","code_information":[{"code":"36120072","type":"CDM"},{"code":"361","type":"RC"},{"code":"21556","type":"HCPCS"}],"standard_charges":[{"gross_charge":7629.0,"discounted_cash":6408.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Tracheostomy Planned Separate Procedure","code_information":[{"code":"36120073","type":"CDM"},{"code":"361","type":"RC"},{"code":"31600","type":"HCPCS"}],"standard_charges":[{"gross_charge":12074.0,"discounted_cash":10142.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drainage Of Forearm Lesion","code_information":[{"code":"36120074","type":"CDM"},{"code":"361","type":"RC"},{"code":"25028","type":"HCPCS"}],"standard_charges":[{"gross_charge":7251.0,"discounted_cash":6090.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Cltx Ulnar Styloid Fracture","code_information":[{"code":"36120075","type":"CDM"},{"code":"361","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":450.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Neck Les Sc < 3 Cm","code_information":[{"code":"36120076","type":"CDM"},{"code":"361","type":"RC"},{"code":"21555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3621.0,"discounted_cash":3041.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Abd Les Sc < 3 Cm","code_information":[{"code":"36120077","type":"CDM"},{"code":"361","type":"RC"},{"code":"22902","type":"HCPCS"}],"standard_charges":[{"gross_charge":3621.0,"discounted_cash":3041.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc S/N/H/F/G Mal+Mrg 1.1-2","code_information":[{"code":"36120078","type":"CDM"},{"code":"361","type":"RC"},{"code":"11622","type":"HCPCS"}],"standard_charges":[{"gross_charge":1573.0,"discounted_cash":1321.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc ?Exc Forearm Les Sc < 3 Cm","code_information":[{"code":"36120079","type":"CDM"},{"code":"361","type":"RC"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":3621.0,"discounted_cash":3041.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Face Tum Deep < 2 Cm","code_information":[{"code":"36120080","type":"CDM"},{"code":"361","type":"RC"},{"code":"21013","type":"HCPCS"}],"standard_charges":[{"gross_charge":3621.0,"discounted_cash":3041.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Face-Mm B9+Marg 3.1-4 Cm","code_information":[{"code":"36120081","type":"CDM"},{"code":"361","type":"RC"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":3621.0,"discounted_cash":3041.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Neck Tum Deep 5 Cm/>","code_information":[{"code":"36120082","type":"CDM"},{"code":"361","type":"RC"},{"code":"21554","type":"HCPCS"}],"standard_charges":[{"gross_charge":6089.0,"discounted_cash":5114.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Arm/Elbow Les Sc 3 Cm/>","code_information":[{"code":"36120083","type":"CDM"},{"code":"361","type":"RC"},{"code":"24071","type":"HCPCS"}],"standard_charges":[{"gross_charge":6396.0,"discounted_cash":5372.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Tis Trnfr S/A/L 10.1-30 Sqcm","code_information":[{"code":"36120084","type":"CDM"},{"code":"361","type":"RC"},{"code":"14021","type":"HCPCS"}],"standard_charges":[{"gross_charge":3892.0,"discounted_cash":3269.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc I&D Upr A/E Dp Absc/Hmtma","code_information":[{"code":"36120085","type":"CDM"},{"code":"361","type":"RC"},{"code":"23930","type":"HCPCS"}],"standard_charges":[{"gross_charge":6396.0,"discounted_cash":5372.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Cltx Prx Hmrl Fx Mnpj+-Tract","code_information":[{"code":"36120086","type":"CDM"},{"code":"361","type":"RC"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3577.0,"discounted_cash":3004.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Treatment Of Thigh Fracture","code_information":[{"code":"36120087","type":"CDM"},{"code":"361","type":"RC"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.0,"discounted_cash":2860.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Insert Pessary/Other Device","code_information":[{"code":"36120088","type":"CDM"},{"code":"361","type":"RC"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.0,"discounted_cash":661.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intro Needle/Intracath Aortic Translumbar","code_information":[{"code":"36120089","type":"CDM"},{"code":"361","type":"RC"},{"code":"36160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3199.0,"discounted_cash":2687.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Treat Thigh Fracture","code_information":[{"code":"36120090","type":"CDM"},{"code":"361","type":"RC"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":3577.0,"discounted_cash":3004.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Exc Shoulder Tum Deep 5 Cm/>","code_information":[{"code":"36120091","type":"CDM"},{"code":"361","type":"RC"},{"code":"23073","type":"HCPCS"}],"standard_charges":[{"gross_charge":6089.0,"discounted_cash":5114.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Csf Shunt Reprogram","code_information":[{"code":"36120092","type":"CDM"},{"code":"361","type":"RC"},{"code":"62252","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":535.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Cardiac Anesthesia Per Min","code_information":[{"code":"37000000","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc General Anesthesia Per Min","code_information":[{"code":"37000001","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Major General Anesthesia Per Min","code_information":[{"code":"37000002","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Regional Anesthesia Per Min","code_information":[{"code":"37000003","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sedation Anesthesia Per Min","code_information":[{"code":"37000004","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Foramen Epidural; Lumbar Or Sacral Add-On","code_information":[{"code":"37100000","type":"CDM"},{"code":"371","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":2197.0,"discounted_cash":1845.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Arc Rare Unit Import - Chrg Only","code_information":[{"code":"39000000","type":"CDM"},{"code":"390","type":"RC"}],"standard_charges":[{"gross_charge":4065.0,"discounted_cash":3414.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Blood Split Unit","code_information":[{"code":"39000001","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":299.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cryoprecipitate Each Unit","code_information":[{"code":"39000002","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":192.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Leukocytes Reduced","code_information":[{"code":"39000003","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":569.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Plasma 1 Donor Frz W/In 8 Hr","code_information":[{"code":"39000004","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Platelet Pheres Leukoreduced","code_information":[{"code":"39000005","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":1480.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Plate Pheres Leukoredu Irrad","code_information":[{"code":"39000006","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":2360.0,"discounted_cash":1982.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rbc Leukoreduced Irradiated","code_information":[{"code":"39000007","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":829.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Platelets, Hla-M, L/R, Unit","code_information":[{"code":"39000008","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9052","type":"HCPCS"}],"standard_charges":[{"gross_charge":3534.0,"discounted_cash":2968.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Plasma, Frz Between 8-24Hour","code_information":[{"code":"39000009","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Platelets Pheresis Path Redu","code_information":[{"code":"39000010","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":2366.0,"discounted_cash":1987.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Administration Of Blood","code_information":[{"code":"39100000","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1093.55,"discounted_cash":918.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mammo Diagnostic Bilateral","code_information":[{"code":"40100002","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":811.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":788.0,"discounted_cash":661.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mammo Diagnostic Unilateral","code_information":[{"code":"40100004","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":657.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":626.0,"discounted_cash":525.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Diagnostic Breast Tomosynthesis Unilateral","code_information":[{"code":"40100006","type":"CDM"},{"code":"401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Diagnostic Breast Tomosynthesis Bilateral","code_information":[{"code":"40100007","type":"CDM"},{"code":"401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mammary Ductogram Or Galactogram Single","code_information":[{"code":"40100008","type":"CDM"},{"code":"401","type":"RC"},{"code":"77053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1014.0,"discounted_cash":851.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":784.0,"discounted_cash":658.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mammary Ductogram Or Galactogram Multiple","code_information":[{"code":"40100009","type":"CDM"},{"code":"401","type":"RC"},{"code":"77054","type":"HCPCS"}],"standard_charges":[{"gross_charge":1014.0,"discounted_cash":851.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":784.0,"discounted_cash":658.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Injection Mammary Ductogram/Galactogram","code_information":[{"code":"40100010","type":"CDM"},{"code":"401","type":"RC"},{"code":"19030","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Drain/Inj Intermediate Joint/Bursa W/O Us","code_information":[{"code":"40200000","type":"CDM"},{"code":"402","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":1042.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":795.0,"discounted_cash":667.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Guide Drainage Abscess","code_information":[{"code":"40200002","type":"CDM"},{"code":"402","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":2457.0,"discounted_cash":2063.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1633.0,"discounted_cash":1371.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc X-Ray Exam Surgical Specimen","code_information":[{"code":"40200003","type":"CDM"},{"code":"402","type":"RC"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":1425.0,"discounted_cash":1197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":993.0,"discounted_cash":834.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Echoenpharlography Exam Of Head","code_information":[{"code":"40200004","type":"CDM"},{"code":"402","type":"RC"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":700.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":500.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Head & Neck Soft Tissue","code_information":[{"code":"40200005","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.0,"discounted_cash":626.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":448.0,"discounted_cash":376.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":226.0,"discounted_cash":189.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Us Exam Chest","code_information":[{"code":"40200006","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":607.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":434.0,"discounted_cash":364.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Breast Complete","code_information":[{"code":"40200007","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":596.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":426.0,"discounted_cash":357.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Breast Limited","code_information":[{"code":"40200008","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":596.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":426.0,"discounted_cash":357.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":186.0,"discounted_cash":156.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Abdominal Complete","code_information":[{"code":"40200010","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":1092.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":781.0,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Echo Exam Of Abdomen Limited","code_information":[{"code":"40200011","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":1092.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":781.0,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Retroperitoneal Complete","code_information":[{"code":"40200012","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":1092.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":781.0,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Retroperitoneal Limited","code_information":[{"code":"40200013","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":1092.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":781.0,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Kidney Transplant W/Doppler","code_information":[{"code":"40200014","type":"CDM"},{"code":"402","type":"RC"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":1092.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":781.0,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Spinal Cord","code_information":[{"code":"40200015","type":"CDM"},{"code":"402","type":"RC"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":877.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":627.0,"discounted_cash":526.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ob Fetal <14 Wks","code_information":[{"code":"40200016","type":"CDM"},{"code":"402","type":"RC"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":607.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":434.0,"discounted_cash":364.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ob Fetal <14 Wks Additional","code_information":[{"code":"40200017","type":"CDM"},{"code":"402","type":"RC"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":355.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":254.0,"discounted_cash":213.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ob Fetal >= 14 Wks Single","code_information":[{"code":"40200018","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":937.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":670.0,"discounted_cash":562.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ob Fetal >=14 Wks Additional","code_information":[{"code":"40200019","type":"CDM"},{"code":"402","type":"RC"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":1092.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":781.0,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ob Fetal, Limited","code_information":[{"code":"40200020","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":607.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":434.0,"discounted_cash":364.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ob Us Fetal Follow-Up Per Fetus","code_information":[{"code":"40200021","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":531.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ob Fetal Transvaginal","code_information":[{"code":"40200022","type":"CDM"},{"code":"402","type":"RC"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":687.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":491.0,"discounted_cash":412.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fetal Biophysical W/Nst","code_information":[{"code":"40200023","type":"CDM"},{"code":"402","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1880.0,"discounted_cash":1579.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":790.0,"discounted_cash":663.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Fetal Bioprofile W/O Nst","code_information":[{"code":"40200024","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.0,"discounted_cash":1160.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":760.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Kus Umbilical Artery Echo","code_information":[{"code":"40200025","type":"CDM"},{"code":"402","type":"RC"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":486.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":447.0,"discounted_cash":375.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Transvaginal","code_information":[{"code":"40200026","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":1092.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":781.0,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Sonohysterosongraphy","code_information":[{"code":"40200027","type":"CDM"},{"code":"402","type":"RC"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":1657.0,"discounted_cash":1391.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":963.0,"discounted_cash":808.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Pelvic Complete","code_information":[{"code":"40200028","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":1092.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":781.0,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Pelvic Limited","code_information":[{"code":"40200029","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":700.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":500.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Scrotum","code_information":[{"code":"40200030","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":1092.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":781.0,"discounted_cash":656.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Nonvascular Extremity Limited","code_information":[{"code":"40200031","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":698.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":790.0,"discounted_cash":663.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":225.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Us Hips Infant, Dynamic","code_information":[{"code":"40200032","type":"CDM"},{"code":"402","type":"RC"},{"code":"76885","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":700.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":482.0,"discounted_cash":404.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Vascular Access","code_information":[{"code":"40200033","type":"CDM"},{"code":"402","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.0,"discounted_cash":1544.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1103.0,"discounted_cash":926.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Echo Guide For Biopsy","code_information":[{"code":"40200034","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1849.0,"discounted_cash":1553.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1109.0,"discounted_cash":931.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":597.0,"discounted_cash":501.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Echo Examination Procedure","code_information":[{"code":"40200035","type":"CDM"},{"code":"402","type":"RC"},{"code":"76999","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":409.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":219.0,"discounted_cash":183.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"},{"gross_charge":219.0,"discounted_cash":183.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Us Transrectal","code_information":[{"code":"40200037","type":"CDM"},{"code":"402","type":"RC"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":607.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":421.0,"discounted_cash":353.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Exam Infant Hips Static","code_information":[{"code":"40200038","type":"CDM"},{"code":"402","type":"RC"},{"code":"76886","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":700.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":482.0,"discounted_cash":404.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Echo Guide For Artery Repair","code_information":[{"code":"40200039","type":"CDM"},{"code":"402","type":"RC"},{"code":"76936","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":667.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":616.0,"discounted_cash":517.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Guided Tissue Ablation","code_information":[{"code":"40200040","type":"CDM"},{"code":"402","type":"RC"},{"code":"76940","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.0,"discounted_cash":824.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":570.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Echo Guide For Amniocentesis","code_information":[{"code":"40200041","type":"CDM"},{"code":"402","type":"RC"},{"code":"76946","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":893.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":638.0,"discounted_cash":535.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ultrasonic Guidance Radioelement","code_information":[{"code":"40200042","type":"CDM"},{"code":"402","type":"RC"},{"code":"76965","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":444.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":480.0,"discounted_cash":403.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Aaa Screening","code_information":[{"code":"40200043","type":"CDM"},{"code":"402","type":"RC"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.0,"discounted_cash":580.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":415.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Echo Fetal Cardiovasc W/Wo M-Mode Recording","code_information":[{"code":"40200044","type":"CDM"},{"code":"402","type":"RC"},{"code":"76825","type":"HCPCS"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":1352.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":933.0,"discounted_cash":783.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Echo Fetal Cardiovasc W/Wo M-Mode Repeat Std","code_information":[{"code":"40200045","type":"CDM"},{"code":"402","type":"RC"},{"code":"76826","type":"HCPCS"}],"standard_charges":[{"gross_charge":1325.0,"discounted_cash":1113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":768.0,"discounted_cash":645.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Doppler Echo Fetal Spectral Display Complete","code_information":[{"code":"40200046","type":"CDM"},{"code":"402","type":"RC"},{"code":"76827","type":"HCPCS"}],"standard_charges":[{"gross_charge":1325.0,"discounted_cash":1113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":795.0,"discounted_cash":667.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Doppler Echo Fetal Puls Spectral F/U/Repeat","code_information":[{"code":"40200047","type":"CDM"},{"code":"402","type":"RC"},{"code":"76828","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":556.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":397.0,"discounted_cash":333.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Guidance Chorionic Villus Sampling Img S&I","code_information":[{"code":"40200048","type":"CDM"},{"code":"402","type":"RC"},{"code":"76945","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":794.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":548.0,"discounted_cash":460.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Preg Uterus W/Detail Fetal Anat 1St Gestation","code_information":[{"code":"40200049","type":"CDM"},{"code":"402","type":"RC"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":556.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":397.0,"discounted_cash":333.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Preg Uterus Detail Fetal Anat Exam Ea Addl Gestat","code_information":[{"code":"40200050","type":"CDM"},{"code":"402","type":"RC"},{"code":"76812","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":556.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":397.0,"discounted_cash":333.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Fetal Nuchal Translucency 1St Gestation","code_information":[{"code":"40200051","type":"CDM"},{"code":"402","type":"RC"},{"code":"76813","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":556.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":397.0,"discounted_cash":333.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Us Fetal Nuchal Translucency Ea Addl Gestation","code_information":[{"code":"40200052","type":"CDM"},{"code":"402","type":"RC"},{"code":"76814","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":351.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":251.0,"discounted_cash":210.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Doppler Velocimetry Fetal Middle Cerebral Art","code_information":[{"code":"40200053","type":"CDM"},{"code":"402","type":"RC"},{"code":"76821","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":414.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":395.0,"discounted_cash":331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dup-Scan Hemo Compl Bi Std","code_information":[{"code":"40200057","type":"CDM"},{"code":"402","type":"RC"},{"code":"93985","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":765.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":706.0,"discounted_cash":593.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dup-Scan Hemo Compl Uni Std","code_information":[{"code":"40200058","type":"CDM"},{"code":"402","type":"RC"},{"code":"93986","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":368.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":339.0,"discounted_cash":284.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Ultrasonic Guidance, Intraoperative","code_information":[{"code":"40200059","type":"CDM"},{"code":"402","type":"RC"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":681.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":735.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mammo Screening Bilateral","code_information":[{"code":"40300001","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":616.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":599.0,"discounted_cash":503.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Screening Breast Tomosynthesis Bilateral","code_information":[{"code":"40300003","type":"CDM"},{"code":"403","type":"RC"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pet Brain Metabolic","code_information":[{"code":"40400000","type":"CDM"},{"code":"404","type":"RC"},{"code":"78608","type":"HCPCS"}],"standard_charges":[{"gross_charge":10239.0,"discounted_cash":8600.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":6993.0,"discounted_cash":5874.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pet Image W/Ct Lmtd","code_information":[{"code":"40400001","type":"CDM"},{"code":"404","type":"RC"},{"code":"78814","type":"HCPCS"}],"standard_charges":[{"gross_charge":14050.0,"discounted_cash":11802.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9134.0,"discounted_cash":7672.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pet Image W/Ct Skull-Thigh","code_information":[{"code":"40400002","type":"CDM"},{"code":"404","type":"RC"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":14050.0,"discounted_cash":11802.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9591.0,"discounted_cash":8056.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Pet Image W/Ct Full Body","code_information":[{"code":"40400003","type":"CDM"},{"code":"404","type":"RC"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":14050.0,"discounted_cash":11802.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":9591.0,"discounted_cash":8056.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Nicu Respiratory Therapy Per Hr","code_information":[{"code":"41000000","type":"CDM"},{"code":"410","type":"RC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Endotracheal Intubation","code_information":[{"code":"41000001","type":"CDM"},{"code":"410","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":516.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Suction Nasotracheal","code_information":[{"code":"41000002","type":"CDM"},{"code":"410","type":"RC"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc \tMech Vent Initial Day Ip","code_information":[{"code":"41000003","type":"CDM"},{"code":"410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.0,"discounted_cash":1138.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc \tMech Vent Subseq Day Ip","code_information":[{"code":"41000004","type":"CDM"},{"code":"410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1251.0,"discounted_cash":1050.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vital Capacity Test","code_information":[{"code":"41000005","type":"CDM"},{"code":"410","type":"RC"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Respiratory Flow Volume Loop","code_information":[{"code":"41000007","type":"CDM"},{"code":"410","type":"RC"},{"code":"94375","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":505.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Surfactant Admin Thru Tube","code_information":[{"code":"41000008","type":"CDM"},{"code":"410","type":"RC"},{"code":"94610","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":347.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antibiotic Nebulizer Treatment","code_information":[{"code":"41000009","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Continous Medication Neb 1St Hr","code_information":[{"code":"41000010","type":"CDM"},{"code":"410","type":"RC"},{"code":"94644","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Continous Medication Neb Ea Add'l Hr","code_information":[{"code":"41000011","type":"CDM"},{"code":"410","type":"RC"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":198.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cpap Therapy","code_information":[{"code":"41000012","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":261.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aerosol Neb/Mdi/Ippb Demo/Eval","code_information":[{"code":"41000013","type":"CDM"},{"code":"410","type":"RC"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chest Physiotherapy Initial","code_information":[{"code":"41000014","type":"CDM"},{"code":"410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chest Physiotherapy Subsequent","code_information":[{"code":"41000015","type":"CDM"},{"code":"410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mechanical Chest Wall Oscill","code_information":[{"code":"41000016","type":"CDM"},{"code":"410","type":"RC"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":321.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Oth Resp Proc, Group","code_information":[{"code":"41000017","type":"CDM"},{"code":"410","type":"RC"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pentamadine Treatment","code_information":[{"code":"41000018","type":"CDM"},{"code":"410","type":"RC"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bipap Initial Day","code_information":[{"code":"41000047","type":"CDM"},{"code":"410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.0,"discounted_cash":1138.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bipap Subsquent Day Ip","code_information":[{"code":"41000048","type":"CDM"},{"code":"410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1251.0,"discounted_cash":1050.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Er Hand Held Nebulizer","code_information":[{"code":"41000049","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hand Held Nebulizer","code_information":[{"code":"41000050","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mdi With Spacer Treatment","code_information":[{"code":"41000051","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sputum Induction","code_information":[{"code":"41000052","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ultra Sonic Nebulizer Treatment","code_information":[{"code":"41000053","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Er Cpap/Bipap Therapy","code_information":[{"code":"41000054","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":261.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mdi With Spacer Initial","code_information":[{"code":"41000055","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Patient Assessment Comprehensive","code_information":[{"code":"41000056","type":"CDM"},{"code":"410","type":"RC"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pep Therapy Initial","code_information":[{"code":"41000057","type":"CDM"},{"code":"410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pep Therapy Subsequent","code_information":[{"code":"41000058","type":"CDM"},{"code":"410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mechanical Chest Wall Oscillation Lung Function","code_information":[{"code":"41000078","type":"CDM"},{"code":"410","type":"RC"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":321.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cardiopulmonary Resuscitation Charge","code_information":[{"code":"41000079","type":"CDM"},{"code":"410","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"discounted_cash":763.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hyperbaric Oxygen","code_information":[{"code":"41300000","type":"CDM"},{"code":"413","type":"RC"},{"code":"99183","type":"HCPCS"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":2639.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hyperbaric Oxygen Therapy 30 Min","code_information":[{"code":"41300001","type":"CDM"},{"code":"413","type":"RC"},{"code":"G0277","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":658.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Short Arm Splint","code_information":[{"code":"42000001","type":"CDM"},{"code":"420","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":360.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Finger Splint","code_information":[{"code":"42000002","type":"CDM"},{"code":"420","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":211.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Finger Splint , Dynamic","code_information":[{"code":"42000003","type":"CDM"},{"code":"420","type":"RC"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Thorax","code_information":[{"code":"42000004","type":"CDM"},{"code":"420","type":"RC"},{"code":"29200","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Shoulder Strapping","code_information":[{"code":"42000005","type":"CDM"},{"code":"420","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":535.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Of Hip","code_information":[{"code":"42000006","type":"CDM"},{"code":"420","type":"RC"},{"code":"29520","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":335.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Knee Strapping","code_information":[{"code":"42000007","type":"CDM"},{"code":"420","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":447.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ankle Strapping","code_information":[{"code":"42000008","type":"CDM"},{"code":"420","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Biofeedback Training By Any Modality","code_information":[{"code":"42000010","type":"CDM"},{"code":"420","type":"RC"},{"code":"90901","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vestibular Canalith Repositioning","code_information":[{"code":"42000012","type":"CDM"},{"code":"420","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Neurobehavioral Status","code_information":[{"code":"42000013","type":"CDM"},{"code":"420","type":"RC"},{"code":"96116","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":328.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mechanical Traction Therapy","code_information":[{"code":"42000015","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":156.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vasopneumatic Device Therapy","code_information":[{"code":"42000016","type":"CDM"},{"code":"420","type":"RC"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":76.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Paraffin Bath Therapy","code_information":[{"code":"42000017","type":"CDM"},{"code":"420","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Whirlpool Therapy","code_information":[{"code":"42000018","type":"CDM"},{"code":"420","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":183.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pt Function Electric Stimulation 15 Min","code_information":[{"code":"42000019","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":154.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iontophoresis Each 15 Min","code_information":[{"code":"42000020","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":170.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ultrasound Therapy","code_information":[{"code":"42000021","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Therapeutic Exercises","code_information":[{"code":"42000022","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":104.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Neuromuscular Reeducation","code_information":[{"code":"42000023","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"42000024","type":"CDM"},{"code":"420","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.78,"discounted_cash":177.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gait Training Therapy","code_information":[{"code":"42000025","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Massage Therapy","code_information":[{"code":"42000026","type":"CDM"},{"code":"420","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Manual Therapy 1/> Regions","code_information":[{"code":"42000027","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Group Therapeutic Procedures","code_information":[{"code":"42000028","type":"CDM"},{"code":"420","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Therapeutic Activities Each 15 Min","code_information":[{"code":"42000029","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Self Care Mngment Training","code_information":[{"code":"42000030","type":"CDM"},{"code":"420","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Community/Work Reintegrationeach 15 Min","code_information":[{"code":"42000031","type":"CDM"},{"code":"420","type":"RC"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Wheelchair Mngment Training","code_information":[{"code":"42000032","type":"CDM"},{"code":"420","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Work Hardening Initial","code_information":[{"code":"42000033","type":"CDM"},{"code":"420","type":"RC"},{"code":"97545","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Work Hardening Additional","code_information":[{"code":"42000034","type":"CDM"},{"code":"420","type":"RC"},{"code":"97546","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Physical Performance Test","code_information":[{"code":"42000035","type":"CDM"},{"code":"420","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Orthotics Mgmt & Traing Initial Enctr Ea 15 Mins","code_information":[{"code":"42000036","type":"CDM"},{"code":"420","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prosthetics Training Initial Enctr Ea 15 Mins","code_information":[{"code":"42000037","type":"CDM"},{"code":"420","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Elec Stim Other Than Wound","code_information":[{"code":"42000038","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Low Back","code_information":[{"code":"42000057","type":"CDM"},{"code":"420","type":"RC"},{"code":"29799","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Elbow","code_information":[{"code":"42000058","type":"CDM"},{"code":"420","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Hand","code_information":[{"code":"42000059","type":"CDM"},{"code":"420","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Toe","code_information":[{"code":"42000060","type":"CDM"},{"code":"420","type":"RC"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":501.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Application Long Arm Splint","code_information":[{"code":"42000061","type":"CDM"},{"code":"420","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":472.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Application Dynamic Arm Splint","code_information":[{"code":"42000062","type":"CDM"},{"code":"420","type":"RC"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc E-Stim(Unattended)","code_information":[{"code":"42000063","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Traction, Mechanical","code_information":[{"code":"42000064","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":156.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Paraffin Bath","code_information":[{"code":"42000065","type":"CDM"},{"code":"420","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fluidotherapy","code_information":[{"code":"42000066","type":"CDM"},{"code":"420","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":183.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hand Rom","code_information":[{"code":"42000072","type":"CDM"},{"code":"420","type":"RC"},{"code":"95852","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Appl Mltlayr Compres Leg Below Knee W/Ankle Foot","code_information":[{"code":"42000074","type":"CDM"},{"code":"420","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":592.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Appl Mltlayr Compres Sys Uparm Lwarm Hand&Fing","code_information":[{"code":"42000075","type":"CDM"},{"code":"420","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":592.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Open Wound Each Additional 20 Sq Cm","code_information":[{"code":"42000076","type":"CDM"},{"code":"420","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":685.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Open Wound 20 Sq Cm/<","code_information":[{"code":"42000077","type":"CDM"},{"code":"420","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.0,"discounted_cash":710.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bfb Training 1St 15 Min","code_information":[{"code":"42000080","type":"CDM"},{"code":"420","type":"RC"},{"code":"90912","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bfb Training Ea Addl 15 Min","code_information":[{"code":"42000081","type":"CDM"},{"code":"420","type":"RC"},{"code":"90913","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pt  Nonphysician Telephone Assessment 5-10 Min","code_information":[{"code":"42000082","type":"CDM"},{"code":"420","type":"RC"},{"code":"98966","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pt  Nonphysician Telephone Assessment 11-20 Min","code_information":[{"code":"42000083","type":"CDM"},{"code":"420","type":"RC"},{"code":"98967","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pt Nonphysician Telephone Assessment 21-30 Min","code_information":[{"code":"42000084","type":"CDM"},{"code":"420","type":"RC"},{"code":"98968","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Physical Performance Test/Meas W/Reprt Ea 15 Min","code_information":[{"code":"42000085","type":"CDM"},{"code":"420","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Therapeutic Px 1/> Areas Each 15 Min Exercises","code_information":[{"code":"42000086","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":104.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ther Px 1/> Areas Each 15 Min Neuromusc Reeduca","code_information":[{"code":"42000087","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ther Px 1/> Areas Ea 15 Min Gait Traing W/Stair","code_information":[{"code":"42000088","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Therapeutic Procedures Group 2/> Individuals","code_information":[{"code":"42000089","type":"CDM"},{"code":"420","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Therapeut Actvity Direct Pt Contact Each 15 Min","code_information":[{"code":"42000090","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Self-Care/Home Mgmt Training Each 15 Minutes","code_information":[{"code":"42000091","type":"CDM"},{"code":"420","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Wheelchair Mgmt Ea 15 Min","code_information":[{"code":"42000092","type":"CDM"},{"code":"420","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Orthotics Mgmt & Traing Initial Enctr Ea 15 Mins","code_information":[{"code":"42000093","type":"CDM"},{"code":"420","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Prosthetics Training Initial Enctr Ea 15 Mins","code_information":[{"code":"42000094","type":"CDM"},{"code":"420","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min","code_information":[{"code":"42000095","type":"CDM"},{"code":"420","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":182.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Caregiver Traing 1St 30 Min","code_information":[{"code":"42000096","type":"CDM"},{"code":"420","type":"RC"},{"code":"97550","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Caregiver Traing Ea Addl 15","code_information":[{"code":"42000097","type":"CDM"},{"code":"420","type":"RC"},{"code":"97551","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Group Caregiver Training","code_information":[{"code":"42000098","type":"CDM"},{"code":"420","type":"RC"},{"code":"97552","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc No Show / Workwell Evaluation","code_information":[{"code":"42400000","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":374.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pt Eval Low Complex 20 Min","code_information":[{"code":"42400003","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pt Eval High Complex 45 Min","code_information":[{"code":"42400004","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pt Re-Eval Est Plan Care","code_information":[{"code":"42400005","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":185.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pt Eval Mod Complex 30 Min","code_information":[{"code":"42400006","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine  Pt Eval Low Complex 20 Min","code_information":[{"code":"42400007","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine  Pt Eval Mod Complex 30 Min","code_information":[{"code":"42400008","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine  Pt Eval High Complex 45 Min","code_information":[{"code":"42400009","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":275.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Pt Re-Eval Est Plan Care 20 Mins","code_information":[{"code":"42400010","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":185.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min","code_information":[{"code":"42400011","type":"CDM"},{"code":"424","type":"RC"},{"code":"97755","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Apply Long Arm Splint","code_information":[{"code":"43000000","type":"CDM"},{"code":"430","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":472.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Short Arm Splint","code_information":[{"code":"43000001","type":"CDM"},{"code":"430","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":360.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Short Arm Splint , Dynamic","code_information":[{"code":"43000002","type":"CDM"},{"code":"430","type":"RC"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Finger Splint","code_information":[{"code":"43000003","type":"CDM"},{"code":"430","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":211.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Finger Splint , Dynamic","code_information":[{"code":"43000004","type":"CDM"},{"code":"430","type":"RC"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Shoulder Strapping","code_information":[{"code":"43000005","type":"CDM"},{"code":"430","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":535.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Elbow Or Wrist Strapping","code_information":[{"code":"43000006","type":"CDM"},{"code":"430","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hand Or Finger Strapping","code_information":[{"code":"43000007","type":"CDM"},{"code":"430","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Developmental Testing","code_information":[{"code":"43000010","type":"CDM"},{"code":"430","type":"RC"},{"code":"96110","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Paraffin Bath Therapy","code_information":[{"code":"43000013","type":"CDM"},{"code":"430","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Whirlpool Therapy","code_information":[{"code":"43000014","type":"CDM"},{"code":"430","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":183.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iontophoresis Each 15 Min","code_information":[{"code":"43000015","type":"CDM"},{"code":"430","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":170.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Contrast Bath Therapy","code_information":[{"code":"43000016","type":"CDM"},{"code":"430","type":"RC"},{"code":"97034","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ultrasound Therapy","code_information":[{"code":"43000017","type":"CDM"},{"code":"430","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Therapeutic Exercises","code_information":[{"code":"43000018","type":"CDM"},{"code":"430","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":104.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Neuromuscular Reeducation","code_information":[{"code":"43000019","type":"CDM"},{"code":"430","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Massage Therapy","code_information":[{"code":"43000021","type":"CDM"},{"code":"430","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":91.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Manual Therapy 1/> Regions","code_information":[{"code":"43000022","type":"CDM"},{"code":"430","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":166.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Group Therapeutic Procedures","code_information":[{"code":"43000023","type":"CDM"},{"code":"430","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Therapeutic Activities Each 15 Min","code_information":[{"code":"43000024","type":"CDM"},{"code":"430","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sensory Integration","code_information":[{"code":"43000026","type":"CDM"},{"code":"430","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Self Care Mngment Training","code_information":[{"code":"43000027","type":"CDM"},{"code":"430","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Community/Work Reintegrationeach 15 Min","code_information":[{"code":"43000028","type":"CDM"},{"code":"430","type":"RC"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Wheelchair Mngment Training","code_information":[{"code":"43000029","type":"CDM"},{"code":"430","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Selective ,<20 Sq Cm","code_information":[{"code":"43000030","type":"CDM"},{"code":"430","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.0,"discounted_cash":710.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Orthotics Mgmt & Traing Initial Enctr Ea 15 Mins","code_information":[{"code":"43000031","type":"CDM"},{"code":"430","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Elec Stim Other Than Wound","code_information":[{"code":"43000033","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Low Back","code_information":[{"code":"43000049","type":"CDM"},{"code":"430","type":"RC"},{"code":"29799","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Thorax","code_information":[{"code":"43000050","type":"CDM"},{"code":"430","type":"RC"},{"code":"29200","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Hip","code_information":[{"code":"43000051","type":"CDM"},{"code":"430","type":"RC"},{"code":"29520","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":335.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Knee","code_information":[{"code":"43000052","type":"CDM"},{"code":"430","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":447.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Ankle","code_information":[{"code":"43000053","type":"CDM"},{"code":"430","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Strapping Toe","code_information":[{"code":"43000054","type":"CDM"},{"code":"430","type":"RC"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":501.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Non-Selective Debridement","code_information":[{"code":"43000055","type":"CDM"},{"code":"430","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":477.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc E-Stim(Unattended)","code_information":[{"code":"43000056","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Paraffin Bath","code_information":[{"code":"43000057","type":"CDM"},{"code":"430","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fluidotherapy","code_information":[{"code":"43000058","type":"CDM"},{"code":"430","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":183.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc E-Stim(Manual)","code_information":[{"code":"43000063","type":"CDM"},{"code":"430","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":154.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hand Rom","code_information":[{"code":"43000064","type":"CDM"},{"code":"430","type":"RC"},{"code":"95852","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min","code_information":[{"code":"43000066","type":"CDM"},{"code":"430","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":182.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Debridement Open Wound Each Additional 20 Sq Cm","code_information":[{"code":"43000068","type":"CDM"},{"code":"430","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":685.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther Ivntj 1St 15 Min (Cog Fxn)","code_information":[{"code":"43000071","type":"CDM"},{"code":"430","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther Ivntj Ea Addl 15 Min (Cog Fxn)","code_information":[{"code":"43000075","type":"CDM"},{"code":"430","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ot Nonphysician Telephone Assessment 5-10 Min","code_information":[{"code":"43000076","type":"CDM"},{"code":"430","type":"RC"},{"code":"98966","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ot  Nonphysician Telephone Assessment 11-20 Min","code_information":[{"code":"43000077","type":"CDM"},{"code":"430","type":"RC"},{"code":"98967","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ot Nonphysician Telephone Assessment 21-30 Min","code_information":[{"code":"43000078","type":"CDM"},{"code":"430","type":"RC"},{"code":"98968","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Physical Performance Test/Meas W/Reprt Ea 15 Min","code_information":[{"code":"43000079","type":"CDM"},{"code":"430","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Therapeutic Px 1/> Areas Each 15 Min Exercises","code_information":[{"code":"43000080","type":"CDM"},{"code":"430","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":104.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Ther Px 1/> Areas Each 15 Min Neuromusc Reeduca","code_information":[{"code":"43000081","type":"CDM"},{"code":"430","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":122.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Ther Px 1/> Areas Ea 15 Min Gait Traing W/Stair","code_information":[{"code":"43000082","type":"CDM"},{"code":"430","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Therapeutic Procedures Group 2/> Individuals","code_information":[{"code":"43000083","type":"CDM"},{"code":"430","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Therapeut Actvity Direct Pt Contact Each 15 Min","code_information":[{"code":"43000084","type":"CDM"},{"code":"430","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Self-Care/Home Mgmt Training Each 15 Minutes","code_information":[{"code":"43000085","type":"CDM"},{"code":"430","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Wheelchair Mgmt Ea 15 Min","code_information":[{"code":"43000086","type":"CDM"},{"code":"430","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Orthotics Mgmt & Traing Initial Enctr Ea 15 Mins","code_information":[{"code":"43000087","type":"CDM"},{"code":"430","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Prosthetics Training Initial Enctr Ea 15 Mins","code_information":[{"code":"43000088","type":"CDM"},{"code":"430","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prosthetics Training Initial Enctr Ea 15 Mins","code_information":[{"code":"43000089","type":"CDM"},{"code":"430","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Application Cast Elbow Finger Short Arm","code_information":[{"code":"43000090","type":"CDM"},{"code":"430","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1094.0,"discounted_cash":918.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":577.0,"discounted_cash":484.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Application Cast Hand & Lower Forearm Gauntlet","code_information":[{"code":"43000091","type":"CDM"},{"code":"430","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.0,"discounted_cash":538.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":338.0,"discounted_cash":283.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Application Cast Finger","code_information":[{"code":"43000092","type":"CDM"},{"code":"430","type":"RC"},{"code":"29086","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.0,"discounted_cash":538.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Caregiver Traing 1St 30 Min","code_information":[{"code":"43000093","type":"CDM"},{"code":"430","type":"RC"},{"code":"97550","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Caregiver Traing Ea Addl 15","code_information":[{"code":"43000094","type":"CDM"},{"code":"430","type":"RC"},{"code":"97551","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Group Caregiver Training","code_information":[{"code":"43000095","type":"CDM"},{"code":"430","type":"RC"},{"code":"97552","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ot Eval Low Complex 30 Min","code_information":[{"code":"43400002","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":265.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ot Eval Mod Complex 45 Min","code_information":[{"code":"43400003","type":"CDM"},{"code":"434","type":"RC"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":265.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ot Eval High Complex 60 Min","code_information":[{"code":"43400004","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":265.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ot Re-Eval Est Plan Care","code_information":[{"code":"43400005","type":"CDM"},{"code":"434","type":"RC"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":174.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Eval Low Complex 30 Min","code_information":[{"code":"43400006","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":265.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Eval Mod Complex 45 Min","code_information":[{"code":"43400007","type":"CDM"},{"code":"434","type":"RC"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":265.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Eval High Complex 60 Min","code_information":[{"code":"43400008","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":265.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Re-Eval Est Plan Care 30 Mins","code_information":[{"code":"43400009","type":"CDM"},{"code":"434","type":"RC"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":174.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Ot Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min","code_information":[{"code":"43400010","type":"CDM"},{"code":"434","type":"RC"},{"code":"97755","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Speech/Lang Therapy Individual","code_information":[{"code":"44000001","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Speech/Lang Therapy Group","code_information":[{"code":"44000002","type":"CDM"},{"code":"440","type":"RC"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Swallowing Treatment","code_information":[{"code":"44000003","type":"CDM"},{"code":"440","type":"RC"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Use Of Speech Device Service","code_information":[{"code":"44000004","type":"CDM"},{"code":"440","type":"RC"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cognitive Test By Hc Pro","code_information":[{"code":"44000005","type":"CDM"},{"code":"440","type":"RC"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Dds Evaluation","code_information":[{"code":"44000035","type":"CDM"},{"code":"440","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc No Show / Dds Evaluation","code_information":[{"code":"44000036","type":"CDM"},{"code":"440","type":"RC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther Ivntj Ea Addl 15 Min (Cog Fxn)","code_information":[{"code":"44000039","type":"CDM"},{"code":"440","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther Ivntj 1St 15 Min (Cog Fxn)","code_information":[{"code":"44000040","type":"CDM"},{"code":"440","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":136.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc St  Nonphysician Telephone Assessment 5-10 Min","code_information":[{"code":"44000041","type":"CDM"},{"code":"440","type":"RC"},{"code":"98966","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc St  Nonphysician Telephone Assessment 11-20 Min","code_information":[{"code":"44000042","type":"CDM"},{"code":"440","type":"RC"},{"code":"98967","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc St Nonphysician Telephone Assessment 21-30 Min","code_information":[{"code":"44000043","type":"CDM"},{"code":"440","type":"RC"},{"code":"98968","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Tx Speech Lang Voice Commj &/Auditory Proc Ind","code_information":[{"code":"44000044","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Caregiver Traing 1St 30 Min","code_information":[{"code":"44000045","type":"CDM"},{"code":"440","type":"RC"},{"code":"97550","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Caregiver Traing Ea Addl 15","code_information":[{"code":"44000046","type":"CDM"},{"code":"440","type":"RC"},{"code":"97551","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Group Caregiver Training","code_information":[{"code":"44000047","type":"CDM"},{"code":"440","type":"RC"},{"code":"97552","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Evaluation Of Speech Fluency","code_information":[{"code":"44400000","type":"CDM"},{"code":"444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":321.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Evaluation Of Speech Production","code_information":[{"code":"44400001","type":"CDM"},{"code":"444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":261.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Speech Sound Lang Comprehension","code_information":[{"code":"44400002","type":"CDM"},{"code":"444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":542.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Behavral Qualit Analys Voice/Res","code_information":[{"code":"44400003","type":"CDM"},{"code":"444","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":272.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Voice Prosthetic Evaluation","code_information":[{"code":"44400004","type":"CDM"},{"code":"444","type":"RC"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Evaluation For Speech Device Rx 1Hr","code_information":[{"code":"44400005","type":"CDM"},{"code":"444","type":"RC"},{"code":"92607","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":444.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Evaluate Swallowing Function","code_information":[{"code":"44400006","type":"CDM"},{"code":"444","type":"RC"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Motion Fluoroscopy/Swallow","code_information":[{"code":"44400007","type":"CDM"},{"code":"444","type":"RC"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aphasia Evaluation Per Hr","code_information":[{"code":"44400008","type":"CDM"},{"code":"444","type":"RC"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":217.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eval Speech Gen Dev Add 30M","code_information":[{"code":"44400009","type":"CDM"},{"code":"444","type":"RC"},{"code":"92608","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fees Eval Swallow","code_information":[{"code":"44400010","type":"CDM"},{"code":"444","type":"RC"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Evaluation Of Speech Fluency","code_information":[{"code":"44400011","type":"CDM"},{"code":"444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":321.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Evaluate Speech Production","code_information":[{"code":"44400012","type":"CDM"},{"code":"444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":261.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Eval Speech Sound Product Language Comprehension","code_information":[{"code":"44400013","type":"CDM"},{"code":"444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":542.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Behavioral & Qualit Analysis Voice And Resonance","code_information":[{"code":"44400014","type":"CDM"},{"code":"444","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":272.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Laryngoscopy Flx/Rgd Telescopic W/Stroboscopy","code_information":[{"code":"44400015","type":"CDM"},{"code":"444","type":"RC"},{"code":"31579","type":"HCPCS"}],"standard_charges":[{"gross_charge":1063.0,"discounted_cash":892.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Laryngeal Function Studies","code_information":[{"code":"44400016","type":"CDM"},{"code":"444","type":"RC"},{"code":"92520","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":353.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc I&D Skin Abcess Simple","code_information":[{"code":"45000000","type":"CDM"},{"code":"450","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":632.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":430.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc I&D Skin Abscess Complicated Or Multiple","code_information":[{"code":"45000001","type":"CDM"},{"code":"450","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":703.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":837.0,"discounted_cash":703.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":837.0,"discounted_cash":703.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Drain Pilonidal Cyst Simple","code_information":[{"code":"45000002","type":"CDM"},{"code":"450","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.0,"discounted_cash":1617.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1834.0,"discounted_cash":1540.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":1511.0,"discounted_cash":1269.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Incision & Removal Of Fb","code_information":[{"code":"45000003","type":"CDM"},{"code":"450","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":624.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":743.0,"discounted_cash":624.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Incis & Remov Of Fb Complicated","code_information":[{"code":"45000004","type":"CDM"},{"code":"450","type":"RC"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":4521.0,"discounted_cash":3797.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4074.0,"discounted_cash":3422.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc I&D Hematoma","code_information":[{"code":"45000005","type":"CDM"},{"code":"450","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":5446.0,"discounted_cash":4574.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4260.0,"discounted_cash":3578.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":3482.0,"discounted_cash":2924.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Puncture Drainage Of Lesion","code_information":[{"code":"45000006","type":"CDM"},{"code":"450","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":5273.0,"discounted_cash":4429.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Avulsion Of Nail Plate","code_information":[{"code":"45000007","type":"CDM"},{"code":"450","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":299.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":357.0,"discounted_cash":299.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":357.0,"discounted_cash":299.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Evac Of Subungual Hematoma","code_information":[{"code":"45000008","type":"CDM"},{"code":"450","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":546.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":335.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Excision Removal Of Nail Bed","code_information":[{"code":"45000009","type":"CDM"},{"code":"450","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1931.0,"discounted_cash":1622.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1083.0,"discounted_cash":909.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Repair Nail Bed Tech","code_information":[{"code":"45000010","type":"CDM"},{"code":"450","type":"RC"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.0,"discounted_cash":750.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":894.0,"discounted_cash":750.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5Cm/<","code_information":[{"code":"45000011","type":"CDM"},{"code":"450","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":669.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm","code_information":[{"code":"45000012","type":"CDM"},{"code":"450","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.0,"discounted_cash":909.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Simple Rpr Scalp/Neck/Ax/Genit/Trunk 7.6-12.5Cm","code_information":[{"code":"45000013","type":"CDM"},{"code":"450","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":1149.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 12.6-20.0Cm","code_information":[{"code":"45000014","type":"CDM"},{"code":"450","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1873.0,"discounted_cash":1573.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":998.0,"discounted_cash":838.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Simple Repair F/E/E/N/L/M 2.5Cm/<","code_information":[{"code":"45000015","type":"CDM"},{"code":"450","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":686.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Simple Repair F/E/E/N/L/M 2.6Cm-5.0 Cm","code_information":[{"code":"45000016","type":"CDM"},{"code":"450","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":782.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Simple Repair F/E/E/N/L/M 5.1Cm-7.5 Cm","code_information":[{"code":"45000017","type":"CDM"},{"code":"450","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1199.0,"discounted_cash":1007.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":501.0,"discounted_cash":420.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Simple Repair F/E/E/N/L/M 7.6Cm-12.5 Cm","code_information":[{"code":"45000018","type":"CDM"},{"code":"450","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1512.0,"discounted_cash":1270.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intmd Rpr Sclp Trnk Extm<2.6Cm","code_information":[{"code":"45000019","type":"CDM"},{"code":"450","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":854.0,"discounted_cash":717.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":854.0,"discounted_cash":717.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Intmd Rpr Scp Trk Ext 2.6-7.5Cm","code_information":[{"code":"45000020","type":"CDM"},{"code":"450","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":757.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":902.0,"discounted_cash":757.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Intmd Rpr S/Tr/Ext 7.6-12.5","code_information":[{"code":"45000021","type":"CDM"},{"code":"450","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":774.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":922.0,"discounted_cash":774.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Intmd Rpr S/A/T/Ext 12.6-20","code_information":[{"code":"45000022","type":"CDM"},{"code":"450","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intmd Rpr N-Hf/Genit 2.5Cm/<","code_information":[{"code":"45000023","type":"CDM"},{"code":"450","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":866.0,"discounted_cash":727.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Intmd Rpr N-Hf/Genit2.6-7.5","code_information":[{"code":"45000024","type":"CDM"},{"code":"450","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":728.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Intmd Rpr N-Hf/Genit7.6-12.5","code_information":[{"code":"45000025","type":"CDM"},{"code":"450","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":791.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intmd Rpr Face/Mm 2.5 Cm/<","code_information":[{"code":"45000026","type":"CDM"},{"code":"450","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":757.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":902.0,"discounted_cash":757.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Intmd Rpr Face/Mm 2.6-5.0 Cm","code_information":[{"code":"45000027","type":"CDM"},{"code":"450","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":817.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":973.0,"discounted_cash":817.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Intmd Rpr Face/Mm 5.1-7.5 Cm","code_information":[{"code":"45000028","type":"CDM"},{"code":"450","type":"RC"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":854.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1017.0,"discounted_cash":854.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Intmd Rpr Face/Mm 12.6-20 Cm","code_information":[{"code":"45000029","type":"CDM"},{"code":"450","type":"RC"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1439.0,"discounted_cash":1208.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cmplx Rpr S/A/L 1.1-2.5 Cm","code_information":[{"code":"45000030","type":"CDM"},{"code":"450","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":791.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cmplx Rpr S/A/L 2.6-7.5 Cm","code_information":[{"code":"45000031","type":"CDM"},{"code":"450","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":2319.0,"discounted_cash":1947.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1770.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Cmplx Rpr F/C/C/M/N/Ax/G/H/F 1.1 To 2.5Cm","code_information":[{"code":"45000032","type":"CDM"},{"code":"450","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":2038.0,"discounted_cash":1711.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cmplx Rpr F/C/C/M/N/Ax/G/H/F 2.6 To 7.5Cm","code_information":[{"code":"45000033","type":"CDM"},{"code":"450","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2038.0,"discounted_cash":1711.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1688.0,"discounted_cash":1417.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Tis Trnfr F/C/C/M/N/A/G/H/F Up To 10Sq Cm","code_information":[{"code":"45000034","type":"CDM"},{"code":"450","type":"RC"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":4243.0,"discounted_cash":3564.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Burn 1St Degr No Dsg/Debridemt Te","code_information":[{"code":"45000035","type":"CDM"},{"code":"940","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"discounted_cash":588.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dress/Debride P Thick Burn S <5% Total Body Area","code_information":[{"code":"45000036","type":"CDM"},{"code":"940","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":735.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dress/Debride P Thick Burn M","code_information":[{"code":"45000037","type":"CDM"},{"code":"940","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.0,"discounted_cash":1045.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dress/Debride P Thick Burn L","code_information":[{"code":"45000038","type":"CDM"},{"code":"940","type":"RC"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1109.0,"discounted_cash":931.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Explore Wound Extremity","code_information":[{"code":"45000039","type":"CDM"},{"code":"450","type":"RC"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":3828.0,"discounted_cash":3215.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Tendon Sheath/Ligament","code_information":[{"code":"45000040","type":"CDM"},{"code":"450","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1039.0,"discounted_cash":872.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Trigger Point 1/2 Muscl","code_information":[{"code":"45000041","type":"CDM"},{"code":"450","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1032.0,"discounted_cash":866.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":790.0,"discounted_cash":663.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Drain/Inj Small Joint/Bursa W/O Us","code_information":[{"code":"45000042","type":"CDM"},{"code":"940","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":1012.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Drain/Inj Intermediate Joint/Bursa W/O Us","code_information":[{"code":"45000043","type":"CDM"},{"code":"940","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":1042.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":790.0,"discounted_cash":663.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Drain/Inj Major Joint/Bursa W/O Us","code_information":[{"code":"45000044","type":"CDM"},{"code":"940","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1441.0,"discounted_cash":1210.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Tx Nose Fx W/O Stablj","code_information":[{"code":"45000046","type":"CDM"},{"code":"940","type":"RC"},{"code":"21315","type":"HCPCS"}],"standard_charges":[{"gross_charge":4485.0,"discounted_cash":3767.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Treatment Nasal Septal Fx W / Wo Stablj","code_information":[{"code":"45000047","type":"CDM"},{"code":"940","type":"RC"},{"code":"21337","type":"HCPCS"}],"standard_charges":[{"gross_charge":7098.0,"discounted_cash":5962.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Tx Orbit W/O Manipulj","code_information":[{"code":"45000048","type":"CDM"},{"code":"940","type":"RC"},{"code":"21400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2997.0,"discounted_cash":2517.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Treat Lower Jaw Fracture","code_information":[{"code":"45000049","type":"CDM"},{"code":"940","type":"RC"},{"code":"21451","type":"HCPCS"}],"standard_charges":[{"gross_charge":3091.0,"discounted_cash":2596.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Reset Dislocated Jaw","code_information":[{"code":"45000050","type":"CDM"},{"code":"940","type":"RC"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":570.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Treatment Clavicle Wo Manip","code_information":[{"code":"45000051","type":"CDM"},{"code":"940","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.0,"discounted_cash":869.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Treatment Clavicle W Manip","code_information":[{"code":"45000052","type":"CDM"},{"code":"450","type":"RC"},{"code":"23505","type":"HCPCS"}],"standard_charges":[{"gross_charge":4845.0,"discounted_cash":4069.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Treat Clavicle Disl W/O Manipul","code_information":[{"code":"45000053","type":"CDM"},{"code":"940","type":"RC"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":501.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Scapula Fracture W/O Manipul","code_information":[{"code":"45000054","type":"CDM"},{"code":"940","type":"RC"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":1070.0,"discounted_cash":898.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Prox Hum Fx W/O Manipula","code_information":[{"code":"45000055","type":"CDM"},{"code":"940","type":"RC"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":607.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Hum Tuber Fx W/O Manipula","code_information":[{"code":"45000056","type":"CDM"},{"code":"940","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":563.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Shoulder Disloc W Manipul W/O Anest","code_information":[{"code":"45000057","type":"CDM"},{"code":"940","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1207.0,"discounted_cash":1013.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove Fb Upper Arm","code_information":[{"code":"45000058","type":"CDM"},{"code":"450","type":"RC"},{"code":"24200","type":"HCPCS"}],"standard_charges":[{"gross_charge":4357.0,"discounted_cash":3659.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hum Shft Fx W/O Manipul","code_information":[{"code":"45000059","type":"CDM"},{"code":"940","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":605.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":536.0,"discounted_cash":450.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Closed Tx Humeral Frac W/Manip","code_information":[{"code":"45000060","type":"CDM"},{"code":"940","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":4311.0,"discounted_cash":3621.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hum Epicond Fx W/O Manipulat","code_information":[{"code":"45000061","type":"CDM"},{"code":"940","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Closed Tx Elbow Dislocate","code_information":[{"code":"45000062","type":"CDM"},{"code":"940","type":"RC"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":6073.0,"discounted_cash":5101.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Treatment Ofsublux Radial W/Manip","code_information":[{"code":"45000063","type":"CDM"},{"code":"940","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.0,"discounted_cash":396.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":472.0,"discounted_cash":396.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Rad Head/Neck Fx W/O Manipulat","code_information":[{"code":"45000064","type":"CDM"},{"code":"940","type":"RC"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":605.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":620.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Ulnar Prox Fx W/O Manipulat","code_information":[{"code":"45000065","type":"CDM"},{"code":"940","type":"RC"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":605.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":665.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Rad Shaft Fx W/O Manipula","code_information":[{"code":"45000066","type":"CDM"},{"code":"940","type":"RC"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":669.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":620.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Rad Shaft Fx W Manipula","code_information":[{"code":"45000067","type":"CDM"},{"code":"940","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":4311.0,"discounted_cash":3621.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Uln Shaft Fx W/O Manipula","code_information":[{"code":"45000068","type":"CDM"},{"code":"940","type":"RC"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":669.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":665.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Uln Shaft Fx W Manipula","code_information":[{"code":"45000069","type":"CDM"},{"code":"940","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":716.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":665.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Closed Tx Radial & Ulnar Frac Wo Manip","code_information":[{"code":"45000070","type":"CDM"},{"code":"940","type":"RC"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":667.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Rad/Ulnar Dis Fx W/O Manipula","code_information":[{"code":"45000071","type":"CDM"},{"code":"940","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":669.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":601.0,"discounted_cash":504.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Rad/Ulnar Dis Fx W Manipula","code_information":[{"code":"45000072","type":"CDM"},{"code":"940","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":5274.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4166.0,"discounted_cash":3499.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":3452.0,"discounted_cash":2899.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Closed Tx Carpal Frac Wo Manip","code_information":[{"code":"45000073","type":"CDM"},{"code":"940","type":"RC"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":608.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Drainage Of Finger Abscess Simple","code_information":[{"code":"45000074","type":"CDM"},{"code":"450","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":531.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Close Tx Metacarpal Fx Wo Manp","code_information":[{"code":"45000075","type":"CDM"},{"code":"940","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":600.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":590.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Close Tx Metacarpal Fx W Manp","code_information":[{"code":"45000076","type":"CDM"},{"code":"940","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":600.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Finger Fx Mid/Prox Phalanx W/O Manipul","code_information":[{"code":"45000077","type":"CDM"},{"code":"940","type":"RC"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.0,"discounted_cash":730.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":665.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Closed Tx Phalangeal Frac W Man","code_information":[{"code":"45000078","type":"CDM"},{"code":"940","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":1444.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":601.0,"discounted_cash":504.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc M-P Or I-P Articluar Fx W/O Manipula","code_information":[{"code":"45000079","type":"CDM"},{"code":"940","type":"RC"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":494.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Distal Phalansgeal Fracture W/O Manipul","code_information":[{"code":"45000080","type":"CDM"},{"code":"940","type":"RC"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.0,"discounted_cash":691.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":590.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Phal Distal Fx Finger W Manipula","code_information":[{"code":"45000081","type":"CDM"},{"code":"940","type":"RC"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":1475.0,"discounted_cash":1239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ip Joint Dislocation W Manipulation","code_information":[{"code":"45000082","type":"CDM"},{"code":"940","type":"RC"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":721.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":601.0,"discounted_cash":504.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Closed Tx Inter Phalg Disloc W/An","code_information":[{"code":"45000083","type":"CDM"},{"code":"940","type":"RC"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":6983.0,"discounted_cash":5865.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hip Dislocate Trauma Wo Anes","code_information":[{"code":"45000084","type":"CDM"},{"code":"940","type":"RC"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Tx Patella Fract Wo Manip","code_information":[{"code":"45000085","type":"CDM"},{"code":"940","type":"RC"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":667.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Closed Tx Distal Rad Fx Wo Man","code_information":[{"code":"45000086","type":"CDM"},{"code":"940","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":625.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Closed Treat Patellar Dislocation W/O Anes","code_information":[{"code":"45000087","type":"CDM"},{"code":"940","type":"RC"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":536.0,"discounted_cash":450.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Med Malleolus Fx W/O Man","code_information":[{"code":"45000088","type":"CDM"},{"code":"940","type":"RC"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":789.0,"discounted_cash":662.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Closed Tx Post Maleolus Wo Man","code_information":[{"code":"45000089","type":"CDM"},{"code":"940","type":"RC"},{"code":"27767","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Tx Prox Tibal Fx Wo Man","code_information":[{"code":"45000090","type":"CDM"},{"code":"940","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":670.0,"discounted_cash":562.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Closed Tx Fibula Dist Frac W/Ma","code_information":[{"code":"45000091","type":"CDM"},{"code":"940","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":661.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Tx Bimal Ankl Fx Wo Man","code_information":[{"code":"45000092","type":"CDM"},{"code":"940","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Close Tx Ankle Bimalor Fx W Manp","code_information":[{"code":"45000093","type":"CDM"},{"code":"940","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":2553.0,"discounted_cash":2144.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ankle Fx Wo Manip","code_information":[{"code":"45000094","type":"CDM"},{"code":"940","type":"RC"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":536.0,"discounted_cash":450.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Close Tx Tibia Fx Wo Manpul","code_information":[{"code":"45000095","type":"CDM"},{"code":"940","type":"RC"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":605.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Removal Of Foot Foreign Body","code_information":[{"code":"45000096","type":"CDM"},{"code":"450","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":2367.79,"discounted_cash":1988.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1884.57,"discounted_cash":1583.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Calcaneal Fx W/O Manipulation","code_information":[{"code":"45000097","type":"CDM"},{"code":"940","type":"RC"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.0,"discounted_cash":661.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Close Tx Talus Fx Wo Manpul","code_information":[{"code":"45000098","type":"CDM"},{"code":"940","type":"RC"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":598.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Metatarsal Fx W/O Manipulation","code_information":[{"code":"45000099","type":"CDM"},{"code":"940","type":"RC"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.0,"discounted_cash":661.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":601.0,"discounted_cash":504.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Metatarsal Fx W/Manipulation","code_information":[{"code":"45000100","type":"CDM"},{"code":"940","type":"RC"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.0,"discounted_cash":661.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Great Toe Fracture W/O Manipulation","code_information":[{"code":"45000101","type":"CDM"},{"code":"940","type":"RC"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":549.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":601.0,"discounted_cash":504.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Toe Fx (Other Than Gr Toe) W/O Manipulation","code_information":[{"code":"45000102","type":"CDM"},{"code":"940","type":"RC"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.0,"discounted_cash":538.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":641.0,"discounted_cash":538.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Interphalangeal Toe Dislocation W/O Anes","code_information":[{"code":"45000103","type":"CDM"},{"code":"940","type":"RC"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Apply Long Arm Splint","code_information":[{"code":"45000104","type":"CDM"},{"code":"940","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":472.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":423.0,"discounted_cash":355.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":338.0,"discounted_cash":283.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Short Arm Splint","code_information":[{"code":"45000105","type":"CDM"},{"code":"940","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":360.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":337.0,"discounted_cash":283.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":274.0,"discounted_cash":230.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Finger Splint","code_information":[{"code":"45000106","type":"CDM"},{"code":"940","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":211.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":252.0,"discounted_cash":211.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":252.0,"discounted_cash":211.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Shoulder Strapping","code_information":[{"code":"45000107","type":"CDM"},{"code":"450","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":535.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":359.0,"discounted_cash":301.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Elbow Or Wrist Strapping","code_information":[{"code":"45000108","type":"CDM"},{"code":"450","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hand Or Finger Strapping","code_information":[{"code":"45000109","type":"CDM"},{"code":"450","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":462.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Splint Long Leg","code_information":[{"code":"45000110","type":"CDM"},{"code":"940","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":380.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Splint Short Leg","code_information":[{"code":"45000111","type":"CDM"},{"code":"940","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":320.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":320.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Knee Strapping","code_information":[{"code":"45000112","type":"CDM"},{"code":"450","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":447.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ankle Strapping","code_information":[{"code":"45000113","type":"CDM"},{"code":"450","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Toes Strapping","code_information":[{"code":"45000114","type":"CDM"},{"code":"450","type":"RC"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":501.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal/Bivalving Boot Or Body Cast","code_information":[{"code":"45000115","type":"CDM"},{"code":"450","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":354.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remov/Bivalv Full Arm Or Full Leg Cast","code_information":[{"code":"45000116","type":"CDM"},{"code":"450","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":721.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drain Absces Nasal Intern Approch","code_information":[{"code":"45000117","type":"CDM"},{"code":"450","type":"RC"},{"code":"30000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":1165.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove Nasal Foreign Body","code_information":[{"code":"45000118","type":"CDM"},{"code":"450","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":401.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":319.0,"discounted_cash":267.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method","code_information":[{"code":"45000119","type":"CDM"},{"code":"450","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":460.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":337.0,"discounted_cash":283.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Control Of Nosebleed W Pks Initial","code_information":[{"code":"45000120","type":"CDM"},{"code":"450","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":360.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Control Of Nosebleed W Pks Subsequent","code_information":[{"code":"45000121","type":"CDM"},{"code":"450","type":"RC"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":392.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Endotracheal Intubation","code_information":[{"code":"45000122","type":"CDM"},{"code":"940","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":516.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":556.0,"discounted_cash":467.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Insertion Of Chest Tube","code_information":[{"code":"45000123","type":"CDM"},{"code":"940","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2034.0,"discounted_cash":1708.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2034.0,"discounted_cash":1708.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Thoracentesis W/O Guidance","code_information":[{"code":"45000124","type":"CDM"},{"code":"940","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":926.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Venipuncture","code_information":[{"code":"45000127","type":"CDM"},{"code":"450","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Non-Tunnel Cv Cath < 5 Years Old","code_information":[{"code":"45000128","type":"CDM"},{"code":"940","type":"RC"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":8862.0,"discounted_cash":7444.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Non-Tunnel Cv Cath => 5 Years Old","code_information":[{"code":"45000129","type":"CDM"},{"code":"940","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":5160.0,"discounted_cash":4334.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Needle Bone Cavity","code_information":[{"code":"45000130","type":"CDM"},{"code":"940","type":"RC"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.0,"discounted_cash":702.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Repair Lip Vermilion Only","code_information":[{"code":"45000131","type":"CDM"},{"code":"450","type":"RC"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":3030.0,"discounted_cash":2545.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rpr Lac 2.5 Cm/< Mouth&/Ant Two-Thirds Tong","code_information":[{"code":"45000132","type":"CDM"},{"code":"450","type":"RC"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":605.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Repair Tongue Laceration >2.6 Cm","code_information":[{"code":"45000133","type":"CDM"},{"code":"450","type":"RC"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":1038.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drainage Of Gum Lesion","code_information":[{"code":"45000134","type":"CDM"},{"code":"450","type":"RC"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":318.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":319.0,"discounted_cash":267.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Gastric Intubation W/Aspir.","code_information":[{"code":"45000135","type":"CDM"},{"code":"940","type":"RC"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":1155.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Incision Of Rectal Abscess","code_information":[{"code":"45000137","type":"CDM"},{"code":"450","type":"RC"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":9130.0,"discounted_cash":7669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Incision Of Anal Abscess","code_information":[{"code":"45000138","type":"CDM"},{"code":"450","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":9130.0,"discounted_cash":7669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2401.0,"discounted_cash":2016.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":1963.0,"discounted_cash":1648.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Incise External Hemorrhoid","code_information":[{"code":"45000139","type":"CDM"},{"code":"450","type":"RC"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Diagnostic Anoscopy Spx","code_information":[{"code":"45000140","type":"CDM"},{"code":"450","type":"RC"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bladder Irrigation","code_information":[{"code":"45000141","type":"CDM"},{"code":"940","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":507.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urethral Cath Inserted","code_information":[{"code":"45000142","type":"CDM"},{"code":"940","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urethral Cath Temporary","code_information":[{"code":"45000143","type":"CDM"},{"code":"450","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Change Cystostomy Tube","code_information":[{"code":"45000144","type":"CDM"},{"code":"940","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":430.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":460.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc I&D Vulva/Perineal Abscess","code_information":[{"code":"45000145","type":"CDM"},{"code":"450","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":757.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":848.0,"discounted_cash":712.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Drainage Of Gland Abscess","code_information":[{"code":"45000146","type":"CDM"},{"code":"450","type":"RC"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":409.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":488.0,"discounted_cash":409.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Fetal Non-Stress Test","code_information":[{"code":"45000147","type":"CDM"},{"code":"450","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":786.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vaginal Delivery Only","code_information":[{"code":"45000148","type":"CDM"},{"code":"450","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":7733.0,"discounted_cash":6495.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Spinal Fluid Tap Diagnostic","code_information":[{"code":"45000149","type":"CDM"},{"code":"940","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.0,"discounted_cash":1107.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj(S), Anes Agent(S) A/O Steroid; Trigeminal Nerve","code_information":[{"code":"45000150","type":"CDM"},{"code":"940","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":893.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":790.0,"discounted_cash":663.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc N Block Other Peripheral","code_information":[{"code":"45000151","type":"CDM"},{"code":"940","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.0,"discounted_cash":1580.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove Foreign Body From Eye Conjuct Sup","code_information":[{"code":"45000152","type":"CDM"},{"code":"450","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":494.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":321.0,"discounted_cash":269.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Remove Foreign Body From Eye Conjuct Embd","code_information":[{"code":"45000153","type":"CDM"},{"code":"450","type":"RC"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":500.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove Foreign Body From Eye Corneal Wo Slt Lmp","code_information":[{"code":"45000154","type":"CDM"},{"code":"450","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"discounted_cash":492.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove Foreign Body From Eye Corneal W Slt Lmp","code_information":[{"code":"45000155","type":"CDM"},{"code":"450","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":500.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":342.0,"discounted_cash":287.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Clear Outer Ear Canal Wo Gen Aneths","code_information":[{"code":"45000156","type":"CDM"},{"code":"450","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":282.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":336.0,"discounted_cash":282.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Remove Impacted Ear Wax Unilateral","code_information":[{"code":"45000157","type":"CDM"},{"code":"450","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":259.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":167.0,"discounted_cash":140.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Ob Fetal, Limited","code_information":[{"code":"45000158","type":"CDM"},{"code":"450","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":607.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Immunization Admin","code_information":[{"code":"45000159","type":"CDM"},{"code":"450","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Immunization Admin Each Add","code_information":[{"code":"45000160","type":"CDM"},{"code":"450","type":"RC"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":129.0,"discounted_cash":108.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Temporary External Pacing","code_information":[{"code":"45000161","type":"CDM"},{"code":"450","type":"RC"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":861.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Hydra Initial =< 1Hr","code_information":[{"code":"45000162","type":"CDM"},{"code":"450","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":700.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Hydration Ea Add'l Hr","code_information":[{"code":"45000163","type":"CDM"},{"code":"450","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":307.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Thera/Proph/Diag Initial","code_information":[{"code":"45000164","type":"CDM"},{"code":"450","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":648.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Thera/Proph/Diag Add-On","code_information":[{"code":"45000165","type":"CDM"},{"code":"450","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":284.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx/Proph/Dg Addl Seq Iv Inf","code_information":[{"code":"45000166","type":"CDM"},{"code":"450","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":295.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther/Diag Concurrent Inf","code_information":[{"code":"45000167","type":"CDM"},{"code":"450","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther/Proph/Diag Inj Sc/Im","code_information":[{"code":"45000168","type":"CDM"},{"code":"450","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thera/Diag Inj-Iv Push Sing/Initl","code_information":[{"code":"45000169","type":"CDM"},{"code":"450","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx/Pro/Dx Inj New Drug Addon","code_information":[{"code":"45000170","type":"CDM"},{"code":"450","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx/Pro/Dx Inj Same Drug Adon","code_information":[{"code":"45000171","type":"CDM"},{"code":"450","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Selective ,<20 Sq Cm","code_information":[{"code":"45000172","type":"CDM"},{"code":"450","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.0,"discounted_cash":710.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":430.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Emergency Dept Visit Level 1","code_information":[{"code":"45000179","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":435.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Emergency Dept Visit Level 2","code_information":[{"code":"45000180","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.0,"discounted_cash":747.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Emergency Dept Visit Level 3","code_information":[{"code":"45000181","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":957.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Emergency Dept Visit Level 4","code_information":[{"code":"45000182","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.0,"discounted_cash":1430.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Emergency Dept Visit Level 5","code_information":[{"code":"45000183","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.0,"discounted_cash":2120.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Critical Care First Hour","code_information":[{"code":"45000184","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3084.0,"discounted_cash":2590.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Critical Care Addl 30 Min","code_information":[{"code":"45000185","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":1374.0,"discounted_cash":1154.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cmplx Rpr S/A/L Addl 5 Cm/>","code_information":[{"code":"45000187","type":"CDM"},{"code":"450","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":1271.0,"discounted_cash":1067.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drainage External Ear, Abscess Or Hematoma; Simple","code_information":[{"code":"45000191","type":"CDM"},{"code":"450","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":1016.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1210.0,"discounted_cash":1016.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Tongue And Mouth Surgery","code_information":[{"code":"45000192","type":"CDM"},{"code":"450","type":"RC"},{"code":"41599","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 1.1 Cm To 2.5 Cm","code_information":[{"code":"45000193","type":"CDM"},{"code":"450","type":"RC"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1889.0,"discounted_cash":1586.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1650.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Remove Impacted Ear Wax Uni","code_information":[{"code":"45000195","type":"CDM"},{"code":"450","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.14,"discounted_cash":247.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":167.03,"discounted_cash":140.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Dental Surgery Procedure","code_information":[{"code":"45000196","type":"CDM"},{"code":"450","type":"RC"},{"code":"41899","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Outer Ear Surgery Procedure","code_information":[{"code":"45000197","type":"CDM"},{"code":"450","type":"RC"},{"code":"69399","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drainage Of Mouth Lesion","code_information":[{"code":"45000198","type":"CDM"},{"code":"450","type":"RC"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":1016.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1210.0,"discounted_cash":1016.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Remove Eyelid Foreign Body","code_information":[{"code":"45000199","type":"CDM"},{"code":"450","type":"RC"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.0,"discounted_cash":1043.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":732.0,"discounted_cash":614.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Treat Toe Dislocation","code_information":[{"code":"45000200","type":"CDM"},{"code":"450","type":"RC"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.0,"discounted_cash":769.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm","code_information":[{"code":"45000201","type":"CDM"},{"code":"450","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":2270.0,"discounted_cash":1906.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Same Phys/Qhp <5 Yrs","code_information":[{"code":"45000204","type":"CDM"},{"code":"450","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":893.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Same Phys/Qhp Initial 15 Mins 5/> Yrs","code_information":[{"code":"45000205","type":"CDM"},{"code":"450","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":1151.0,"discounted_cash":966.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Same Phys/Qhp Each Addl 15 Mins","code_information":[{"code":"45000206","type":"CDM"},{"code":"450","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Other Phys/Qhp Initial 15 Mins &Lt<5 Yrs","code_information":[{"code":"45000207","type":"CDM"},{"code":"450","type":"RC"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":1374.0,"discounted_cash":1154.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Other Phys/Qhp Initial 15 Mins 5/> Yrs","code_information":[{"code":"45000208","type":"CDM"},{"code":"450","type":"RC"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":1218.0,"discounted_cash":1023.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Other Phys/Qhp Each Addl 15 Mins","code_information":[{"code":"45000209","type":"CDM"},{"code":"450","type":"RC"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":551.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Debridement Subcutaneous Tissue 20 Sq Cm/&Lt;","code_information":[{"code":"45000210","type":"CDM"},{"code":"450","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":1245.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Repair Intermediate F/E/E/N/L&/Muc 7.6-12.5 Cm","code_information":[{"code":"45000211","type":"CDM"},{"code":"450","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":889.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Clsd Tx Shoulder Dislc W/Manipulation Req Anes","code_information":[{"code":"45000212","type":"CDM"},{"code":"450","type":"RC"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":6018.0,"discounted_cash":5055.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Artclr Fx Invg Mtcarphlngl/Iphal Jt W/Manj","code_information":[{"code":"45000213","type":"CDM"},{"code":"450","type":"RC"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":6501.0,"discounted_cash":5460.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx Spon Hip Dislc Abdct Splnt/Trcj W/Manj Anes","code_information":[{"code":"45000214","type":"CDM"},{"code":"450","type":"RC"},{"code":"27257","type":"HCPCS"}],"standard_charges":[{"gross_charge":6501.0,"discounted_cash":5460.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Post Hip Arthrp Dislc Req Anes","code_information":[{"code":"45000215","type":"CDM"},{"code":"450","type":"RC"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":6501.0,"discounted_cash":5460.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Trimalleolar Ankle Fx W/Manipulation","code_information":[{"code":"45000216","type":"CDM"},{"code":"450","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":6501.0,"discounted_cash":5460.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Control Nasal Hemorrhage Anterior Complex","code_information":[{"code":"45000217","type":"CDM"},{"code":"450","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":392.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Incision & Drainage Pilonidal Cyst Complicated","code_information":[{"code":"45000218","type":"CDM"},{"code":"450","type":"RC"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":2879.0,"discounted_cash":2418.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Treatment Closed Elbow Dislocation W/O Anes","code_information":[{"code":"45000219","type":"CDM"},{"code":"450","type":"RC"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":896.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insj Temp Ndwellg Bladder Catheter Complicated","code_information":[{"code":"45000220","type":"CDM"},{"code":"450","type":"RC"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":570.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Open Treatment Proximal Humeral Fracture","code_information":[{"code":"45000221","type":"CDM"},{"code":"450","type":"RC"},{"code":"23615","type":"HCPCS"}],"standard_charges":[{"gross_charge":40523.0,"discounted_cash":34039.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Hip Dislocation Traumatic Req Anesthesia","code_information":[{"code":"45000222","type":"CDM"},{"code":"450","type":"RC"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":3491.0,"discounted_cash":2932.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Post Hip Arthrp Dislc W/O Anes","code_information":[{"code":"45000223","type":"CDM"},{"code":"450","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":896.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Blepharotomy Drainage Abscess Eyelid","code_information":[{"code":"45000224","type":"CDM"},{"code":"450","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.0,"discounted_cash":1203.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":729.0,"discounted_cash":612.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc I&D Epididymis Tstis&/Scrotal Space","code_information":[{"code":"45000225","type":"CDM"},{"code":"450","type":"RC"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":8785.0,"discounted_cash":7379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 20.1-30.0Cm","code_information":[{"code":"45000226","type":"CDM"},{"code":"450","type":"RC"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":2270.0,"discounted_cash":1906.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1048.0,"discounted_cash":880.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc I&D Abscess Peritonsillar","code_information":[{"code":"45000227","type":"CDM"},{"code":"450","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":792.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Repair Intermediate S/A/T/E 20.1-30.0 Cm","code_information":[{"code":"45000228","type":"CDM"},{"code":"450","type":"RC"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1439.0,"discounted_cash":1208.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1295.0,"discounted_cash":1087.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Incision&Drainage Upper Arm/Elbow Bursa","code_information":[{"code":"45000229","type":"CDM"},{"code":"450","type":"RC"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":5241.0,"discounted_cash":4402.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Tx Radial&Ulnar Shaft Fractures W/Manj","code_information":[{"code":"45000230","type":"CDM"},{"code":"450","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2749.0,"discounted_cash":2309.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Fx Phlx/Phlg Oth/Thn Grt Toe W/Manj","code_information":[{"code":"45000231","type":"CDM"},{"code":"450","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":896.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":665.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Unlisted Procedure Abdomen Peritoneum & Omentum","code_information":[{"code":"45000232","type":"CDM"},{"code":"450","type":"RC"},{"code":"49999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2491.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Intrauterine Device Iud","code_information":[{"code":"45000233","type":"CDM"},{"code":"450","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1474.0,"discounted_cash":1238.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rmvl Fecal Impaction/Fb Spx Under Anes","code_information":[{"code":"45000234","type":"CDM"},{"code":"450","type":"RC"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":5474.0,"discounted_cash":4598.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Metatarsophlngl Jt Dislc Req Anes","code_information":[{"code":"45000235","type":"CDM"},{"code":"450","type":"RC"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":6507.0,"discounted_cash":5465.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Irrigation Corpora Cavernosa Priapism","code_information":[{"code":"45000236","type":"CDM"},{"code":"450","type":"RC"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.0,"discounted_cash":968.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Tarsal Dislc Oth/Thn Talotarsal W/Anes","code_information":[{"code":"45000237","type":"CDM"},{"code":"450","type":"RC"},{"code":"28545","type":"HCPCS"}],"standard_charges":[{"gross_charge":15197.0,"discounted_cash":12765.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drainage Abscess Palate Uvula","code_information":[{"code":"45000238","type":"CDM"},{"code":"450","type":"RC"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":926.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Tx Patellar Dislocation W/Anesthesia","code_information":[{"code":"45000240","type":"CDM"},{"code":"450","type":"RC"},{"code":"27562","type":"HCPCS"}],"standard_charges":[{"gross_charge":6516.0,"discounted_cash":5473.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tracheotomy Tube Change Prior To Fistula Tract","code_information":[{"code":"45000241","type":"CDM"},{"code":"450","type":"RC"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":792.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Njx C/P/A Cavernosa W/Pharmacologic Agt","code_information":[{"code":"45000242","type":"CDM"},{"code":"450","type":"RC"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.0,"discounted_cash":968.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Fx Grt Toe Phlx/Phlg W/Manj","code_information":[{"code":"45000243","type":"CDM"},{"code":"450","type":"RC"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.0,"discounted_cash":856.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Interphalangeal Joint Dislocation Req Anes","code_information":[{"code":"45000244","type":"CDM"},{"code":"450","type":"RC"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":945.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Simple Repair F/E/E/N/L/M 12.6Cm-20.0 Cm","code_information":[{"code":"45000245","type":"CDM"},{"code":"450","type":"RC"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":2047.0,"discounted_cash":1719.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Tx Talus Fracture W/Manipulation","code_information":[{"code":"45000246","type":"CDM"},{"code":"450","type":"RC"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":6208.0,"discounted_cash":5214.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Repair Complex F/C/C/M/N/Ax/G/H/F Ea Addl 5 Cm/&Lt;","code_information":[{"code":"45000247","type":"CDM"},{"code":"450","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.0,"discounted_cash":1186.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drainage Scrotal Wall Abscess","code_information":[{"code":"45000248","type":"CDM"},{"code":"450","type":"RC"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":6306.0,"discounted_cash":5297.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aspiration Bladder Insert Suprapubic Catheter","code_information":[{"code":"45000249","type":"CDM"},{"code":"450","type":"RC"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":7731.0,"discounted_cash":6494.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":5097.0,"discounted_cash":4281.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Amp F/Th 1/2 Jt/Phalanx W/Neurect W/Dir Clsr","code_information":[{"code":"45000250","type":"CDM"},{"code":"450","type":"RC"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":12438.0,"discounted_cash":10447.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Trans-Scaphoprilunar Typ Fx Dislc W/Manj","code_information":[{"code":"45000251","type":"CDM"},{"code":"450","type":"RC"},{"code":"25680","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.0,"discounted_cash":856.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Simple Repair Scalp/Neck/Ax/Genit/Trunk >30.0Cm","code_information":[{"code":"45000252","type":"CDM"},{"code":"450","type":"RC"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":2755.0,"discounted_cash":2314.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Ankle Dislc Req Anes W/Wo Prq Skel Fixj","code_information":[{"code":"45000253","type":"CDM"},{"code":"450","type":"RC"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":7054.0,"discounted_cash":5925.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Amp F/Th 1/2 Jt/Phalanx W/Neurect Local Flap","code_information":[{"code":"45000254","type":"CDM"},{"code":"450","type":"RC"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":13817.0,"discounted_cash":11606.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Tx Carpal Scaphoid Fracture W/Manj","code_information":[{"code":"45000255","type":"CDM"},{"code":"450","type":"RC"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":7054.0,"discounted_cash":5925.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Open Tx Distal Phalangeal Fracture Each","code_information":[{"code":"45000256","type":"CDM"},{"code":"450","type":"RC"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":14338.0,"discounted_cash":12043.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":6952.0,"discounted_cash":5839.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Cltx Metacarpophalangeal Dislc W/Manj W/Anes","code_information":[{"code":"45000257","type":"CDM"},{"code":"450","type":"RC"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":7318.0,"discounted_cash":6147.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Implantable Contraceptive Capsules","code_information":[{"code":"45000258","type":"CDM"},{"code":"450","type":"RC"},{"code":"11976","type":"HCPCS"}],"standard_charges":[{"gross_charge":3104.0,"discounted_cash":2607.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cysto W/Simple Removal Stone & Stent","code_information":[{"code":"45000259","type":"CDM"},{"code":"450","type":"RC"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":8063.0,"discounted_cash":6772.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Foreign Body Pharynx","code_information":[{"code":"45000260","type":"CDM"},{"code":"450","type":"RC"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":1723.0,"discounted_cash":1447.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Carpo/Metacarpl Dislc Thmb Manj Ea W/O Anes","code_information":[{"code":"45000262","type":"CDM"},{"code":"450","type":"RC"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1122.0,"discounted_cash":942.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perq Replacement Gtube Not Req Revj Gstrst Trc","code_information":[{"code":"45000263","type":"CDM"},{"code":"450","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":1012.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":530.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Perq Replacement Gtube Req Revj Gstrst Trc","code_information":[{"code":"45000264","type":"CDM"},{"code":"450","type":"RC"},{"code":"43763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":1012.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Skn Tags Mlt Fibrq Tags Any Area Upw/15","code_information":[{"code":"45000265","type":"CDM"},{"code":"450","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":771.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx Tarsal Bone Fx Xcp Talus&Calcn W/O Manj","code_information":[{"code":"45000266","type":"CDM"},{"code":"450","type":"RC"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.0,"discounted_cash":981.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":620.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Closed Tx Ankle Dislocation W/O Anesthesia","code_information":[{"code":"45000267","type":"CDM"},{"code":"450","type":"RC"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.0,"discounted_cash":981.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Replantation Digit Complete","code_information":[{"code":"45000268","type":"CDM"},{"code":"450","type":"RC"},{"code":"20822","type":"HCPCS"}],"standard_charges":[{"gross_charge":5206.0,"discounted_cash":4373.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Simple Repair F/E/E/N/L/M 20.1Cm-30.0 Cm","code_information":[{"code":"45000269","type":"CDM"},{"code":"450","type":"RC"},{"code":"12017","type":"HCPCS"}],"standard_charges":[{"gross_charge":2429.0,"discounted_cash":2040.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insj Non-Biodegradable Drug Delivery Implant","code_information":[{"code":"45000270","type":"CDM"},{"code":"450","type":"RC"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":622.0,"discounted_cash":522.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Intrauterine Device Iud","code_information":[{"code":"45000271","type":"CDM"},{"code":"450","type":"RC"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":4498.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tracheostomy Emergency Procedure Transtracheal","code_information":[{"code":"45000272","type":"CDM"},{"code":"450","type":"RC"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":5070.0,"discounted_cash":4258.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Application Finger Splint Dynamic","code_information":[{"code":"45000274","type":"CDM"},{"code":"450","type":"RC"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Exc Thrombosed Hemorrhoid Xtrnl","code_information":[{"code":"45000279","type":"CDM"},{"code":"450","type":"RC"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":5713.0,"discounted_cash":4798.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2535.0,"discounted_cash":2129.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Pericardiocentesis W/Imaging","code_information":[{"code":"45000280","type":"CDM"},{"code":"450","type":"RC"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":7873.0,"discounted_cash":6613.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cysto Calibration Dilat Urtl Strix/Stenosis","code_information":[{"code":"45000281","type":"CDM"},{"code":"450","type":"RC"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":9135.0,"discounted_cash":7673.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rpr Lac 2.5 Cm/< Pst One-Third Tongue","code_information":[{"code":"45000282","type":"CDM"},{"code":"450","type":"RC"},{"code":"41251","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.0,"discounted_cash":968.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Unlisted Procedure Pharynx Adenoids/Tonsils","code_information":[{"code":"45000283","type":"CDM"},{"code":"450","type":"RC"},{"code":"42999","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.0,"discounted_cash":756.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fine Needle Aspiration Bx W/O Img Gdn 1St Lesion","code_information":[{"code":"45000284","type":"CDM"},{"code":"450","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1809.0,"discounted_cash":1519.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Chem Caut Of Granltj Tissue","code_information":[{"code":"45000285","type":"CDM"},{"code":"450","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":493.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":430.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Abdom Paracentesis Dx/Ther W/Imaging Guidance","code_information":[{"code":"45000287","type":"CDM"},{"code":"450","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1958.0,"discounted_cash":1644.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Abdom Paracentesis Dx/Ther W/O Imaging Guidance","code_information":[{"code":"45000288","type":"CDM"},{"code":"450","type":"RC"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":3532.0,"discounted_cash":2966.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Peritoneal Lavage W/Wo Imaging Guidance","code_information":[{"code":"45000289","type":"CDM"},{"code":"450","type":"RC"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":3532.0,"discounted_cash":2966.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Casirivi And Imdevi Infusion","code_information":[{"code":"45000290","type":"CDM"},{"code":"940","type":"RC"},{"code":"M0243","type":"HCPCS"}],"standard_charges":[{"gross_charge":1506.0,"discounted_cash":1265.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Canthotomy Separate Procedure","code_information":[{"code":"45000291","type":"CDM"},{"code":"450","type":"RC"},{"code":"67715","type":"HCPCS"}],"standard_charges":[{"gross_charge":9351.0,"discounted_cash":7854.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Rpr Lip Full Thickness Half/< Vertical Height","code_information":[{"code":"45000292","type":"CDM"},{"code":"450","type":"RC"},{"code":"40652","type":"HCPCS"}],"standard_charges":[{"gross_charge":2355.0,"discounted_cash":1978.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Im Adm Intransl/Oral 1 Vaccine","code_information":[{"code":"45000293","type":"CDM"},{"code":"450","type":"RC"},{"code":"90473","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":215.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Im Adm Intransl/Oral Ea Addl Vaccine","code_information":[{"code":"45000294","type":"CDM"},{"code":"450","type":"RC"},{"code":"90474","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Bamlan And Etesev Infusion","code_information":[{"code":"45000295","type":"CDM"},{"code":"450","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.0,"discounted_cash":1054.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Cltx Shoulder Dislc W/Surg/Antmcl Neck Fx W/Manj","code_information":[{"code":"45000296","type":"CDM"},{"code":"450","type":"RC"},{"code":"23675","type":"HCPCS"}],"standard_charges":[{"gross_charge":7244.0,"discounted_cash":6084.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Perq Drainage Pleura Insert Cath W/O Imaging","code_information":[{"code":"45000297","type":"CDM"},{"code":"450","type":"RC"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":8454.0,"discounted_cash":7101.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Cystourethroscopy","code_information":[{"code":"45000298","type":"CDM"},{"code":"450","type":"RC"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2722.0,"discounted_cash":2286.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closed Tx Radial Head/Neck Fx W/Manipulation","code_information":[{"code":"45000299","type":"CDM"},{"code":"450","type":"RC"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":7244.0,"discounted_cash":6084.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Facial","code_information":[{"code":"45000300","type":"CDM"},{"code":"450","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thrombolysis Cerebral Iv Infusion","code_information":[{"code":"45000301","type":"CDM"},{"code":"450","type":"RC"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":1173.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intro Any Hemostatic Agent/Pack Vag Hemrrg Spx","code_information":[{"code":"45000302","type":"CDM"},{"code":"450","type":"RC"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":885.0,"discounted_cash":743.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Rmvl Embedded Fb Vestibule Mouth Smpl","code_information":[{"code":"45000303","type":"CDM"},{"code":"450","type":"RC"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":3649.0,"discounted_cash":3065.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2398.0,"discounted_cash":2014.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc  Excision Lesion Conjunctiva </1 Cm","code_information":[{"code":"45000304","type":"CDM"},{"code":"450","type":"RC"},{"code":"68110","type":"HCPCS"}],"standard_charges":[{"gross_charge":8595.0,"discounted_cash":7219.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Repair Complex Trunk 2.6-7.5 Cm","code_information":[{"code":"45000305","type":"CDM"},{"code":"450","type":"RC"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":2364.0,"discounted_cash":1985.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1770.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc  Cltx Fx W8 Brg Artclr Prtn Dstl Tib W/Skel Tracj","code_information":[{"code":"45000306","type":"CDM"},{"code":"450","type":"RC"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":5274.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Closed Tx Femoral Shaft Fx W/O Manipulation","code_information":[{"code":"45000308","type":"CDM"},{"code":"450","type":"RC"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":780.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Cltx Fem Shft Fx W/Manj W/Wo Skin/Skeletal Tracj","code_information":[{"code":"45000309","type":"CDM"},{"code":"450","type":"RC"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":5977.0,"discounted_cash":5020.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Cltx Medial Malls Fx W/Manj W/Wo Skn/Skel Tracj","code_information":[{"code":"45000310","type":"CDM"},{"code":"450","type":"RC"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":5274.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Cltx Tibial Shaft Fx W/Manj W/Wo Skel Tracj","code_information":[{"code":"45000312","type":"CDM"},{"code":"450","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":5274.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Cltx Acetabulm Hip/Sockt Fx Manj W/Wo Skel Tracj","code_information":[{"code":"45000313","type":"CDM"},{"code":"450","type":"RC"},{"code":"27222","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.0,"discounted_cash":742.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Metacarpophalangeal Dislc W/Manj W/O Anes","code_information":[{"code":"45000314","type":"CDM"},{"code":"450","type":"RC"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":780.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Repair Intermediate N/H/F/Xtrnl Gent 12.6-20 Cm","code_information":[{"code":"45000315","type":"CDM"},{"code":"450","type":"RC"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":2364.0,"discounted_cash":1985.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Closed Treatment Nasal Fracture W/Stabilization","code_information":[{"code":"45000316","type":"CDM"},{"code":"450","type":"RC"},{"code":"21320","type":"HCPCS"}],"standard_charges":[{"gross_charge":11864.0,"discounted_cash":9965.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Thoracotomy W/Cardiac Massage","code_information":[{"code":"45000317","type":"CDM"},{"code":"450","type":"RC"},{"code":"32160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2324.0,"discounted_cash":1952.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Insertion Catheter Artery","code_information":[{"code":"45000318","type":"CDM"},{"code":"450","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":414.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Twist Drill Hole Subdural/Ventricular Puncture","code_information":[{"code":"45000319","type":"CDM"},{"code":"450","type":"RC"},{"code":"61105","type":"HCPCS"}],"standard_charges":[{"gross_charge":1855.0,"discounted_cash":1558.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Twist Drill Hole Evac&/Drg Subdural Hematoma","code_information":[{"code":"45000320","type":"CDM"},{"code":"450","type":"RC"},{"code":"61108","type":"HCPCS"}],"standard_charges":[{"gross_charge":1855.0,"discounted_cash":1558.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Shoulder Dislc W/Fx Humeral Tubrst W/Manj","code_information":[{"code":"45000321","type":"CDM"},{"code":"450","type":"RC"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":6314.0,"discounted_cash":5303.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx Incomplete Abortion Any Trimester Surgical","code_information":[{"code":"45000322","type":"CDM"},{"code":"450","type":"RC"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":11895.0,"discounted_cash":9991.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc I&D Deep Absc/Hmtma Soft Tissue Neck/Thorax","code_information":[{"code":"45000323","type":"CDM"},{"code":"450","type":"RC"},{"code":"21501","type":"HCPCS"}],"standard_charges":[{"gross_charge":10749.0,"discounted_cash":9029.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Im Adm Thru 18Yr Any Rte 1St/Only Compt Vac/Tox","code_information":[{"code":"45000324","type":"CDM"},{"code":"450","type":"RC"},{"code":"90460","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Im Adm Thru 18Yr Any Rte Addl Vac/Tox Compt","code_information":[{"code":"45000325","type":"CDM"},{"code":"450","type":"RC"},{"code":"90461","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Sprcndylr/Transcndylr Humeral Fx W/Wo Manj","code_information":[{"code":"45000326","type":"CDM"},{"code":"450","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":746.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":665.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":506.0,"discounted_cash":425.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Manipulation Tmj Therapeutic Require Anesthesia","code_information":[{"code":"45000327","type":"CDM"},{"code":"450","type":"RC"},{"code":"21073","type":"HCPCS"}],"standard_charges":[{"gross_charge":5560.0,"discounted_cash":4670.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Tibial Fx Proximal W/Wo Manj W/Skel Tracj","code_information":[{"code":"45000328","type":"CDM"},{"code":"450","type":"RC"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":12104.0,"discounted_cash":10167.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7251.0,"discounted_cash":6090.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc \tRdctj Torsion Tstis W/Wo Fixj Clat Testis","code_information":[{"code":"45000329","type":"CDM"},{"code":"450","type":"RC"},{"code":"54600","type":"HCPCS"}],"standard_charges":[{"gross_charge":12406.0,"discounted_cash":10421.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Expl W/Removal Deep Foreign Body Forearm/Wrist","code_information":[{"code":"45000330","type":"CDM"},{"code":"450","type":"RC"},{"code":"25248","type":"HCPCS"}],"standard_charges":[{"gross_charge":5832.0,"discounted_cash":4898.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4166.0,"discounted_cash":3499.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Removal Foreign Body Foot Deep","code_information":[{"code":"45000331","type":"CDM"},{"code":"450","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":6097.0,"discounted_cash":5121.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4354.0,"discounted_cash":3657.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc \tDrainage Finger Abscess Complicated","code_information":[{"code":"45000332","type":"CDM"},{"code":"450","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":6399.0,"discounted_cash":5375.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4057.0,"discounted_cash":3407.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Osteopathic Manipulative Tx 1-2 Body Regions","code_information":[{"code":"45000334","type":"CDM"},{"code":"450","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Rpr Intermediate N/H/F/Xtrnl Gent 20.1-30.0 Cm","code_information":[{"code":"45000335","type":"CDM"},{"code":"450","type":"RC"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":2478.0,"discounted_cash":2081.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Repair Intermediate N/H/F/Xtrnl Gent >30.0 Cm","code_information":[{"code":"45000336","type":"CDM"},{"code":"450","type":"RC"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":7197.0,"discounted_cash":6045.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tis Trnfr E/N/E/L 10 Sq Cm/<","code_information":[{"code":"45000337","type":"CDM"},{"code":"450","type":"RC"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":6851.0,"discounted_cash":5754.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Treat Elbow Fracture","code_information":[{"code":"45000338","type":"CDM"},{"code":"450","type":"RC"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":6343.0,"discounted_cash":5328.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Sprcndylr/Transcndylr Humeral Fx W/Manj","code_information":[{"code":"45000339","type":"CDM"},{"code":"450","type":"RC"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":6342.0,"discounted_cash":5327.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tracheostomy Emergency Cricothyroid Membrane","code_information":[{"code":"45000340","type":"CDM"},{"code":"450","type":"RC"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":771.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rpr Blood Vessel Direct Lower Extremity","code_information":[{"code":"45000341","type":"CDM"},{"code":"450","type":"RC"},{"code":"35226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2643.0,"discounted_cash":2220.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Closure Laceration Vestibule Mouth 2.5 Cm/<","code_information":[{"code":"45000342","type":"CDM"},{"code":"450","type":"RC"},{"code":"40830","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":577.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Rmvl Foreign Body Muscle/Tendon Sheath Deep/Comp","code_information":[{"code":"45000343","type":"CDM"},{"code":"450","type":"RC"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":6728.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Rpr Lip Fth Over One-Half Vert Height/Complex","code_information":[{"code":"45000344","type":"CDM"},{"code":"450","type":"RC"},{"code":"40654","type":"HCPCS"}],"standard_charges":[{"gross_charge":6018.0,"discounted_cash":5055.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dcmprn Fasct F/Arm&/Wrst Flxr&Xtnsr W/O Db","code_information":[{"code":"45000345","type":"CDM"},{"code":"450","type":"RC"},{"code":"25024","type":"HCPCS"}],"standard_charges":[{"gross_charge":12774.0,"discounted_cash":10730.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Repair Blood Vessel Direct Upper Extremity","code_information":[{"code":"45000346","type":"CDM"},{"code":"450","type":"RC"},{"code":"35206","type":"HCPCS"}],"standard_charges":[{"gross_charge":11974.0,"discounted_cash":10058.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc \tDrg Absc Submaxillary/Sublingual Intraoral","code_information":[{"code":"45000347","type":"CDM"},{"code":"450","type":"RC"},{"code":"42310","type":"HCPCS"}],"standard_charges":[{"gross_charge":2068.0,"discounted_cash":1737.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc \tThoracostomy Open Flap Drainage Empyema","code_information":[{"code":"45000348","type":"CDM"},{"code":"450","type":"RC"},{"code":"32036","type":"HCPCS"}],"standard_charges":[{"gross_charge":2324.0,"discounted_cash":1952.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cltx Carpo/Metacarpal Dislocation Thumb W/Manj","code_information":[{"code":"45000350","type":"CDM"},{"code":"450","type":"RC"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.0,"discounted_cash":562.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"}]},{"description":"Hc Ed Level 0","code_information":[{"code":"45100000","type":"CDM"},{"code":"451","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":425.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 15 To 29 Min","code_information":[{"code":"45600001","type":"CDM"},{"code":"456","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":320.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 30-44 Min","code_information":[{"code":"45600002","type":"CDM"},{"code":"456","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":432.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 45-59 Min","code_information":[{"code":"45600003","type":"CDM"},{"code":"456","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Spirometry Simple Or Bedside","code_information":[{"code":"46000000","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":383.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Spirometry Pre And Post","code_information":[{"code":"46000001","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":733.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Spirometry Multiple W Admin Agnts","code_information":[{"code":"46000002","type":"CDM"},{"code":"460","type":"RC"},{"code":"94070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1130.0,"discounted_cash":949.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pulm Funct Tst Plethysmograp","code_information":[{"code":"46000004","type":"CDM"},{"code":"460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":309.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pulm Function Test By Gas","code_information":[{"code":"46000005","type":"CDM"},{"code":"460","type":"RC"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":301.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C02/Membane Diffuse Capacity","code_information":[{"code":"46000006","type":"CDM"},{"code":"460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":356.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc O2 Protocol Spot Check","code_information":[{"code":"46000007","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Measure Blood Oxygen Level; Multiple","code_information":[{"code":"46000008","type":"CDM"},{"code":"460","type":"RC"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":224.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Measure Blood Oxygen Level; Cont Overnight Monitoring","code_information":[{"code":"46000009","type":"CDM"},{"code":"460","type":"RC"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Extubation Of Airway","code_information":[{"code":"46000011","type":"CDM"},{"code":"460","type":"RC"},{"code":"94799","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nitric Oxide Expired Gas Determ","code_information":[{"code":"46000012","type":"CDM"},{"code":"460","type":"RC"},{"code":"95012","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":98.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pulse Ox Spot Check","code_information":[{"code":"46000014","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Incentive Spirometry","code_information":[{"code":"46000015","type":"CDM"},{"code":"460","type":"RC"},{"code":"94799","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Peak Flow Measurements Pre/Post","code_information":[{"code":"46000016","type":"CDM"},{"code":"460","type":"RC"},{"code":"94799","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tracheostomy Tube Care","code_information":[{"code":"46000017","type":"CDM"},{"code":"460","type":"RC"},{"code":"94799","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Exercise Test For Bronchospasm","code_information":[{"code":"46000018","type":"CDM"},{"code":"460","type":"RC"},{"code":"94617","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":477.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pulmonary Stress Testing","code_information":[{"code":"46000019","type":"CDM"},{"code":"460","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":477.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Noninvasive Ear/Pulse Ox Single Deter Pre-Op","code_information":[{"code":"46900000","type":"CDM"},{"code":"469","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Aep Scr Auditory Potential W/Stimuli Auto Alys","code_information":[{"code":"47100001","type":"CDM"},{"code":"471","type":"RC"},{"code":"92650","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":654.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Heart/Lung Resuscitation Cpr","code_information":[{"code":"48000000","type":"CDM"},{"code":"480","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"discounted_cash":763.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cardioversion Electrical Ext","code_information":[{"code":"48000001","type":"CDM"},{"code":"480","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":2228.0,"discounted_cash":1871.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echo Peds Complete","code_information":[{"code":"48000002","type":"CDM"},{"code":"480","type":"RC"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1709.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echo Peds Fu/Limited","code_information":[{"code":"48000003","type":"CDM"},{"code":"480","type":"RC"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":856.0,"discounted_cash":719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echo 2D W/ Doppler & Color Flow; Complete","code_information":[{"code":"48000004","type":"CDM"},{"code":"480","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":3305.0,"discounted_cash":2776.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echo 2D W/O Doppler & Color Flow; Complete","code_information":[{"code":"48000005","type":"CDM"},{"code":"480","type":"RC"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1578.0,"discounted_cash":1325.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echo 2D Fu/Limited","code_information":[{"code":"48000006","type":"CDM"},{"code":"480","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":903.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echo Transesophageal (Tee)","code_information":[{"code":"48000007","type":"CDM"},{"code":"480","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":2955.0,"discounted_cash":2482.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echo Cardiac Doppler; Complete","code_information":[{"code":"48000008","type":"CDM"},{"code":"480","type":"RC"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":839.0,"discounted_cash":704.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echo Cardiac Doppler; Fu/Limited","code_information":[{"code":"48000009","type":"CDM"},{"code":"480","type":"RC"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":723.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echo Cardiac Doppler Color Flow Add-On","code_information":[{"code":"48000010","type":"CDM"},{"code":"480","type":"RC"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":604.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Stress Tte Only","code_information":[{"code":"48000011","type":"CDM"},{"code":"480","type":"RC"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1188.0,"discounted_cash":997.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Stress Tte Complete","code_information":[{"code":"48000012","type":"CDM"},{"code":"480","type":"RC"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":1811.0,"discounted_cash":1521.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Electrophysiology Evaluation","code_information":[{"code":"48000014","type":"CDM"},{"code":"480","type":"RC"},{"code":"93642","type":"HCPCS"}],"standard_charges":[{"gross_charge":4270.0,"discounted_cash":3586.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tilt Table Evaluation","code_information":[{"code":"48000015","type":"CDM"},{"code":"480","type":"RC"},{"code":"93660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":1133.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1080.0,"discounted_cash":907.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Tte W Or Wo Fol Wcon,Doppler","code_information":[{"code":"48000016","type":"CDM"},{"code":"480","type":"RC"},{"code":"C8929","type":"HCPCS"}],"standard_charges":[{"gross_charge":2401.0,"discounted_cash":2016.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tte Congenital Complete With Contrast","code_information":[{"code":"48000017","type":"CDM"},{"code":"480","type":"RC"},{"code":"C8921","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":2086.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tte Congenital Follow Up Or Limited With Contrast","code_information":[{"code":"48000018","type":"CDM"},{"code":"480","type":"RC"},{"code":"C8922","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":2086.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tte Complete W/O Doppler, Cf With Contrast","code_information":[{"code":"48000019","type":"CDM"},{"code":"480","type":"RC"},{"code":"C8923","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":2086.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tte Follow Up Or Limited With Contrast","code_information":[{"code":"48000020","type":"CDM"},{"code":"480","type":"RC"},{"code":"C8924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1662.0,"discounted_cash":1396.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tee Placement, Acq, Inter, Report With Contrast","code_information":[{"code":"48000021","type":"CDM"},{"code":"480","type":"RC"},{"code":"C8925","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":2086.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tee Congenital Placement, Image, Inter, Report With Contrast","code_information":[{"code":"48000022","type":"CDM"},{"code":"480","type":"RC"},{"code":"C8926","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":2086.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tee Monitor, Placement, Acq, Inter, W/ Contrast","code_information":[{"code":"48000023","type":"CDM"},{"code":"480","type":"RC"},{"code":"C8927","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":2086.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Stress Tte (No Ecg Monitoring) With Contrast","code_information":[{"code":"48000024","type":"CDM"},{"code":"480","type":"RC"},{"code":"C8928","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":2086.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Stress Tte (With Ecg Monitoring ) With Contrast","code_information":[{"code":"48000025","type":"CDM"},{"code":"480","type":"RC"},{"code":"C8930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":2086.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Ephys Eval Subq Implantable Defibrillator","code_information":[{"code":"48000027","type":"CDM"},{"code":"480","type":"RC"},{"code":"93644","type":"HCPCS"}],"standard_charges":[{"gross_charge":2578.0,"discounted_cash":2165.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intracard Echocard W/Ther/Dx Ivntj Incl Img S&I","code_information":[{"code":"48000028","type":"CDM"},{"code":"480","type":"RC"},{"code":"93662","type":"HCPCS"}],"standard_charges":[{"gross_charge":5977.0,"discounted_cash":5020.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tmvi W/Prosthetic Valve Percutaneous Approach","code_information":[{"code":"48000030","type":"CDM"},{"code":"480","type":"RC"},{"code":"0483T","type":"HCPCS"}],"standard_charges":[{"gross_charge":20540.0,"discounted_cash":17253.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tmvi W/Prosthetic Valve Transthoracic Exposure","code_information":[{"code":"48000031","type":"CDM"},{"code":"480","type":"RC"},{"code":"0484T","type":"HCPCS"}],"standard_charges":[{"gross_charge":26000.0,"discounted_cash":21840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Heart Pm Atrial","code_information":[{"code":"48100001","type":"CDM"},{"code":"481","type":"RC"},{"code":"33206","type":"HCPCS"}],"standard_charges":[{"gross_charge":28510.0,"discounted_cash":23948.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert/Repl Perm Pacer W/Ventricular","code_information":[{"code":"48100002","type":"CDM"},{"code":"481","type":"RC"},{"code":"33207","type":"HCPCS"}],"standard_charges":[{"gross_charge":33515.0,"discounted_cash":28152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert/Repl Perm Pacemaker W/Atrial And Ventricular","code_information":[{"code":"48100003","type":"CDM"},{"code":"481","type":"RC"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":40077.0,"discounted_cash":33664.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Electrd/Pm Cath Sngl","code_information":[{"code":"48100004","type":"CDM"},{"code":"481","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":11735.0,"discounted_cash":9857.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Kcc Reposition Pacer Lead 33215","code_information":[{"code":"48100005","type":"CDM"},{"code":"481","type":"RC"},{"code":"33215","type":"HCPCS"}],"standard_charges":[{"gross_charge":11000.0,"discounted_cash":9240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert 1 Electrode Pm-Defibrillator","code_information":[{"code":"48100006","type":"CDM"},{"code":"481","type":"RC"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":14386.0,"discounted_cash":12084.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert 2 Electrode Pm-Defibrillator","code_information":[{"code":"48100007","type":"CDM"},{"code":"481","type":"RC"},{"code":"33217","type":"HCPCS"}],"standard_charges":[{"gross_charge":14386.0,"discounted_cash":12084.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Pm Pulse Gen Mult Leads","code_information":[{"code":"48100008","type":"CDM"},{"code":"481","type":"RC"},{"code":"33221","type":"HCPCS"}],"standard_charges":[{"gross_charge":28642.0,"discounted_cash":24059.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Relocate Skin Pocket For Pacemaker","code_information":[{"code":"48100009","type":"CDM"},{"code":"481","type":"RC"},{"code":"33222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3915.0,"discounted_cash":3288.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Relocate Skin Pocket For Defibrillator","code_information":[{"code":"48100010","type":"CDM"},{"code":"481","type":"RC"},{"code":"33223","type":"HCPCS"}],"standard_charges":[{"gross_charge":4682.0,"discounted_cash":3932.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Pacing Lead & Connect","code_information":[{"code":"48100011","type":"CDM"},{"code":"481","type":"RC"},{"code":"33224","type":"HCPCS"}],"standard_charges":[{"gross_charge":48949.0,"discounted_cash":41117.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Left Ventricular Pacing Lead Add-On","code_information":[{"code":"48100012","type":"CDM"},{"code":"481","type":"RC"},{"code":"33225","type":"HCPCS"}],"standard_charges":[{"gross_charge":57542.0,"discounted_cash":48335.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Reposition Left Ventricular Lead","code_information":[{"code":"48100013","type":"CDM"},{"code":"481","type":"RC"},{"code":"33226","type":"HCPCS"}],"standard_charges":[{"gross_charge":5652.0,"discounted_cash":4747.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove&Replace Pm Gen Singl","code_information":[{"code":"48100014","type":"CDM"},{"code":"481","type":"RC"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":26985.0,"discounted_cash":22667.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remv&Replc Pm Generator Dual Lead","code_information":[{"code":"48100015","type":"CDM"},{"code":"481","type":"RC"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":34790.0,"discounted_cash":29223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remv&Replc Pm Gen Mult Leads","code_information":[{"code":"48100016","type":"CDM"},{"code":"481","type":"RC"},{"code":"33229","type":"HCPCS"}],"standard_charges":[{"gross_charge":29594.0,"discounted_cash":24858.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insrt Pulse Gen W/Mult Leads","code_information":[{"code":"48100017","type":"CDM"},{"code":"481","type":"RC"},{"code":"33231","type":"HCPCS"}],"standard_charges":[{"gross_charge":97820.0,"discounted_cash":82168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Of Pm Generator","code_information":[{"code":"48100018","type":"CDM"},{"code":"481","type":"RC"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":21667.0,"discounted_cash":18200.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Of Pacemaker System","code_information":[{"code":"48100019","type":"CDM"},{"code":"481","type":"RC"},{"code":"33234","type":"HCPCS"}],"standard_charges":[{"gross_charge":6905.0,"discounted_cash":5800.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove Pulse Generator","code_information":[{"code":"48100020","type":"CDM"},{"code":"481","type":"RC"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":6905.0,"discounted_cash":5800.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove Elctrd Transvenously","code_information":[{"code":"48100021","type":"CDM"},{"code":"481","type":"RC"},{"code":"33244","type":"HCPCS"}],"standard_charges":[{"gross_charge":6235.0,"discounted_cash":5237.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insj/Rplcmt Defib W/Lead(S)","code_information":[{"code":"48100022","type":"CDM"},{"code":"481","type":"RC"},{"code":"33249","type":"HCPCS"}],"standard_charges":[{"gross_charge":116248.0,"discounted_cash":97648.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rmvl& Replc Pulse Gen 1 Lead","code_information":[{"code":"48100023","type":"CDM"},{"code":"481","type":"RC"},{"code":"33262","type":"HCPCS"}],"standard_charges":[{"gross_charge":97820.0,"discounted_cash":82168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rmvl & Rplcmt Dfb Gen 2 Lead","code_information":[{"code":"48100024","type":"CDM"},{"code":"481","type":"RC"},{"code":"33263","type":"HCPCS"}],"standard_charges":[{"gross_charge":114995.0,"discounted_cash":96595.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rmvl & Rplcmt Dfb Gen Mlt Ld","code_information":[{"code":"48100025","type":"CDM"},{"code":"481","type":"RC"},{"code":"33264","type":"HCPCS"}],"standard_charges":[{"gross_charge":114995.0,"discounted_cash":96595.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ins/Rep Subq Defibrillator","code_information":[{"code":"48100026","type":"CDM"},{"code":"481","type":"RC"},{"code":"33270","type":"HCPCS"}],"standard_charges":[{"gross_charge":101974.0,"discounted_cash":85658.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert I-Aort Percut Device","code_information":[{"code":"48100029","type":"CDM"},{"code":"481","type":"RC"},{"code":"33967","type":"HCPCS"}],"standard_charges":[{"gross_charge":5123.0,"discounted_cash":4303.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cath Access-Aorta","code_information":[{"code":"48100032","type":"CDM"},{"code":"481","type":"RC"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2541.0,"discounted_cash":2134.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thoracic/Brachiocephalic 1St Ord","code_information":[{"code":"48100033","type":"CDM"},{"code":"481","type":"RC"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":2939.0,"discounted_cash":2468.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thoracic/Brachiocephalic 2Nd Ord","code_information":[{"code":"48100034","type":"CDM"},{"code":"481","type":"RC"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":2797.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Place Cath Thoracic Aorta","code_information":[{"code":"48100035","type":"CDM"},{"code":"481","type":"RC"},{"code":"36221","type":"HCPCS"}],"standard_charges":[{"gross_charge":7368.0,"discounted_cash":6189.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Place Cath Carotid/Inom Art","code_information":[{"code":"48100036","type":"CDM"},{"code":"481","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":7368.0,"discounted_cash":6189.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Place Cath Subclavian Art","code_information":[{"code":"48100037","type":"CDM"},{"code":"481","type":"RC"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":7368.0,"discounted_cash":6189.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ins Cath Abd/L-Ext Art 1St","code_information":[{"code":"48100038","type":"CDM"},{"code":"481","type":"RC"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":3541.0,"discounted_cash":2974.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ins Cath Abd/L-Extremity Artery 2Nd","code_information":[{"code":"48100039","type":"CDM"},{"code":"481","type":"RC"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":3486.0,"discounted_cash":2928.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ins Cath Abd/L-Extremity Artery 3Rd","code_information":[{"code":"48100040","type":"CDM"},{"code":"481","type":"RC"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":4282.0,"discounted_cash":3596.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ins Cath Renal Artery 1St Unilateral","code_information":[{"code":"48100041","type":"CDM"},{"code":"481","type":"RC"},{"code":"36251","type":"HCPCS"}],"standard_charges":[{"gross_charge":9560.0,"discounted_cash":8030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ins Cath Ren Art 1St Bilat","code_information":[{"code":"48100042","type":"CDM"},{"code":"481","type":"RC"},{"code":"36252","type":"HCPCS"}],"standard_charges":[{"gross_charge":7390.0,"discounted_cash":6207.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ins Cath Ren Art 2Nd+ Bilat","code_information":[{"code":"48100043","type":"CDM"},{"code":"481","type":"RC"},{"code":"36254","type":"HCPCS"}],"standard_charges":[{"gross_charge":7390.0,"discounted_cash":6207.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prim Art Mech Thrombectomy","code_information":[{"code":"48100044","type":"CDM"},{"code":"481","type":"RC"},{"code":"37184","type":"HCPCS"}],"standard_charges":[{"gross_charge":29606.0,"discounted_cash":24869.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thrombolytic Art Therapy","code_information":[{"code":"48100045","type":"CDM"},{"code":"481","type":"RC"},{"code":"37211","type":"HCPCS"}],"standard_charges":[{"gross_charge":14063.0,"discounted_cash":11812.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transcath Stent Cca W/Eps","code_information":[{"code":"48100046","type":"CDM"},{"code":"481","type":"RC"},{"code":"37215","type":"HCPCS"}],"standard_charges":[{"gross_charge":12949.0,"discounted_cash":10877.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iliac Revasc","code_information":[{"code":"48100047","type":"CDM"},{"code":"481","type":"RC"},{"code":"37220","type":"HCPCS"}],"standard_charges":[{"gross_charge":13438.0,"discounted_cash":11287.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iliac Revasc W/Stent","code_information":[{"code":"48100048","type":"CDM"},{"code":"481","type":"RC"},{"code":"37221","type":"HCPCS"}],"standard_charges":[{"gross_charge":30861.0,"discounted_cash":25923.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iliac Revasc W/Stent Add-On","code_information":[{"code":"48100049","type":"CDM"},{"code":"481","type":"RC"},{"code":"37223","type":"HCPCS"}],"standard_charges":[{"gross_charge":17279.0,"discounted_cash":14514.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fem/Popl Revas W/Tla","code_information":[{"code":"48100050","type":"CDM"},{"code":"481","type":"RC"},{"code":"37224","type":"HCPCS"}],"standard_charges":[{"gross_charge":13438.0,"discounted_cash":11287.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fem/Popl Revasc W/Stent","code_information":[{"code":"48100051","type":"CDM"},{"code":"481","type":"RC"},{"code":"37226","type":"HCPCS"}],"standard_charges":[{"gross_charge":28538.0,"discounted_cash":23971.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tib/Per Revasc W/Tla","code_information":[{"code":"48100052","type":"CDM"},{"code":"481","type":"RC"},{"code":"37228","type":"HCPCS"}],"standard_charges":[{"gross_charge":31872.0,"discounted_cash":26772.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tib/Per Revasc W/Stent","code_information":[{"code":"48100053","type":"CDM"},{"code":"481","type":"RC"},{"code":"37230","type":"HCPCS"}],"standard_charges":[{"gross_charge":40173.0,"discounted_cash":33745.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tib/Per Revasc Add-On","code_information":[{"code":"48100054","type":"CDM"},{"code":"481","type":"RC"},{"code":"37232","type":"HCPCS"}],"standard_charges":[{"gross_charge":13003.0,"discounted_cash":10922.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Open/Perq Place Stent 1St","code_information":[{"code":"48100055","type":"CDM"},{"code":"481","type":"RC"},{"code":"37236","type":"HCPCS"}],"standard_charges":[{"gross_charge":33018.0,"discounted_cash":27735.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Open/Perq Place Stent Ea Add","code_information":[{"code":"48100056","type":"CDM"},{"code":"481","type":"RC"},{"code":"37237","type":"HCPCS"}],"standard_charges":[{"gross_charge":15968.0,"discounted_cash":13413.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vasc Embolize/Occlude Artery","code_information":[{"code":"48100057","type":"CDM"},{"code":"481","type":"RC"},{"code":"37242","type":"HCPCS"}],"standard_charges":[{"gross_charge":35438.0,"discounted_cash":29767.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Angiography Extremity Unilateral Rs&I","code_information":[{"code":"48100058","type":"CDM"},{"code":"323","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":9727.0,"discounted_cash":8170.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Angio Bilateral Extremity","code_information":[{"code":"48100059","type":"CDM"},{"code":"323","type":"RC"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":10950.0,"discounted_cash":9198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Cardiac Angioplast 1 Art","code_information":[{"code":"48100060","type":"CDM"},{"code":"481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":15378.0,"discounted_cash":12917.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Cardiac Angio Addl Art","code_information":[{"code":"48100061","type":"CDM"},{"code":"481","type":"RC"},{"code":"92921","type":"HCPCS"}],"standard_charges":[{"gross_charge":15378.0,"discounted_cash":12917.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Card Stent W/Angio 1 Vsl","code_information":[{"code":"48100062","type":"CDM"},{"code":"481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":23358.0,"discounted_cash":19620.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Card Stent W/Angio Addl","code_information":[{"code":"48100063","type":"CDM"},{"code":"481","type":"RC"},{"code":"92929","type":"HCPCS"}],"standard_charges":[{"gross_charge":23358.0,"discounted_cash":19620.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Revasc Byp Graft 1 Vsl","code_information":[{"code":"48100064","type":"CDM"},{"code":"481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":23358.0,"discounted_cash":19620.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Card Revasc Mi 1 Vsl","code_information":[{"code":"48100065","type":"CDM"},{"code":"481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":23358.0,"discounted_cash":19620.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cardioversion Electrical Ext","code_information":[{"code":"48100066","type":"CDM"},{"code":"481","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":2228.0,"discounted_cash":1871.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intravasc Us Heart Add-On","code_information":[{"code":"48100067","type":"CDM"},{"code":"481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":5286.0,"discounted_cash":4440.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Right Heart Cath","code_information":[{"code":"48100068","type":"CDM"},{"code":"481","type":"RC"},{"code":"93451","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc R&L Hrt Cath W/Ventriclgrphy","code_information":[{"code":"48100069","type":"CDM"},{"code":"481","type":"RC"},{"code":"93453","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Coronary Artery Angio S&I","code_information":[{"code":"48100070","type":"CDM"},{"code":"481","type":"RC"},{"code":"93454","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Coronary Art/Grft Angio S&I","code_information":[{"code":"48100071","type":"CDM"},{"code":"481","type":"RC"},{"code":"93455","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc R Hrt Coronary Artery Angio","code_information":[{"code":"48100072","type":"CDM"},{"code":"481","type":"RC"},{"code":"93456","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc R Hrt Art/Grft Angio","code_information":[{"code":"48100073","type":"CDM"},{"code":"481","type":"RC"},{"code":"93457","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc L Hrt Artery/Ventricle Angio","code_information":[{"code":"48100074","type":"CDM"},{"code":"481","type":"RC"},{"code":"93458","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc L Hrt Art/Grft Angio","code_information":[{"code":"48100075","type":"CDM"},{"code":"481","type":"RC"},{"code":"93459","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc R&L Hrt Art/Ventricle Angio","code_information":[{"code":"48100076","type":"CDM"},{"code":"481","type":"RC"},{"code":"93460","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc R&L Hrt Art/Ventricle Angio W Imaging Of Bypass Grafts","code_information":[{"code":"48100077","type":"CDM"},{"code":"481","type":"RC"},{"code":"93461","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inject Supravalvular Aortagraphy","code_information":[{"code":"48100078","type":"CDM"},{"code":"481","type":"RC"},{"code":"93567","type":"HCPCS"}],"standard_charges":[{"gross_charge":1521.0,"discounted_cash":1277.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Heart Flow Reserve Measurement; Initial","code_information":[{"code":"48100079","type":"CDM"},{"code":"481","type":"RC"},{"code":"93571","type":"HCPCS"}],"standard_charges":[{"gross_charge":4287.0,"discounted_cash":3601.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Heart Flow Reserve Measurement; Additional","code_information":[{"code":"48100080","type":"CDM"},{"code":"481","type":"RC"},{"code":"93572","type":"HCPCS"}],"standard_charges":[{"gross_charge":2875.0,"discounted_cash":2415.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Map Tachycardia Add-On","code_information":[{"code":"48100081","type":"CDM"},{"code":"481","type":"RC"},{"code":"93609","type":"HCPCS"}],"standard_charges":[{"gross_charge":5694.0,"discounted_cash":4782.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Electrophys Map 3D Add-On","code_information":[{"code":"48100082","type":"CDM"},{"code":"481","type":"RC"},{"code":"93613","type":"HCPCS"}],"standard_charges":[{"gross_charge":9291.0,"discounted_cash":7804.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Comprehensive Electrophysiology Eval W/O Induction","code_information":[{"code":"48100083","type":"CDM"},{"code":"481","type":"RC"},{"code":"93619","type":"HCPCS"}],"standard_charges":[{"gross_charge":17484.0,"discounted_cash":14686.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Comprehensive Electrophysiology Eval W/Induct Or Attempt","code_information":[{"code":"48100084","type":"CDM"},{"code":"481","type":"RC"},{"code":"93620","type":"HCPCS"}],"standard_charges":[{"gross_charge":17484.0,"discounted_cash":14686.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Program Stimulation After Iv Drug Infusion","code_information":[{"code":"48100085","type":"CDM"},{"code":"481","type":"RC"},{"code":"93623","type":"HCPCS"}],"standard_charges":[{"gross_charge":6417.0,"discounted_cash":5390.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Electrophysiology Evaluation; Initial Imp/Rep & Testing","code_information":[{"code":"48100086","type":"CDM"},{"code":"481","type":"RC"},{"code":"93641","type":"HCPCS"}],"standard_charges":[{"gross_charge":3863.0,"discounted_cash":3244.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Electrophysiology Evaluation","code_information":[{"code":"48100087","type":"CDM"},{"code":"481","type":"RC"},{"code":"93642","type":"HCPCS"}],"standard_charges":[{"gross_charge":4270.0,"discounted_cash":3586.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ablate Heart Dysrhythm Focus","code_information":[{"code":"48100088","type":"CDM"},{"code":"481","type":"RC"},{"code":"93650","type":"HCPCS"}],"standard_charges":[{"gross_charge":13466.0,"discounted_cash":11311.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ep & Ablate Supravent Arrhyt","code_information":[{"code":"48100089","type":"CDM"},{"code":"481","type":"RC"},{"code":"93653","type":"HCPCS"}],"standard_charges":[{"gross_charge":50083.0,"discounted_cash":42069.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ep & Ablate Ventric Tachy","code_information":[{"code":"48100090","type":"CDM"},{"code":"481","type":"RC"},{"code":"93654","type":"HCPCS"}],"standard_charges":[{"gross_charge":42604.0,"discounted_cash":35787.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ablate Arrhythmia Add On","code_information":[{"code":"48100091","type":"CDM"},{"code":"481","type":"RC"},{"code":"93655","type":"HCPCS"}],"standard_charges":[{"gross_charge":27317.0,"discounted_cash":22946.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perc Drug-El Cor Stent Bran","code_information":[{"code":"48100092","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9600","type":"HCPCS"}],"standard_charges":[{"gross_charge":22255.0,"discounted_cash":18694.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perc D-E Cor Revasc T Cabg S","code_information":[{"code":"48100093","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9601","type":"HCPCS"}],"standard_charges":[{"gross_charge":22255.0,"discounted_cash":18694.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perc D-E Cor Revasc T Cabg B","code_information":[{"code":"48100094","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9604","type":"HCPCS"}],"standard_charges":[{"gross_charge":22255.0,"discounted_cash":18694.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perc D-E Cor Revasc W Ami S","code_information":[{"code":"48100095","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9605","type":"HCPCS"}],"standard_charges":[{"gross_charge":22255.0,"discounted_cash":18694.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cak Pta/Ather/Stent Stemi Des","code_information":[{"code":"48100096","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49144.0,"discounted_cash":41280.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iliac Art Angio,Cardiac Cath","code_information":[{"code":"48100097","type":"CDM"},{"code":"481","type":"RC"},{"code":"G0278","type":"HCPCS"}],"standard_charges":[{"gross_charge":2899.0,"discounted_cash":2435.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Of Implantable Defibrillator Pulse Generator ; Dual Leads","code_information":[{"code":"48100098","type":"CDM"},{"code":"481","type":"RC"},{"code":"33230","type":"HCPCS"}],"standard_charges":[{"gross_charge":101974.0,"discounted_cash":85658.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Of Implantable Defibrillator Pulse Generator ; Single Lead","code_information":[{"code":"48100099","type":"CDM"},{"code":"481","type":"RC"},{"code":"33240","type":"HCPCS"}],"standard_charges":[{"gross_charge":75828.0,"discounted_cash":63695.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Subq Implantable Defibrillator Electrode","code_information":[{"code":"48100100","type":"CDM"},{"code":"481","type":"RC"},{"code":"33271","type":"HCPCS"}],"standard_charges":[{"gross_charge":21659.0,"discounted_cash":18193.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Introduction Of Needle Or Intracatheter, Carotid Or Vertebral Artery","code_information":[{"code":"48100104","type":"CDM"},{"code":"481","type":"RC"},{"code":"36100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":1334.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Selective Catheter Placement, Internal Carotid Artery","code_information":[{"code":"48100105","type":"CDM"},{"code":"481","type":"RC"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":17002.0,"discounted_cash":14281.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Selective Catheter Placement, Vertebral Artery W Cervicocerbral Arch","code_information":[{"code":"48100106","type":"CDM"},{"code":"481","type":"RC"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":20402.0,"discounted_cash":17137.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ins Cath Ren Art 2Nd+ Unilat","code_information":[{"code":"48100107","type":"CDM"},{"code":"481","type":"RC"},{"code":"36253","type":"HCPCS"}],"standard_charges":[{"gross_charge":9560.0,"discounted_cash":8030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thrombolysis Venous Infusion","code_information":[{"code":"48100108","type":"CDM"},{"code":"481","type":"RC"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":3883.0,"discounted_cash":3261.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thrombolysis Arterial Or Venous Infustion Day 2","code_information":[{"code":"48100109","type":"CDM"},{"code":"481","type":"RC"},{"code":"37213","type":"HCPCS"}],"standard_charges":[{"gross_charge":9858.0,"discounted_cash":8280.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thrombolysis Arterial Or Venous Infustion Final Day","code_information":[{"code":"48100110","type":"CDM"},{"code":"481","type":"RC"},{"code":"37214","type":"HCPCS"}],"standard_charges":[{"gross_charge":9858.0,"discounted_cash":8280.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Carotid Artery Stent Without Distal Embolic Protection","code_information":[{"code":"48100111","type":"CDM"},{"code":"481","type":"RC"},{"code":"37216","type":"HCPCS"}],"standard_charges":[{"gross_charge":6609.0,"discounted_cash":5551.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Common Carotid Or Innominate Stent Placement By Retrograde Treatment","code_information":[{"code":"48100112","type":"CDM"},{"code":"481","type":"RC"},{"code":"37217","type":"HCPCS"}],"standard_charges":[{"gross_charge":15225.0,"discounted_cash":12789.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pta Iliac Artery Each Add'l Ipsilateral","code_information":[{"code":"48100113","type":"CDM"},{"code":"481","type":"RC"},{"code":"37222","type":"HCPCS"}],"standard_charges":[{"gross_charge":15164.0,"discounted_cash":12737.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pta/ Stent Tibioperoneal Atery Each Add'l","code_information":[{"code":"48100114","type":"CDM"},{"code":"481","type":"RC"},{"code":"37234","type":"HCPCS"}],"standard_charges":[{"gross_charge":19769.0,"discounted_cash":16605.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transcatheter Placement Of Stent Initial Vein Open/Perq","code_information":[{"code":"48100115","type":"CDM"},{"code":"481","type":"RC"},{"code":"37238","type":"HCPCS"}],"standard_charges":[{"gross_charge":66450.0,"discounted_cash":55818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transcatheter Placement Of Stent Each Additional Vein Open/Perq","code_information":[{"code":"48100116","type":"CDM"},{"code":"481","type":"RC"},{"code":"37239","type":"HCPCS"}],"standard_charges":[{"gross_charge":32135.0,"discounted_cash":26993.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vascular Embolization/ Occlusion Venous (Other Than Hemorrhage Or Tumor)","code_information":[{"code":"48100117","type":"CDM"},{"code":"481","type":"RC"},{"code":"37241","type":"HCPCS"}],"standard_charges":[{"gross_charge":55961.0,"discounted_cash":47007.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Post Embolization Angio","code_information":[{"code":"48100118","type":"CDM"},{"code":"481","type":"RC"},{"code":"75898","type":"HCPCS"}],"standard_charges":[{"gross_charge":8436.0,"discounted_cash":7086.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Atherectomy With Or Without Balloon Angioplasty, Single Vessel","code_information":[{"code":"48100119","type":"CDM"},{"code":"481","type":"RC"},{"code":"92924","type":"HCPCS"}],"standard_charges":[{"gross_charge":29325.0,"discounted_cash":24633.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Atherectomy With Or Without Balloon Angioplasty, Each Add'l Vessel","code_information":[{"code":"48100120","type":"CDM"},{"code":"481","type":"RC"},{"code":"92925","type":"HCPCS"}],"standard_charges":[{"gross_charge":29325.0,"discounted_cash":24633.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pta/Atherectomy/ Stent","code_information":[{"code":"48100121","type":"CDM"},{"code":"481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":49144.0,"discounted_cash":41280.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pta/ Atherecomty/ Stent Each Additional Branch","code_information":[{"code":"48100122","type":"CDM"},{"code":"481","type":"RC"},{"code":"92934","type":"HCPCS"}],"standard_charges":[{"gross_charge":41088.0,"discounted_cash":34513.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Percutaneous Transluminal Revascularization Bypass Graft Addl","code_information":[{"code":"48100123","type":"CDM"},{"code":"481","type":"RC"},{"code":"92938","type":"HCPCS"}],"standard_charges":[{"gross_charge":23358.0,"discounted_cash":19620.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Percutaneous Transluminal Revascularization Chronic Single Vessel","code_information":[{"code":"48100124","type":"CDM"},{"code":"481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":23358.0,"discounted_cash":19620.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intravasc Us Heart Add-On","code_information":[{"code":"48100125","type":"CDM"},{"code":"481","type":"RC"},{"code":"92979","type":"HCPCS"}],"standard_charges":[{"gross_charge":3362.0,"discounted_cash":2824.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Left Heart Catheterization W/Ventrclgrphy","code_information":[{"code":"48100126","type":"CDM"},{"code":"481","type":"RC"},{"code":"93452","type":"HCPCS"}],"standard_charges":[{"gross_charge":12827.0,"discounted_cash":10774.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inject Pulm Art Hrt Cath","code_information":[{"code":"48100128","type":"CDM"},{"code":"481","type":"RC"},{"code":"93568","type":"HCPCS"}],"standard_charges":[{"gross_charge":2880.0,"discounted_cash":2419.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intra-Atrial Pacing","code_information":[{"code":"48100129","type":"CDM"},{"code":"481","type":"RC"},{"code":"93610","type":"HCPCS"}],"standard_charges":[{"gross_charge":15344.0,"discounted_cash":12888.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intraventricular Pacing","code_information":[{"code":"48100130","type":"CDM"},{"code":"481","type":"RC"},{"code":"93612","type":"HCPCS"}],"standard_charges":[{"gross_charge":15344.0,"discounted_cash":12888.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Induction Of Arrhythmia By Electriacal Pacing","code_information":[{"code":"48100131","type":"CDM"},{"code":"481","type":"RC"},{"code":"93618","type":"HCPCS"}],"standard_charges":[{"gross_charge":3173.0,"discounted_cash":2665.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Electrophysiologic Study","code_information":[{"code":"48100132","type":"CDM"},{"code":"481","type":"RC"},{"code":"93624","type":"HCPCS"}],"standard_charges":[{"gross_charge":17484.0,"discounted_cash":14686.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ep Eval With Induction And Ventricular Tachycardia Ablation","code_information":[{"code":"48100133","type":"CDM"},{"code":"481","type":"RC"},{"code":"93654","type":"HCPCS"}],"standard_charges":[{"gross_charge":42604.0,"discounted_cash":35787.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transluminal Peripheral Atherectomy Renal Artery","code_information":[{"code":"48100134","type":"CDM"},{"code":"481","type":"RC"},{"code":"0234T","type":"HCPCS"}],"standard_charges":[{"gross_charge":28056.0,"discounted_cash":23567.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Visceral Artery Each Vessel","code_information":[{"code":"48100135","type":"CDM"},{"code":"481","type":"RC"},{"code":"0235T","type":"HCPCS"}],"standard_charges":[{"gross_charge":28056.0,"discounted_cash":23567.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perc D-E Cor Stent Ather S","code_information":[{"code":"48100136","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9602","type":"HCPCS"}],"standard_charges":[{"gross_charge":49144.0,"discounted_cash":41280.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perc D-E Cor Stent Ather Br","code_information":[{"code":"48100137","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9603","type":"HCPCS"}],"standard_charges":[{"gross_charge":22255.0,"discounted_cash":18694.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perc D-E Cor Revasc Chro Sin","code_information":[{"code":"48100138","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9607","type":"HCPCS"}],"standard_charges":[{"gross_charge":49144.0,"discounted_cash":41280.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perc D-E Cor Revasc Chro Add","code_information":[{"code":"48100139","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9608","type":"HCPCS"}],"standard_charges":[{"gross_charge":22255.0,"discounted_cash":18694.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tavr/Tavi Percu Fem Artery Appr","code_information":[{"code":"48100140","type":"CDM"},{"code":"481","type":"RC"},{"code":"33361","type":"HCPCS"}],"standard_charges":[{"gross_charge":25737.0,"discounted_cash":21619.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tavr/Tavi Transapical Exposure","code_information":[{"code":"48100141","type":"CDM"},{"code":"481","type":"RC"},{"code":"33366","type":"HCPCS"}],"standard_charges":[{"gross_charge":25737.0,"discounted_cash":21619.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pta/Atherec Fem-Pop","code_information":[{"code":"48100142","type":"CDM"},{"code":"481","type":"RC"},{"code":"37225","type":"HCPCS"}],"standard_charges":[{"gross_charge":32202.0,"discounted_cash":27049.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pta/St/Ath Fem/Pop","code_information":[{"code":"48100143","type":"CDM"},{"code":"481","type":"RC"},{"code":"37227","type":"HCPCS"}],"standard_charges":[{"gross_charge":55768.0,"discounted_cash":46845.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pta/Ather Tib/Per Initial","code_information":[{"code":"48100144","type":"CDM"},{"code":"481","type":"RC"},{"code":"37229","type":"HCPCS"}],"standard_charges":[{"gross_charge":40915.0,"discounted_cash":34368.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pta/Stent/Ath Tib/Per","code_information":[{"code":"48100145","type":"CDM"},{"code":"481","type":"RC"},{"code":"37231","type":"HCPCS"}],"standard_charges":[{"gross_charge":43731.0,"discounted_cash":36734.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pta/Ath Additional Tib/Peroneal","code_information":[{"code":"48100146","type":"CDM"},{"code":"481","type":"RC"},{"code":"37233","type":"HCPCS"}],"standard_charges":[{"gross_charge":31157.0,"discounted_cash":26171.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tib/Per Revasc Stnt & Ather","code_information":[{"code":"48100147","type":"CDM"},{"code":"481","type":"RC"},{"code":"37235","type":"HCPCS"}],"standard_charges":[{"gross_charge":55768.0,"discounted_cash":46845.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Atherectomy/Ivc Abdominal Aorta","code_information":[{"code":"48100148","type":"CDM"},{"code":"481","type":"RC"},{"code":"0236T","type":"HCPCS"}],"standard_charges":[{"gross_charge":24861.0,"discounted_cash":20883.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Atherectomy/Ivc Brachiocephalic Trunk And Branches Each Vessel","code_information":[{"code":"48100149","type":"CDM"},{"code":"481","type":"RC"},{"code":"0237T","type":"HCPCS"}],"standard_charges":[{"gross_charge":24861.0,"discounted_cash":20883.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Atherectomy/Ivc Iliac Artery Each Vessel","code_information":[{"code":"48100150","type":"CDM"},{"code":"481","type":"RC"},{"code":"0238T","type":"HCPCS"}],"standard_charges":[{"gross_charge":53805.0,"discounted_cash":45196.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ivus Inital Vessel","code_information":[{"code":"48100151","type":"CDM"},{"code":"481","type":"RC"},{"code":"37252","type":"HCPCS"}],"standard_charges":[{"gross_charge":4678.0,"discounted_cash":3929.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ivus Each Add'l Vessel","code_information":[{"code":"48100152","type":"CDM"},{"code":"481","type":"RC"},{"code":"37253","type":"HCPCS"}],"standard_charges":[{"gross_charge":3316.0,"discounted_cash":2785.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Angiography Pulmonary","code_information":[{"code":"48100153","type":"CDM"},{"code":"481","type":"RC"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":4586.0,"discounted_cash":3852.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Venography Caval Superior","code_information":[{"code":"48100155","type":"CDM"},{"code":"481","type":"RC"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":2798.0,"discounted_cash":2350.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Programming Subcut Icd","code_information":[{"code":"48100156","type":"CDM"},{"code":"481","type":"RC"},{"code":"93260","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Interrogate Subcut Icd","code_information":[{"code":"48100157","type":"CDM"},{"code":"481","type":"RC"},{"code":"93261","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bundle Of His Recording","code_information":[{"code":"48100158","type":"CDM"},{"code":"481","type":"RC"},{"code":"93600","type":"HCPCS"}],"standard_charges":[{"gross_charge":15344.0,"discounted_cash":12888.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intra-Atrial Recording","code_information":[{"code":"48100159","type":"CDM"},{"code":"481","type":"RC"},{"code":"93602","type":"HCPCS"}],"standard_charges":[{"gross_charge":15344.0,"discounted_cash":12888.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Right Ventricular Recording","code_information":[{"code":"48100160","type":"CDM"},{"code":"481","type":"RC"},{"code":"93603","type":"HCPCS"}],"standard_charges":[{"gross_charge":3944.0,"discounted_cash":3312.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Trlml Balo Angiop Open/Perq Img S&I 1St Art","code_information":[{"code":"48100161","type":"CDM"},{"code":"481","type":"RC"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":25538.0,"discounted_cash":21451.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Trlml Balo Angiop Open/Perq Img S&I Ea Addl Art","code_information":[{"code":"48100162","type":"CDM"},{"code":"481","type":"RC"},{"code":"37247","type":"HCPCS"}],"standard_charges":[{"gross_charge":12771.0,"discounted_cash":10727.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Trlml Balo Angiop Open/Perq W/Img S&I 1St Vein","code_information":[{"code":"48100163","type":"CDM"},{"code":"481","type":"RC"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":25538.0,"discounted_cash":21451.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Trlml Balo Angiop Open/Perq W/Img S&I Addl Vein","code_information":[{"code":"48100164","type":"CDM"},{"code":"481","type":"RC"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":12771.0,"discounted_cash":10727.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Upg Pacemaker Sys Convert 1Chmbr Sys 2Chmbr Sys","code_information":[{"code":"48100165","type":"CDM"},{"code":"481","type":"RC"},{"code":"33214","type":"HCPCS"}],"standard_charges":[{"gross_charge":43346.0,"discounted_cash":36410.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insj/Rplcmt Temp Transvns 2Chmbr Pacg Eltrds Spx","code_information":[{"code":"48100167","type":"CDM"},{"code":"481","type":"RC"},{"code":"33211","type":"HCPCS"}],"standard_charges":[{"gross_charge":32125.0,"discounted_cash":26985.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rpr 1 Transvns Eltrd Prm Pm/Pacing Implntbl Dfb","code_information":[{"code":"48100169","type":"CDM"},{"code":"481","type":"RC"},{"code":"33218","type":"HCPCS"}],"standard_charges":[{"gross_charge":11000.0,"discounted_cash":9240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rpr 2 Transvns Electrodes Prm Pm/Implantable Dfb","code_information":[{"code":"48100170","type":"CDM"},{"code":"481","type":"RC"},{"code":"33220","type":"HCPCS"}],"standard_charges":[{"gross_charge":11000.0,"discounted_cash":9240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rmvl Transvns Pm Eltrd Dual Lead Sys","code_information":[{"code":"48100171","type":"CDM"},{"code":"481","type":"RC"},{"code":"33235","type":"HCPCS"}],"standard_charges":[{"gross_charge":11000.0,"discounted_cash":9240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Remove Subq Implantable Defibrillator Electrode","code_information":[{"code":"48100172","type":"CDM"},{"code":"481","type":"RC"},{"code":"33272","type":"HCPCS"}],"standard_charges":[{"gross_charge":11000.0,"discounted_cash":9240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Repos Previously Implanted Subq Implantable Dfb","code_information":[{"code":"48100173","type":"CDM"},{"code":"481","type":"RC"},{"code":"33273","type":"HCPCS"}],"standard_charges":[{"gross_charge":11000.0,"discounted_cash":9240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vasc Embolize/Occlude Organ","code_information":[{"code":"48100174","type":"CDM"},{"code":"481","type":"RC"},{"code":"37243","type":"HCPCS"}],"standard_charges":[{"gross_charge":55961.0,"discounted_cash":47007.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vascular Embolization Or Occlusion Hemorrhage","code_information":[{"code":"48100175","type":"CDM"},{"code":"481","type":"RC"},{"code":"37244","type":"HCPCS"}],"standard_charges":[{"gross_charge":55961.0,"discounted_cash":47007.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Trluml Coronry Chrnic Occlus Revasc Addl Vsl","code_information":[{"code":"48100176","type":"CDM"},{"code":"481","type":"RC"},{"code":"92944","type":"HCPCS"}],"standard_charges":[{"gross_charge":23358.0,"discounted_cash":19620.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Transluminal Coronary Mechanicl Thrombectomy","code_information":[{"code":"48100177","type":"CDM"},{"code":"481","type":"RC"},{"code":"92973","type":"HCPCS"}],"standard_charges":[{"gross_charge":7183.0,"discounted_cash":6033.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Flow Directed Catheter For Monitoring","code_information":[{"code":"48100178","type":"CDM"},{"code":"481","type":"RC"},{"code":"93503","type":"HCPCS"}],"standard_charges":[{"gross_charge":4986.0,"discounted_cash":4188.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Endomyocardial Biopsy","code_information":[{"code":"48100179","type":"CDM"},{"code":"481","type":"RC"},{"code":"93505","type":"HCPCS"}],"standard_charges":[{"gross_charge":10872.0,"discounted_cash":9132.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Esophgl Rec Atrial W/Wo Ventr Electrgrams W/Pacg","code_information":[{"code":"48100180","type":"CDM"},{"code":"481","type":"RC"},{"code":"93616","type":"HCPCS"}],"standard_charges":[{"gross_charge":3944.0,"discounted_cash":3312.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ephys Evl Trnsptl Tx Atrial Fib Isolat Pulm Vein","code_information":[{"code":"48100181","type":"CDM"},{"code":"481","type":"RC"},{"code":"93656","type":"HCPCS"}],"standard_charges":[{"gross_charge":42604.0,"discounted_cash":35787.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ablate L/R Atrial Fibril W/Isolated Pulm Vein","code_information":[{"code":"48100182","type":"CDM"},{"code":"481","type":"RC"},{"code":"93657","type":"HCPCS"}],"standard_charges":[{"gross_charge":27317.0,"discounted_cash":22946.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ins Pacemaker Pulse Gen Only W/Exist Dual Leads","code_information":[{"code":"48100185","type":"CDM"},{"code":"481","type":"RC"},{"code":"33213","type":"HCPCS"}],"standard_charges":[{"gross_charge":27250.0,"discounted_cash":22890.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insert Ppg Only With Existing Single Lead System","code_information":[{"code":"48100186","type":"CDM"},{"code":"481","type":"RC"},{"code":"33212","type":"HCPCS"}],"standard_charges":[{"gross_charge":25856.0,"discounted_cash":21719.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perq Balloon Valvuloplasty Aortic Valve","code_information":[{"code":"48100189","type":"CDM"},{"code":"481","type":"RC"},{"code":"92986","type":"HCPCS"}],"standard_charges":[{"gross_charge":22892.0,"discounted_cash":19229.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perq Balloon Valvuloplasty Pulmonary Valve","code_information":[{"code":"48100190","type":"CDM"},{"code":"481","type":"RC"},{"code":"92990","type":"HCPCS"}],"standard_charges":[{"gross_charge":47318.0,"discounted_cash":39747.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insj Perq Vad L Hrt Arterial","code_information":[{"code":"48100191","type":"CDM"},{"code":"481","type":"RC"},{"code":"33990","type":"HCPCS"}],"standard_charges":[{"gross_charge":9096.0,"discounted_cash":7640.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rmvl Perq Left Heart Vad","code_information":[{"code":"48100192","type":"CDM"},{"code":"481","type":"RC"},{"code":"33992","type":"HCPCS"}],"standard_charges":[{"gross_charge":6299.0,"discounted_cash":5291.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Reposg Perq R/L Hrt Vad","code_information":[{"code":"48100193","type":"CDM"},{"code":"481","type":"RC"},{"code":"33993","type":"HCPCS"}],"standard_charges":[{"gross_charge":9096.0,"discounted_cash":7640.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Open Fem Art Expos Slvr Evasc Prosth Uni","code_information":[{"code":"48100194","type":"CDM"},{"code":"481","type":"RC"},{"code":"34812","type":"HCPCS"}],"standard_charges":[{"gross_charge":7697.0,"discounted_cash":6465.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tcat Insj/Rpl Perm Leadless Pacemaker Rv W/Img","code_information":[{"code":"48100195","type":"CDM"},{"code":"481","type":"RC"},{"code":"33274","type":"HCPCS"}],"standard_charges":[{"gross_charge":67364.0,"discounted_cash":56585.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tcat Rmvl Perm Ldls Pm Rt Vent, Incl Image Guidance","code_information":[{"code":"48100196","type":"CDM"},{"code":"481","type":"RC"},{"code":"33275","type":"HCPCS"}],"standard_charges":[{"gross_charge":12761.0,"discounted_cash":10719.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Subq Cardiac Rhythm Monitor W/Prgrmg","code_information":[{"code":"48100197","type":"CDM"},{"code":"481","type":"RC"},{"code":"33285","type":"HCPCS"}],"standard_charges":[{"gross_charge":32483.0,"discounted_cash":27285.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Subcutaneous Cardiac Rhythm Monitor","code_information":[{"code":"48100198","type":"CDM"},{"code":"481","type":"RC"},{"code":"33286","type":"HCPCS"}],"standard_charges":[{"gross_charge":2542.0,"discounted_cash":2135.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perq Clsr Tcat L Atr Apndge W/Endocardial Implnt","code_information":[{"code":"48100199","type":"CDM"},{"code":"481","type":"RC"},{"code":"33340","type":"HCPCS"}],"standard_charges":[{"gross_charge":15707.0,"discounted_cash":13193.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Us Guide Vascular Access","code_information":[{"code":"48100200","type":"CDM"},{"code":"481","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.0,"discounted_cash":1544.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Place Cath Intracranial Art","code_information":[{"code":"48100201","type":"CDM"},{"code":"481","type":"RC"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":5425.0,"discounted_cash":4557.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tcat Permanent Occlusion/Embolization Prq Cns","code_information":[{"code":"48100202","type":"CDM"},{"code":"481","type":"RC"},{"code":"61624","type":"HCPCS"}],"standard_charges":[{"gross_charge":47355.0,"discounted_cash":39778.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Evasc Prlng Admn Rx Agnt 1St","code_information":[{"code":"48100203","type":"CDM"},{"code":"481","type":"RC"},{"code":"61650","type":"HCPCS"}],"standard_charges":[{"gross_charge":28875.0,"discounted_cash":24255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Evasc Prlng Admn Rx Agnt Add","code_information":[{"code":"48100204","type":"CDM"},{"code":"481","type":"RC"},{"code":"61651","type":"HCPCS"}],"standard_charges":[{"gross_charge":28875.0,"discounted_cash":24255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perq Art Trluml M-Thrombec &/Nfs Intracranial","code_information":[{"code":"48100205","type":"CDM"},{"code":"481","type":"RC"},{"code":"61645","type":"HCPCS"}],"standard_charges":[{"gross_charge":28875.0,"discounted_cash":24255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Arysm Vasc Malfrmj Ia Embolization","code_information":[{"code":"48100206","type":"CDM"},{"code":"481","type":"RC"},{"code":"61710","type":"HCPCS"}],"standard_charges":[{"gross_charge":10046.0,"discounted_cash":8438.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Balloon Angioplasty Intracranial Percutaneous","code_information":[{"code":"48100207","type":"CDM"},{"code":"481","type":"RC"},{"code":"61630","type":"HCPCS"}],"standard_charges":[{"gross_charge":28875.0,"discounted_cash":24255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intracran Angioplsty W/Stent","code_information":[{"code":"48100208","type":"CDM"},{"code":"481","type":"RC"},{"code":"61635","type":"HCPCS"}],"standard_charges":[{"gross_charge":28875.0,"discounted_cash":24255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tcat Permant Occlusion/Embolization Prq Non-Cns","code_information":[{"code":"48100209","type":"CDM"},{"code":"481","type":"RC"},{"code":"61626","type":"HCPCS"}],"standard_charges":[{"gross_charge":29606.0,"discounted_cash":24869.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc X-Rays Transcath Therapy","code_information":[{"code":"48100210","type":"CDM"},{"code":"481","type":"RC"},{"code":"75894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4912.0,"discounted_cash":4126.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pericardiocentesis W/Imaging","code_information":[{"code":"48100217","type":"CDM"},{"code":"481","type":"RC"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":7873.0,"discounted_cash":6613.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":7219.0,"discounted_cash":6063.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Prim Art M-Thrmbc Sbsq Vsl","code_information":[{"code":"48100218","type":"CDM"},{"code":"481","type":"RC"},{"code":"37185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5568.0,"discounted_cash":4677.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sec Art Thrombectomy Add-On","code_information":[{"code":"48100219","type":"CDM"},{"code":"481","type":"RC"},{"code":"37186","type":"HCPCS"}],"standard_charges":[{"gross_charge":6776.0,"discounted_cash":5691.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Transluminal Mechanical Thrombectomy Vein","code_information":[{"code":"48100220","type":"CDM"},{"code":"481","type":"RC"},{"code":"37187","type":"HCPCS"}],"standard_charges":[{"gross_charge":21847.0,"discounted_cash":18351.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Trluml Mchnl Thrmbc Vein Repeat Tx","code_information":[{"code":"48100221","type":"CDM"},{"code":"481","type":"RC"},{"code":"37188","type":"HCPCS"}],"standard_charges":[{"gross_charge":12221.0,"discounted_cash":10265.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Revasc Intravasc Lithotripsy","code_information":[{"code":"48100222","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"gross_charge":22295.0,"discounted_cash":18727.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Revasc Intra Lithotrip-Stent","code_information":[{"code":"48100223","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"gross_charge":45168.0,"discounted_cash":37941.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Revasc Lithotrip-Stent-Ather","code_information":[{"code":"48100224","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9767","type":"HCPCS"}],"standard_charges":[{"gross_charge":72251.0,"discounted_cash":60690.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Revasc Intra Lithotrip-Ather","code_information":[{"code":"48100225","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9766","type":"HCPCS"}],"standard_charges":[{"gross_charge":45168.0,"discounted_cash":37941.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Revasc Lithotrip Tibi/Perone","code_information":[{"code":"48100226","type":"CDM"},{"code":"361","type":"RC"},{"code":"C9772","type":"HCPCS"}],"standard_charges":[{"gross_charge":45168.0,"discounted_cash":37941.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Revasc Lithotr-Stent Tib/Per","code_information":[{"code":"48100227","type":"CDM"},{"code":"361","type":"RC"},{"code":"C9773","type":"HCPCS"}],"standard_charges":[{"gross_charge":72251.0,"discounted_cash":60690.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Revasc Lithotr-Ather Tib/Per","code_information":[{"code":"48100228","type":"CDM"},{"code":"361","type":"RC"},{"code":"C9774","type":"HCPCS"}],"standard_charges":[{"gross_charge":72251.0,"discounted_cash":60690.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Revasc Lith-Sten-Ath Tib/Per","code_information":[{"code":"48100229","type":"CDM"},{"code":"361","type":"RC"},{"code":"C9775","type":"HCPCS"}],"standard_charges":[{"gross_charge":72251.0,"discounted_cash":60690.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Unlisted Cardiovascular Service/Procedure","code_information":[{"code":"48100230","type":"CDM"},{"code":"481","type":"RC"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":483.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Unlisted Cardiac Surgery","code_information":[{"code":"48100231","type":"CDM"},{"code":"481","type":"RC"},{"code":"33999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2435.0,"discounted_cash":2045.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tcat Plmt&Rmvl Cepd Perq","code_information":[{"code":"48100232","type":"CDM"},{"code":"481","type":"RC"},{"code":"33370","type":"HCPCS"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":827.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thrombolysis Intracoronary Nfs Slctv Angrph","code_information":[{"code":"48100233","type":"CDM"},{"code":"481","type":"RC"},{"code":"92975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Percutaneous Transluminal Coronary Lithotripsy","code_information":[{"code":"48100234","type":"CDM"},{"code":"481","type":"RC"},{"code":"92972","type":"HCPCS"}],"standard_charges":[{"gross_charge":39234.0,"discounted_cash":32956.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transcath Closure Of Asd","code_information":[{"code":"48100235","type":"CDM"},{"code":"481","type":"RC"},{"code":"93580","type":"HCPCS"}],"standard_charges":[{"gross_charge":65875.0,"discounted_cash":55335.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prq Balloon Valvuloplasty Mitral Valve","code_information":[{"code":"48100236","type":"CDM"},{"code":"481","type":"RC"},{"code":"92987","type":"HCPCS"}],"standard_charges":[{"gross_charge":41329.0,"discounted_cash":34716.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tcat Mitral Valve Repair Initial Prosthesis","code_information":[{"code":"48100237","type":"CDM"},{"code":"481","type":"RC"},{"code":"33418","type":"HCPCS"}],"standard_charges":[{"gross_charge":41329.0,"discounted_cash":34716.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tcat Mitral Valve Repair Addl Prosthesis","code_information":[{"code":"48100238","type":"CDM"},{"code":"481","type":"RC"},{"code":"33419","type":"HCPCS"}],"standard_charges":[{"gross_charge":41329.0,"discounted_cash":34716.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cardiovascular Stress Test W/O Intrp And Report","code_information":[{"code":"48200000","type":"CDM"},{"code":"482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1302.0,"discounted_cash":1093.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Echo 2D W/ Doppler & Color Flow; Complete","code_information":[{"code":"48300000","type":"CDM"},{"code":"483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":3305.0,"discounted_cash":2776.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ds Minor Procedure Per Minute","code_information":[{"code":"49000000","type":"CDM"},{"code":"490","type":"RC"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Tendon Sheath/Ligament","code_information":[{"code":"49000002","type":"CDM"},{"code":"490","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1039.0,"discounted_cash":872.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Inj Trigger Point 1/2 Muscl","code_information":[{"code":"49000003","type":"CDM"},{"code":"490","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1032.0,"discounted_cash":866.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inject Trigger Points 3/>","code_information":[{"code":"49000004","type":"CDM"},{"code":"490","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.0,"discounted_cash":984.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Drain/Inj Intermediate Joint/Bursa W/O Us","code_information":[{"code":"49000005","type":"CDM"},{"code":"490","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":1042.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Drain/Inj Major Joint/Bursa W/O Us","code_information":[{"code":"49000006","type":"CDM"},{"code":"490","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1441.0,"discounted_cash":1210.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":835.0,"discounted_cash":701.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":637.0,"discounted_cash":535.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Inject Epidural Patch","code_information":[{"code":"49000007","type":"CDM"},{"code":"490","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.0,"discounted_cash":2860.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Implant Neuroelectrodes","code_information":[{"code":"49000010","type":"CDM"},{"code":"490","type":"RC"},{"code":"63650","type":"HCPCS"}],"standard_charges":[{"gross_charge":19000.0,"discounted_cash":15960.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj(S), Anes Agent(S) A/O Steroid; Trigeminal Nerve","code_information":[{"code":"49000011","type":"CDM"},{"code":"490","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":893.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Inj Ilioinguinal,Iliohypogastrc Nerve","code_information":[{"code":"49000012","type":"CDM"},{"code":"940","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1611.0,"discounted_cash":1353.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Other Peripheral","code_information":[{"code":"49000013","type":"CDM"},{"code":"490","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.0,"discounted_cash":1580.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1485.0,"discounted_cash":1247.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Inj Foramen Epidural L/S","code_information":[{"code":"49000014","type":"CDM"},{"code":"490","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":4594.82,"discounted_cash":3859.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Foramen Epidural; Lumbar Or Sacral Add-On","code_information":[{"code":"49000015","type":"CDM"},{"code":"490","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":2197.0,"discounted_cash":1845.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Paravertebral Facet Jnt C/T 1 Lev","code_information":[{"code":"49000016","type":"CDM"},{"code":"490","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2862.57,"discounted_cash":2404.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Paravert F Jnt L/S 1 Lev","code_information":[{"code":"49000017","type":"CDM"},{"code":"490","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":4594.82,"discounted_cash":3859.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Paravert F Jnt L/S 2 Lev","code_information":[{"code":"49000018","type":"CDM"},{"code":"490","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":2691.34,"discounted_cash":2260.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj Paravert F Jnt L/S 3 Lev","code_information":[{"code":"49000019","type":"CDM"},{"code":"490","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":6455.0,"discounted_cash":5422.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc N Block Lumbar/Thoracic","code_information":[{"code":"49000020","type":"CDM"},{"code":"490","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2344.0,"discounted_cash":1968.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Destroy Cerv/Thor Facet Jnt","code_information":[{"code":"49000021","type":"CDM"},{"code":"490","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":3633.0,"discounted_cash":3051.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Electronic Analysis Neuro Stim Generator Complex","code_information":[{"code":"49000022","type":"CDM"},{"code":"490","type":"RC"},{"code":"95972","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":330.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj For Sacroiliac Jt Anesth","code_information":[{"code":"49000023","type":"CDM"},{"code":"490","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2391.95,"discounted_cash":2009.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj For Discogr Ea Level Lumbar","code_information":[{"code":"49000024","type":"CDM"},{"code":"490","type":"RC"},{"code":"62290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2839.0,"discounted_cash":2384.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inj(S), Anes Agent(S) A/O Steroid; Greater Occipital Nerve","code_information":[{"code":"49000025","type":"CDM"},{"code":"490","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1435.0,"discounted_cash":1205.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nerve Block Suprascapular","code_information":[{"code":"49000026","type":"CDM"},{"code":"490","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.0,"discounted_cash":923.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intercostal Nerve Block Single","code_information":[{"code":"49000027","type":"CDM"},{"code":"490","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2138.0,"discounted_cash":1795.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transfora Epidur Cervi/Thor Sing","code_information":[{"code":"49000028","type":"CDM"},{"code":"490","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":4441.0,"discounted_cash":3730.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transfora Epidur Cervi/Thor Addtl","code_information":[{"code":"49000029","type":"CDM"},{"code":"490","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":6649.0,"discounted_cash":5585.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Facet Cerv Thor 2Nd Lvl","code_information":[{"code":"49000030","type":"CDM"},{"code":"490","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1765.86,"discounted_cash":1483.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Facet Cerv Thor 3Rd Or More Lvl","code_information":[{"code":"49000031","type":"CDM"},{"code":"490","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1262.0,"discounted_cash":1060.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Neuro Destr Intercostal Nerve","code_information":[{"code":"49000032","type":"CDM"},{"code":"490","type":"RC"},{"code":"64620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2124.0,"discounted_cash":1784.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Destroy C/Th Facet Jnt Addl","code_information":[{"code":"49000033","type":"CDM"},{"code":"490","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":715.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Destroy Lumb/Sac Facet Jnt","code_information":[{"code":"49000034","type":"CDM"},{"code":"490","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3544.0,"discounted_cash":2976.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Destroy L/S Facet Jnt Addl","code_information":[{"code":"49000035","type":"CDM"},{"code":"490","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":1726.0,"discounted_cash":1449.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Neuro Destr Othr Periph Nerve","code_information":[{"code":"49000036","type":"CDM"},{"code":"490","type":"RC"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":2287.0,"discounted_cash":1921.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bier Block","code_information":[{"code":"49000037","type":"CDM"},{"code":"490","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Njx Interlaminar Crv/Thrc","code_information":[{"code":"49000038","type":"CDM"},{"code":"490","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2644.0,"discounted_cash":2220.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Njx Interlaminar Lmbr/Sac","code_information":[{"code":"49000039","type":"CDM"},{"code":"490","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":2644.0,"discounted_cash":2220.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Brnchsc W/Tracheal/Bronchial Dilat/Clsd Rdctj Fx","code_information":[{"code":"49000040","type":"CDM"},{"code":"490","type":"RC"},{"code":"31630","type":"HCPCS"}],"standard_charges":[{"gross_charge":11022.0,"discounted_cash":9258.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronchoscopic Thermoplasty One Lobe","code_information":[{"code":"49000041","type":"CDM"},{"code":"490","type":"RC"},{"code":"31660","type":"HCPCS"}],"standard_charges":[{"gross_charge":19782.0,"discounted_cash":16616.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Non-Selective Debridement","code_information":[{"code":"51000000","type":"CDM"},{"code":"510","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":477.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Negative Pressure <= 50 Sq Cm","code_information":[{"code":"51000001","type":"CDM"},{"code":"510","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":477.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Negative Pressure > 50 Sq Cm","code_information":[{"code":"51000002","type":"CDM"},{"code":"510","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1004.0,"discounted_cash":843.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":893.0,"discounted_cash":750.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office O/P New Sf 15 To 29 Min","code_information":[{"code":"51000004","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":194.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office O/P New Sf 30-44 Min","code_information":[{"code":"51000005","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":231.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office O/P New Sf 45-59 Min","code_information":[{"code":"51000006","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":271.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office O/P New Sf 60-74 Min","code_information":[{"code":"51000007","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office O/P Est Minimal Prob","code_information":[{"code":"51000008","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":155.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office O/P Est Sf 10-19 Min","code_information":[{"code":"51000009","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":155.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office O/P Est Low 20-29 Min","code_information":[{"code":"51000010","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":231.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":155.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office O/P Est Mod 30-39 Min","code_information":[{"code":"51000011","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":271.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":155.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office O/P Est Hi 40-54 Min","code_information":[{"code":"51000012","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Urgent Care Technical Fee Schedule 189"},{"gross_charge":155.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office Consultation New/Estab Patient 30 Min","code_information":[{"code":"51000015","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":469.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Low 20-29 Min","code_information":[{"code":"51000016","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":231.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prolng E/M Svc Before&/After Dir Pt Care 1St Hr","code_information":[{"code":"51000019","type":"CDM"},{"code":"510","type":"RC"},{"code":"99358","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prolng E/M Before&/After Dir Care Ea 30 Minutes","code_information":[{"code":"51000020","type":"CDM"},{"code":"510","type":"RC"},{"code":"99359","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":204.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Advance Care Planning First 30 Mins","code_information":[{"code":"51000021","type":"CDM"},{"code":"510","type":"RC"},{"code":"99497","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"discounted_cash":338.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Advance Care Planning Ea Addl 30 Mins","code_information":[{"code":"51000022","type":"CDM"},{"code":"510","type":"RC"},{"code":"99498","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":299.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 15-29 Min (Telemed)","code_information":[{"code":"51000024","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":194.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 30-44 Min (Telemed)","code_information":[{"code":"51000025","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":231.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 45-59 Min (Telemed)","code_information":[{"code":"51000026","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":271.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 60-74 Min (Telemed)","code_information":[{"code":"51000027","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Minimal Prob (Telemed)","code_information":[{"code":"51000028","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Sf 10-19 Min (Telemed)","code_information":[{"code":"51000029","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Low 20-29 Min (Telemed)","code_information":[{"code":"51000030","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":231.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Mod 30-39 Min (Telemed)","code_information":[{"code":"51000031","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":271.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Hi 40-54 Min (Telemed)","code_information":[{"code":"51000032","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Impacted Cerumen Irrigation/Lvg Unilat","code_information":[{"code":"51000034","type":"CDM"},{"code":"510","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":246.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Removal Impacted Cerumen Instrumentation Unilat","code_information":[{"code":"51000035","type":"CDM"},{"code":"510","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":259.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc I&D Hematoma Seroma/Fluid Collection","code_information":[{"code":"51000036","type":"CDM"},{"code":"510","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":5446.0,"discounted_cash":4574.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Paring/Cutting Benign Hyperkeratotic Lesion 1","code_information":[{"code":"51000037","type":"CDM"},{"code":"510","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":783.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Paring/Cutting Benign Hyperkeratotic Lesion 2-4","code_information":[{"code":"51000038","type":"CDM"},{"code":"510","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":783.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sub Grft F/S/N/H/F/G/M/D >/= 100Scm 1St 100Sq Cm","code_information":[{"code":"51000039","type":"CDM"},{"code":"510","type":"RC"},{"code":"15277","type":"HCPCS"}],"standard_charges":[{"gross_charge":7079.0,"discounted_cash":5946.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sub Grft F/S/N/H/F/G/M/D >/= 100Scm Adl 100Sq Cm","code_information":[{"code":"51000040","type":"CDM"},{"code":"510","type":"RC"},{"code":"15278","type":"HCPCS"}],"standard_charges":[{"gross_charge":1706.0,"discounted_cash":1433.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prolonged Office/Outpatient E/M Svc Ea 15 Min","code_information":[{"code":"51000041","type":"CDM"},{"code":"510","type":"RC"},{"code":"G2212","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":52.0,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Em Mntr Physiol Param 1St Set Up Pt Educaj Eqp","code_information":[{"code":"51000042","type":"CDM"},{"code":"510","type":"RC"},{"code":"99453","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":393.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Rem Mntr Physiol Param 1St Dev Supply Ea 30 D","code_information":[{"code":"51000043","type":"CDM"},{"code":"510","type":"RC"},{"code":"99454","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Principal Care Mgmt Svc 1St 30 Staff Cal Mo","code_information":[{"code":"51000044","type":"CDM"},{"code":"510","type":"RC"},{"code":"99426","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":254.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Principal Care Mgmt Svc Ea Addl 30 Staff Cal Mo","code_information":[{"code":"51000045","type":"CDM"},{"code":"510","type":"RC"},{"code":"99427","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"51000046","type":"CDM"},{"code":"510","type":"RC"},{"code":"96040","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":156.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transj Care Mgmt High F2F 7D","code_information":[{"code":"51000047","type":"CDM"},{"code":"510","type":"RC"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":236.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Office O/P New Sf 30-44 Min","code_information":[{"code":"51100000","type":"CDM"},{"code":"511","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":231.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 45-59 Min","code_information":[{"code":"51100001","type":"CDM"},{"code":"511","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":271.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 60-74 Min","code_information":[{"code":"51100002","type":"CDM"},{"code":"511","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Minimal Prob","code_information":[{"code":"51100003","type":"CDM"},{"code":"511","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Sf 10-19 Min","code_information":[{"code":"51100004","type":"CDM"},{"code":"511","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Mod 30-39 Min","code_information":[{"code":"51100006","type":"CDM"},{"code":"511","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":271.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Hi 40-54 Min","code_information":[{"code":"51100007","type":"CDM"},{"code":"511","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Op/Ov Consult Ation Level 3","code_information":[{"code":"51100008","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":568.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Op/Ov Consult Ation Level 4","code_information":[{"code":"51100009","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.0,"discounted_cash":841.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Op/Ov Consult Ation Level 5","code_information":[{"code":"51100010","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"discounted_cash":1034.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":206.0,"discounted_cash":173.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Nicu Transport","code_information":[{"code":"54600000","type":"CDM"},{"code":"546","type":"RC"}],"standard_charges":[{"gross_charge":2564.0,"discounted_cash":2153.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mri Tmj","code_information":[{"code":"61000001","type":"CDM"},{"code":"610","type":"RC"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":3687.0,"discounted_cash":3097.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2765.0,"discounted_cash":2322.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Orbit Bilateral","code_information":[{"code":"61000002","type":"CDM"},{"code":"610","type":"RC"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":3886.0,"discounted_cash":3264.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2846.0,"discounted_cash":2390.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Orbit/Face/Neck W/O & W Contrast","code_information":[{"code":"61000003","type":"CDM"},{"code":"610","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":8394.0,"discounted_cash":7050.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4197.0,"discounted_cash":3525.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mr Angiography Head W/O Contrast","code_information":[{"code":"61000004","type":"CDM"},{"code":"610","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":3779.0,"discounted_cash":3174.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2834.0,"discounted_cash":2380.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mr Angiography Head W/ Contrast","code_information":[{"code":"61000005","type":"CDM"},{"code":"610","type":"RC"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":5004.0,"discounted_cash":4203.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3452.0,"discounted_cash":2899.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mr Angiography Head W/O & W Contrast","code_information":[{"code":"61000006","type":"CDM"},{"code":"610","type":"RC"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":5196.0,"discounted_cash":4364.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4358.0,"discounted_cash":3660.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mr Angiography Neck W/O Contrast","code_information":[{"code":"61000007","type":"CDM"},{"code":"610","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":3779.0,"discounted_cash":3174.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2834.0,"discounted_cash":2380.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mr Angiography Neck W Contrast","code_information":[{"code":"61000008","type":"CDM"},{"code":"610","type":"RC"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":5004.0,"discounted_cash":4203.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3288.0,"discounted_cash":2761.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mr Angiography Neck W/O & W Contrast","code_information":[{"code":"61000009","type":"CDM"},{"code":"610","type":"RC"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":5196.0,"discounted_cash":4364.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4358.0,"discounted_cash":3660.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Chest W/O Contrast","code_information":[{"code":"61000010","type":"CDM"},{"code":"610","type":"RC"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":3687.0,"discounted_cash":3097.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2765.0,"discounted_cash":2322.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Chest W/O & W Contrast","code_information":[{"code":"61000011","type":"CDM"},{"code":"610","type":"RC"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5307.0,"discounted_cash":4457.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4359.0,"discounted_cash":3661.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Neck Spine W Contrast","code_information":[{"code":"61000012","type":"CDM"},{"code":"610","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":5304.0,"discounted_cash":4455.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2122.0,"discounted_cash":1782.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Chest Spine W Contrast","code_information":[{"code":"61000013","type":"CDM"},{"code":"610","type":"RC"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":5644.0,"discounted_cash":4740.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2062.0,"discounted_cash":1732.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Pelvis Wo Contrast","code_information":[{"code":"61000014","type":"CDM"},{"code":"610","type":"RC"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":3504.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2848.0,"discounted_cash":2392.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Pelvis Wo/W Contrast","code_information":[{"code":"61000015","type":"CDM"},{"code":"610","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":6009.0,"discounted_cash":5047.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4359.0,"discounted_cash":3661.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Upper Extremity W/O Cont","code_information":[{"code":"61000016","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":4164.0,"discounted_cash":3497.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2840.0,"discounted_cash":2385.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Uppr Extremity W/O&W/Cont","code_information":[{"code":"61000017","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":5629.0,"discounted_cash":4728.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4222.0,"discounted_cash":3546.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Joint Upr Extrem W/O Cont","code_information":[{"code":"61000018","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":4498.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2840.0,"discounted_cash":2385.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Joint Upr Extrem W/ Cont","code_information":[{"code":"61000019","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.0,"discounted_cash":5169.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3385.0,"discounted_cash":2843.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Joint Upr Extr W/O&W/Cont","code_information":[{"code":"61000020","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":7286.0,"discounted_cash":6120.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4351.0,"discounted_cash":3654.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mr Angio Upr Extr W/O&W/Cont","code_information":[{"code":"61000021","type":"CDM"},{"code":"610","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2848.0,"discounted_cash":2392.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2563.0,"discounted_cash":2152.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Lower Extremity W/O Cont","code_information":[{"code":"61000022","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":5301.0,"discounted_cash":4452.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2814.0,"discounted_cash":2363.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Lower Extremity W/ Cont","code_information":[{"code":"61000023","type":"CDM"},{"code":"610","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":6360.0,"discounted_cash":5342.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3413.0,"discounted_cash":2866.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Lower Extremity W/O&W/Cont","code_information":[{"code":"61000024","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":9259.0,"discounted_cash":7777.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4167.0,"discounted_cash":3500.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Joint Of Lower Extremity W/O Cont","code_information":[{"code":"61000025","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":5301.0,"discounted_cash":4452.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2814.0,"discounted_cash":2363.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Joint Of Lower Extremity W/ Cont","code_information":[{"code":"61000026","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":5949.0,"discounted_cash":4997.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3272.0,"discounted_cash":2748.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Joint Lower Extr W/O&W/Cont","code_information":[{"code":"61000027","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":6117.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4309.0,"discounted_cash":3619.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mr Angio Lower Ext W Or W/O Cont","code_information":[{"code":"61000028","type":"CDM"},{"code":"610","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5101.0,"discounted_cash":4284.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4591.0,"discounted_cash":3856.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Abdomen W/O Contrast","code_information":[{"code":"61000029","type":"CDM"},{"code":"610","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":3931.0,"discounted_cash":3302.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2848.0,"discounted_cash":2392.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Abdomen W/O & W/Contrast","code_information":[{"code":"61000030","type":"CDM"},{"code":"610","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":5542.0,"discounted_cash":4655.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4157.0,"discounted_cash":3491.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cardiac Mri For Morph W/O Cont","code_information":[{"code":"61000031","type":"CDM"},{"code":"610","type":"RC"},{"code":"75557","type":"HCPCS"}],"standard_charges":[{"gross_charge":2325.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1860.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cardiac Mri For Morph W/ Cont","code_information":[{"code":"61000032","type":"CDM"},{"code":"610","type":"RC"},{"code":"75561","type":"HCPCS"}],"standard_charges":[{"gross_charge":2520.0,"discounted_cash":2116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2016.0,"discounted_cash":1693.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Card Mri Veloc Flow Mapping Add","code_information":[{"code":"61000033","type":"CDM"},{"code":"610","type":"RC"},{"code":"75565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1877.0,"discounted_cash":1576.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1566.0,"discounted_cash":1315.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc 3D Render W/Intrp Postproces","code_information":[{"code":"61000034","type":"CDM"},{"code":"610","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.0,"discounted_cash":565.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":217.0,"discounted_cash":182.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Procedure","code_information":[{"code":"61000035","type":"CDM"},{"code":"610","type":"RC"},{"code":"76498","type":"HCPCS"}],"standard_charges":[{"gross_charge":2329.0,"discounted_cash":1956.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1803.0,"discounted_cash":1514.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mr Guidance For Needle Place","code_information":[{"code":"61000036","type":"CDM"},{"code":"610","type":"RC"},{"code":"77021","type":"HCPCS"}],"standard_charges":[{"gross_charge":3407.0,"discounted_cash":2861.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2924.0,"discounted_cash":2456.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mra Abdomen W/Contrast","code_information":[{"code":"61000038","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4792.0,"discounted_cash":4025.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3253.0,"discounted_cash":2732.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mra Abdomen Wo/Contrast","code_information":[{"code":"61000039","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8901","type":"HCPCS"}],"standard_charges":[{"gross_charge":4187.0,"discounted_cash":3517.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2848.0,"discounted_cash":2392.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mra Abdomen Wo/W Contrast","code_information":[{"code":"61000040","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"gross_charge":5629.0,"discounted_cash":4728.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4151.0,"discounted_cash":3486.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mra Chest Wo/Contrast","code_information":[{"code":"61000041","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8910","type":"HCPCS"}],"standard_charges":[{"gross_charge":3802.0,"discounted_cash":3193.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2852.0,"discounted_cash":2395.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mra Wo Fol W/Contrast, Chest","code_information":[{"code":"61000042","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"gross_charge":5657.0,"discounted_cash":4751.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4243.0,"discounted_cash":3564.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mra W/Contrast, Lower Extremity","code_information":[{"code":"61000043","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8912","type":"HCPCS"}],"standard_charges":[{"gross_charge":5242.0,"discounted_cash":4403.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3250.0,"discounted_cash":2730.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mra W/O Contrast, Lower Extremity","code_information":[{"code":"61000044","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8913","type":"HCPCS"}],"standard_charges":[{"gross_charge":5101.0,"discounted_cash":4284.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2680.0,"discounted_cash":2251.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mra W/O Fol W/Contrast, Lower Extremity","code_information":[{"code":"61000045","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8914","type":"HCPCS"}],"standard_charges":[{"gross_charge":6743.0,"discounted_cash":5664.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4104.0,"discounted_cash":3447.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mra Pelvis W/O Contrast","code_information":[{"code":"61000046","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8919","type":"HCPCS"}],"standard_charges":[{"gross_charge":3542.0,"discounted_cash":2975.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2712.0,"discounted_cash":2278.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mra W/O Fol W/Contrast, Pelvis","code_information":[{"code":"61000047","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8920","type":"HCPCS"}],"standard_charges":[{"gross_charge":5656.0,"discounted_cash":4751.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4242.0,"discounted_cash":3563.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Chest W Contrast","code_information":[{"code":"61000048","type":"CDM"},{"code":"610","type":"RC"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3963.0,"discounted_cash":3328.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2309.0,"discounted_cash":1939.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Angiogram Spine W Wo Contrast","code_information":[{"code":"61000050","type":"CDM"},{"code":"610","type":"RC"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":2953.0,"discounted_cash":2480.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2534.0,"discounted_cash":2128.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Pelvis W Contrast","code_information":[{"code":"61000051","type":"CDM"},{"code":"610","type":"RC"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":4605.0,"discounted_cash":3868.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2763.0,"discounted_cash":2320.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Angiogram Pelvis W Wo Contrast","code_information":[{"code":"61000052","type":"CDM"},{"code":"610","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":5142.0,"discounted_cash":4319.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4628.0,"discounted_cash":3887.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Upper Extremity W Contrast","code_information":[{"code":"61000053","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":4755.0,"discounted_cash":3994.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2371.0,"discounted_cash":1991.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Abdomen W Contrast","code_information":[{"code":"61000054","type":"CDM"},{"code":"610","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":4367.0,"discounted_cash":3668.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2839.0,"discounted_cash":2384.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Fetal Sngl/1St Gestation","code_information":[{"code":"61000056","type":"CDM"},{"code":"610","type":"RC"},{"code":"74712","type":"HCPCS"}],"standard_charges":[{"gross_charge":1308.0,"discounted_cash":1098.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1010.0,"discounted_cash":848.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Fetal Ea Addl Gestation","code_information":[{"code":"61000057","type":"CDM"},{"code":"610","type":"RC"},{"code":"74713","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":548.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mr Spectroscopy","code_information":[{"code":"61000058","type":"CDM"},{"code":"610","type":"RC"},{"code":"76390","type":"HCPCS"}],"standard_charges":[{"gross_charge":3437.0,"discounted_cash":2887.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2952.0,"discounted_cash":2479.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Breast Without Contrast Material Unilateral","code_information":[{"code":"61000059","type":"CDM"},{"code":"610","type":"RC"},{"code":"77046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":897.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":801.0,"discounted_cash":672.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Breast Without Contrast Material Bilateral","code_information":[{"code":"61000060","type":"CDM"},{"code":"610","type":"RC"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":897.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":801.0,"discounted_cash":672.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Breast W/Out&With Contrast W/Cad Unilateral","code_information":[{"code":"61000061","type":"CDM"},{"code":"610","type":"RC"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":5715.0,"discounted_cash":4800.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4286.0,"discounted_cash":3600.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Breast Without&With Contrast W/Cad Bilateral","code_information":[{"code":"61000062","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8908","type":"HCPCS"}],"standard_charges":[{"gross_charge":6661.0,"discounted_cash":5595.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4996.0,"discounted_cash":4196.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri W/Cont, Breast, Uni","code_information":[{"code":"61000063","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8903","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":783.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":698.0,"discounted_cash":586.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Cad Breast Mri","code_information":[{"code":"61000064","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8937","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":120.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":122.0,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Magnetic Resonance Elastography","code_information":[{"code":"61000065","type":"CDM"},{"code":"610","type":"RC"},{"code":"76391","type":"HCPCS"}],"standard_charges":[{"gross_charge":2520.0,"discounted_cash":2116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1890.0,"discounted_cash":1587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Brain Stem W/O Contrast","code_information":[{"code":"61100000","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3503.0,"discounted_cash":2942.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2802.0,"discounted_cash":2353.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Brain Stem W Contrast","code_information":[{"code":"61100001","type":"CDM"},{"code":"611","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3650.0,"discounted_cash":3066.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3468.0,"discounted_cash":2913.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Brain Stem W/O & W Contrast","code_information":[{"code":"61100002","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":6186.0,"discounted_cash":5196.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4330.0,"discounted_cash":3637.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Neck Spine W/O Contrast","code_information":[{"code":"61200000","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":4855.0,"discounted_cash":4078.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2818.0,"discounted_cash":2367.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Chest Spine W/O Contrast","code_information":[{"code":"61200001","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":5211.0,"discounted_cash":4377.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2810.0,"discounted_cash":2360.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Lumbar Spine W/O Contrast","code_information":[{"code":"61200002","type":"CDM"},{"code":"612","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":4013.0,"discounted_cash":3370.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":2809.0,"discounted_cash":2359.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Lumbar Spine W Contrast","code_information":[{"code":"61200003","type":"CDM"},{"code":"612","type":"RC"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":4245.0,"discounted_cash":3565.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":3396.0,"discounted_cash":2852.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Neck Spine W/Wo Contrast","code_information":[{"code":"61200004","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":10670.0,"discounted_cash":8962.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4268.0,"discounted_cash":3585.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Chest Spine W/Wo Contrast","code_information":[{"code":"61200005","type":"CDM"},{"code":"612","type":"RC"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":10423.0,"discounted_cash":8755.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4169.0,"discounted_cash":3501.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Mri Lumbar Spine Wo/W Contrast","code_information":[{"code":"61200006","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":8820.0,"discounted_cash":7408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":4358.0,"discounted_cash":3660.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Trauma Code","code_information":[{"code":"68100000","type":"CDM"},{"code":"681","type":"RC"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"gross_charge":5459.0,"discounted_cash":4585.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Trauma Alert","code_information":[{"code":"68200000","type":"CDM"},{"code":"682","type":"RC"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"gross_charge":4609.0,"discounted_cash":3871.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Trauma Referral","code_information":[{"code":"68300000","type":"CDM"},{"code":"683","type":"RC"}],"standard_charges":[{"gross_charge":4088.0,"discounted_cash":3433.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C-Section Recovery 30 M","code_information":[{"code":"71000000","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":440.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C-Section Recovery 60 M","code_information":[{"code":"71000001","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":819.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C-Section Recovery 90 M","code_information":[{"code":"71000002","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":1302.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C-Section Recovery Addtn 30M","code_information":[{"code":"71000003","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":417.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phase 1 Recovery","code_information":[{"code":"71000005","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phase Ii Recovery","code_information":[{"code":"71000006","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vaginal Delivery Recovery 120 M","code_information":[{"code":"71000007","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":1643.0,"discounted_cash":1380.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vaginal Delivery Recovery 60 M","code_information":[{"code":"71000008","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":655.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Vaginal Delivery Recovery 90 M","code_information":[{"code":"71000009","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":957.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Venipuncture","code_information":[{"code":"71000010","type":"CDM"},{"code":"710","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C-Section <=90 Min","code_information":[{"code":"72000000","type":"CDM"},{"code":"720","type":"RC"}],"standard_charges":[{"gross_charge":7364.0,"discounted_cash":6185.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc C-Section > 90 Min Per 30 Min","code_information":[{"code":"72000001","type":"CDM"},{"code":"720","type":"RC"}],"standard_charges":[{"gross_charge":1214.0,"discounted_cash":1019.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Delivery Vaginal","code_information":[{"code":"72000002","type":"CDM"},{"code":"720","type":"RC"}],"standard_charges":[{"gross_charge":5544.0,"discounted_cash":4656.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Delivery Vaginal Complex","code_information":[{"code":"72000003","type":"CDM"},{"code":"720","type":"RC"}],"standard_charges":[{"gross_charge":8391.0,"discounted_cash":7048.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urethral Cath Inserted","code_information":[{"code":"72000004","type":"CDM"},{"code":"720","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Urethral Cath Temporary","code_information":[{"code":"72000005","type":"CDM"},{"code":"720","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Amniocentesis, Diagnostic","code_information":[{"code":"72000006","type":"CDM"},{"code":"720","type":"RC"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2230.0,"discounted_cash":1873.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fetal Contraction Stress Test","code_information":[{"code":"72000007","type":"CDM"},{"code":"720","type":"RC"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":644.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fetal Non-Stress Test","code_information":[{"code":"72000008","type":"CDM"},{"code":"720","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":786.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Antepartum Manipulation","code_information":[{"code":"72000009","type":"CDM"},{"code":"720","type":"RC"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":6588.0,"discounted_cash":5533.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Delivery Of Placenta","code_information":[{"code":"72000010","type":"CDM"},{"code":"720","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":8302.0,"discounted_cash":6973.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Hydra Initial =< 1Hr","code_information":[{"code":"72000011","type":"CDM"},{"code":"720","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":700.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Hydration Ea Add'l Hr","code_information":[{"code":"72000012","type":"CDM"},{"code":"720","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":307.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Thera/Proph/Diag Initial","code_information":[{"code":"72000013","type":"CDM"},{"code":"720","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":648.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Thera/Proph/Diag Add-On","code_information":[{"code":"72000014","type":"CDM"},{"code":"720","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":284.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx/Proph/Dg Addl Seq Iv Inf","code_information":[{"code":"72000015","type":"CDM"},{"code":"720","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":295.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther/Diag Concurrent Inf","code_information":[{"code":"72000016","type":"CDM"},{"code":"720","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther/Proph/Diag Inj Sc/Im","code_information":[{"code":"72000017","type":"CDM"},{"code":"720","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thera/Diag Inj-Iv Push Sing/Initl","code_information":[{"code":"72000018","type":"CDM"},{"code":"720","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx/Pro/Dx Inj New Drug Addon","code_information":[{"code":"72000019","type":"CDM"},{"code":"720","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx/Pro/Dx Inj Same Drug Adon","code_information":[{"code":"72000020","type":"CDM"},{"code":"720","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 15-29 Min","code_information":[{"code":"72000022","type":"CDM"},{"code":"720","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":300.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 30-44 Min","code_information":[{"code":"72000023","type":"CDM"},{"code":"720","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 45-59 Min","code_information":[{"code":"72000024","type":"CDM"},{"code":"720","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P New Sf 60-74 Min","code_information":[{"code":"72000025","type":"CDM"},{"code":"720","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Minimal Prob","code_information":[{"code":"72000026","type":"CDM"},{"code":"720","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":254.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Sf 10-19 Min","code_information":[{"code":"72000027","type":"CDM"},{"code":"720","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":291.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Low 20-29 Min","code_information":[{"code":"72000028","type":"CDM"},{"code":"720","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":320.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Mod 30-39 Min","code_information":[{"code":"72000029","type":"CDM"},{"code":"720","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":368.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Office O/P Est Hi 40-54 Min","code_information":[{"code":"72000030","type":"CDM"},{"code":"720","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":485.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chorionic Villus Sampling","code_information":[{"code":"72000031","type":"CDM"},{"code":"720","type":"RC"},{"code":"59015","type":"HCPCS"}],"standard_charges":[{"gross_charge":3314.0,"discounted_cash":2783.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insj Non-Biodegradable Drug Delivery Implant","code_information":[{"code":"72000032","type":"CDM"},{"code":"720","type":"RC"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":622.0,"discounted_cash":522.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Intrauterine Device Iud","code_information":[{"code":"72000033","type":"CDM"},{"code":"720","type":"RC"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":4498.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Unlisted Procedure Maternity Care & Delivery","code_information":[{"code":"72000034","type":"CDM"},{"code":"720","type":"RC"},{"code":"59899","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":609.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Insertion Cervical Dilator","code_information":[{"code":"72100000","type":"CDM"},{"code":"721","type":"RC"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":618.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Electrocardiogram Tracing","code_information":[{"code":"73000000","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":317.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Event Monitor Setup","code_information":[{"code":"73000001","type":"CDM"},{"code":"730","type":"RC"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":216.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Event Monitor Scan","code_information":[{"code":"73000002","type":"CDM"},{"code":"730","type":"RC"},{"code":"93271","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":599.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Holter Monitor Set-Up","code_information":[{"code":"73100000","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":651.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Holter Monitor Scan","code_information":[{"code":"73100001","type":"CDM"},{"code":"731","type":"RC"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":919.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Event Monitor Setup","code_information":[{"code":"73100002","type":"CDM"},{"code":"731","type":"RC"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":216.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  External Ecg Rec>48Hr<7D Recording","code_information":[{"code":"73100005","type":"CDM"},{"code":"731","type":"RC"},{"code":"93242","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":119.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc External Ecg Rec>7D<15D Recording","code_information":[{"code":"73100006","type":"CDM"},{"code":"731","type":"RC"},{"code":"93246","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":196.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  External Ecg Rec>48Hr<7D Scanning Alys W/Report","code_information":[{"code":"73100007","type":"CDM"},{"code":"731","type":"RC"},{"code":"93243","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":196.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  External Ecg Rec>7D<15D Scanning Alys W/Report","code_information":[{"code":"73100008","type":"CDM"},{"code":"731","type":"RC"},{"code":"93247","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":393.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cpap Follow-Up","code_information":[{"code":"74000003","type":"CDM"},{"code":"740","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":7945.0,"discounted_cash":6673.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eeg Extended Monitoring 61-119 Mins","code_information":[{"code":"74000004","type":"CDM"},{"code":"740","type":"RC"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":1108.0,"discounted_cash":930.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eeg Awake And Drowsy","code_information":[{"code":"74000005","type":"CDM"},{"code":"740","type":"RC"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1156.0,"discounted_cash":971.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Home Sleep Test/Type 3 Porta","code_information":[{"code":"74000008","type":"CDM"},{"code":"740","type":"RC"},{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"gross_charge":2842.0,"discounted_cash":2387.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eeg W/O Vid 2-12 Hr Unmntr","code_information":[{"code":"74000010","type":"CDM"},{"code":"740","type":"RC"},{"code":"95705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1123.0,"discounted_cash":943.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eeg Wo Vid 2-12Hr Intmt Mntr","code_information":[{"code":"74000011","type":"CDM"},{"code":"740","type":"RC"},{"code":"95706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1123.0,"discounted_cash":943.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eeg W/O Vid 2-12Hr Cont Mntr","code_information":[{"code":"74000012","type":"CDM"},{"code":"740","type":"RC"},{"code":"95707","type":"HCPCS"}],"standard_charges":[{"gross_charge":1123.0,"discounted_cash":943.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eeg Wo Vid Ea 12-26Hr Unmntr","code_information":[{"code":"74000013","type":"CDM"},{"code":"740","type":"RC"},{"code":"95708","type":"HCPCS"}],"standard_charges":[{"gross_charge":1918.0,"discounted_cash":1611.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eeg W/O Vid Ea 12-26Hr Intmt","code_information":[{"code":"74000014","type":"CDM"},{"code":"740","type":"RC"},{"code":"95709","type":"HCPCS"}],"standard_charges":[{"gross_charge":1918.0,"discounted_cash":1611.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eeg W/O Vid Ea 12-26Hr Cont","code_information":[{"code":"74000015","type":"CDM"},{"code":"740","type":"RC"},{"code":"95710","type":"HCPCS"}],"standard_charges":[{"gross_charge":1918.0,"discounted_cash":1611.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eeg Cont Rec W/Vid Eeg Tech","code_information":[{"code":"74000032","type":"CDM"},{"code":"740","type":"RC"},{"code":"95700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":924.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Veeg 2-12 Hr Unmonitored","code_information":[{"code":"74000033","type":"CDM"},{"code":"740","type":"RC"},{"code":"95711","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":924.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Veeg 2-12 Hr Intmt Mntr","code_information":[{"code":"74000034","type":"CDM"},{"code":"740","type":"RC"},{"code":"95712","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":924.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Veeg 2-12 Hr Cont Mntr","code_information":[{"code":"74000035","type":"CDM"},{"code":"740","type":"RC"},{"code":"95713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2112.0,"discounted_cash":1774.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Veeg Ea 12-26 Hr Unmntr","code_information":[{"code":"74000036","type":"CDM"},{"code":"740","type":"RC"},{"code":"95714","type":"HCPCS"}],"standard_charges":[{"gross_charge":2112.0,"discounted_cash":1774.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Veeg Ea 12-26Hr Intmt Mntr","code_information":[{"code":"74000037","type":"CDM"},{"code":"740","type":"RC"},{"code":"95715","type":"HCPCS"}],"standard_charges":[{"gross_charge":2112.0,"discounted_cash":1774.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Veeg Ea 12-26Hr Cont Mntr","code_information":[{"code":"74000038","type":"CDM"},{"code":"740","type":"RC"},{"code":"95716","type":"HCPCS"}],"standard_charges":[{"gross_charge":3951.0,"discounted_cash":3318.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time","code_information":[{"code":"74000039","type":"CDM"},{"code":"740","type":"RC"},{"code":"95800","type":"HCPCS"}],"standard_charges":[{"gross_charge":2842.0,"discounted_cash":2387.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc \tSleep Std Airflow Hrt Rate&O2 Sat Effort Unatt","code_information":[{"code":"74000040","type":"CDM"},{"code":"740","type":"RC"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":2842.0,"discounted_cash":2387.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Polysom <6 Yrs Sleep Stage 4/> Addl Param Attnd","code_information":[{"code":"74000041","type":"CDM"},{"code":"740","type":"RC"},{"code":"95782","type":"HCPCS"}],"standard_charges":[{"gross_charge":3616.0,"discounted_cash":3037.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Diagnostic Bronchoscopy/Wash","code_information":[{"code":"75000000","type":"CDM"},{"code":"750","type":"RC"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":2716.0,"discounted_cash":2281.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Diagnostic Bronchoscopy/Lavage","code_information":[{"code":"75000001","type":"CDM"},{"code":"750","type":"RC"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":2716.0,"discounted_cash":2281.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronchoscopy W/Biopsy(S)","code_information":[{"code":"75000002","type":"CDM"},{"code":"750","type":"RC"},{"code":"31625","type":"HCPCS"}],"standard_charges":[{"gross_charge":2716.0,"discounted_cash":2281.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronchoscopy/Lung Bx Each","code_information":[{"code":"75000003","type":"CDM"},{"code":"750","type":"RC"},{"code":"31628","type":"HCPCS"}],"standard_charges":[{"gross_charge":9132.0,"discounted_cash":7670.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronch W/Transbronch Need Asp Bx Each","code_information":[{"code":"75000004","type":"CDM"},{"code":"750","type":"RC"},{"code":"31629","type":"HCPCS"}],"standard_charges":[{"gross_charge":8750.0,"discounted_cash":7350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronch W/Trach Dilate & Placment Of Stent","code_information":[{"code":"75000005","type":"CDM"},{"code":"750","type":"RC"},{"code":"31631","type":"HCPCS"}],"standard_charges":[{"gross_charge":17164.0,"discounted_cash":14417.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Esophagoscopy With Submuscoal Injection","code_information":[{"code":"75000006","type":"CDM"},{"code":"750","type":"RC"},{"code":"43201","type":"HCPCS"}],"standard_charges":[{"gross_charge":2840.0,"discounted_cash":2385.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Diagnostic Brush Wash","code_information":[{"code":"75000007","type":"CDM"},{"code":"750","type":"RC"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Biopsy Single/Multiple","code_information":[{"code":"75000008","type":"CDM"},{"code":"750","type":"RC"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Injection Varices","code_information":[{"code":"75000009","type":"CDM"},{"code":"750","type":"RC"},{"code":"43243","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Varices Ligation","code_information":[{"code":"75000010","type":"CDM"},{"code":"750","type":"RC"},{"code":"43244","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Place Gastrostomy Tube","code_information":[{"code":"75000011","type":"CDM"},{"code":"750","type":"RC"},{"code":"43246","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Remove Foreign Body","code_information":[{"code":"75000012","type":"CDM"},{"code":"750","type":"RC"},{"code":"43247","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Guide Wire Insertion","code_information":[{"code":"75000013","type":"CDM"},{"code":"750","type":"RC"},{"code":"43248","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd W/Dilation/Balloon <30Mm","code_information":[{"code":"75000014","type":"CDM"},{"code":"750","type":"RC"},{"code":"43249","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Cautery Tumor Polyp","code_information":[{"code":"75000015","type":"CDM"},{"code":"750","type":"RC"},{"code":"43250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Remove Lesion Snare","code_information":[{"code":"75000016","type":"CDM"},{"code":"750","type":"RC"},{"code":"43251","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Control Bleeding Any","code_information":[{"code":"75000017","type":"CDM"},{"code":"750","type":"RC"},{"code":"43255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.0,"discounted_cash":2236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ercp W/Specimen Collection","code_information":[{"code":"75000018","type":"CDM"},{"code":"750","type":"RC"},{"code":"43260","type":"HCPCS"}],"standard_charges":[{"gross_charge":6788.0,"discounted_cash":5701.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Endo Cholangiopancreatograph","code_information":[{"code":"75000019","type":"CDM"},{"code":"750","type":"RC"},{"code":"43262","type":"HCPCS"}],"standard_charges":[{"gross_charge":6788.0,"discounted_cash":5701.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ercp Remove Duct Calculi","code_information":[{"code":"75000020","type":"CDM"},{"code":"750","type":"RC"},{"code":"43264","type":"HCPCS"}],"standard_charges":[{"gross_charge":6788.0,"discounted_cash":5701.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ercp Duct Stent Placement","code_information":[{"code":"75000021","type":"CDM"},{"code":"750","type":"RC"},{"code":"43274","type":"HCPCS"}],"standard_charges":[{"gross_charge":14683.0,"discounted_cash":12333.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ercp Remove Forgn Body Duct","code_information":[{"code":"75000022","type":"CDM"},{"code":"750","type":"RC"},{"code":"43275","type":"HCPCS"}],"standard_charges":[{"gross_charge":14683.0,"discounted_cash":12333.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ercp Stent Exchange W/Dilate","code_information":[{"code":"75000023","type":"CDM"},{"code":"750","type":"RC"},{"code":"43276","type":"HCPCS"}],"standard_charges":[{"gross_charge":14683.0,"discounted_cash":12333.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Small Bowel Endoscopy","code_information":[{"code":"75000025","type":"CDM"},{"code":"750","type":"RC"},{"code":"44360","type":"HCPCS"}],"standard_charges":[{"gross_charge":2594.0,"discounted_cash":2178.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Small Bowel Endoscopy Br/Wa","code_information":[{"code":"75000026","type":"CDM"},{"code":"750","type":"RC"},{"code":"44380","type":"HCPCS"}],"standard_charges":[{"gross_charge":2594.0,"discounted_cash":2178.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy Thru Stoma Spx","code_information":[{"code":"75000027","type":"CDM"},{"code":"750","type":"RC"},{"code":"44388","type":"HCPCS"}],"standard_charges":[{"gross_charge":2825.0,"discounted_cash":2373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy/Stoma W/Snare Polypec","code_information":[{"code":"75000029","type":"CDM"},{"code":"750","type":"RC"},{"code":"44394","type":"HCPCS"}],"standard_charges":[{"gross_charge":2825.0,"discounted_cash":2373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Diagnostic Sigmoidoscopy","code_information":[{"code":"75000030","type":"CDM"},{"code":"750","type":"RC"},{"code":"45330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":1480.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sigmoidoscopy And Biopsy","code_information":[{"code":"75000031","type":"CDM"},{"code":"750","type":"RC"},{"code":"45331","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":1480.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sigmoidoscopy For Bleeding","code_information":[{"code":"75000032","type":"CDM"},{"code":"750","type":"RC"},{"code":"45334","type":"HCPCS"}],"standard_charges":[{"gross_charge":2897.0,"discounted_cash":2433.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sigmoidoscopy W/Lesion Removal By Snare","code_information":[{"code":"75000033","type":"CDM"},{"code":"750","type":"RC"},{"code":"45338","type":"HCPCS"}],"standard_charges":[{"gross_charge":2823.0,"discounted_cash":2371.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Diagnostic Colonoscopy","code_information":[{"code":"75000034","type":"CDM"},{"code":"750","type":"RC"},{"code":"45378","type":"HCPCS"}],"standard_charges":[{"gross_charge":2825.0,"discounted_cash":2373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy W/Fb Removal","code_information":[{"code":"75000035","type":"CDM"},{"code":"750","type":"RC"},{"code":"45379","type":"HCPCS"}],"standard_charges":[{"gross_charge":2825.0,"discounted_cash":2373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy And Biopsy","code_information":[{"code":"75000036","type":"CDM"},{"code":"750","type":"RC"},{"code":"45380","type":"HCPCS"}],"standard_charges":[{"gross_charge":2825.0,"discounted_cash":2373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colon W/Sub-Mucosal Inj","code_information":[{"code":"75000037","type":"CDM"},{"code":"750","type":"RC"},{"code":"45381","type":"HCPCS"}],"standard_charges":[{"gross_charge":3043.0,"discounted_cash":2556.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy W/Cntrl Of Bleeding","code_information":[{"code":"75000038","type":"CDM"},{"code":"750","type":"RC"},{"code":"45382","type":"HCPCS"}],"standard_charges":[{"gross_charge":2825.0,"discounted_cash":2373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy W/Lesion Removal By Hot Bx","code_information":[{"code":"75000039","type":"CDM"},{"code":"750","type":"RC"},{"code":"45384","type":"HCPCS"}],"standard_charges":[{"gross_charge":2825.0,"discounted_cash":2373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy W/Lesion Removal By Snare","code_information":[{"code":"75000040","type":"CDM"},{"code":"750","type":"RC"},{"code":"45385","type":"HCPCS"}],"standard_charges":[{"gross_charge":2825.0,"discounted_cash":2373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy W/Balloon Dilat","code_information":[{"code":"75000041","type":"CDM"},{"code":"750","type":"RC"},{"code":"45386","type":"HCPCS"}],"standard_charges":[{"gross_charge":3043.0,"discounted_cash":2556.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy W/Ablation","code_information":[{"code":"75000042","type":"CDM"},{"code":"750","type":"RC"},{"code":"45388","type":"HCPCS"}],"standard_charges":[{"gross_charge":4738.0,"discounted_cash":3979.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Esophageal Motility Testing","code_information":[{"code":"75000043","type":"CDM"},{"code":"750","type":"RC"},{"code":"91010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2037.0,"discounted_cash":1711.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc G-Esophagus Reflux Tst W/Electrod","code_information":[{"code":"75000044","type":"CDM"},{"code":"750","type":"RC"},{"code":"91035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2441.0,"discounted_cash":2050.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gi Tract Capsule Endoscopy","code_information":[{"code":"75000045","type":"CDM"},{"code":"750","type":"RC"},{"code":"91110","type":"HCPCS"}],"standard_charges":[{"gross_charge":3830.0,"discounted_cash":3217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gi Endoscopic Ultrasound","code_information":[{"code":"75000046","type":"CDM"},{"code":"750","type":"RC"},{"code":"43237","type":"HCPCS"}],"standard_charges":[{"gross_charge":5993.0,"discounted_cash":5034.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Enteroscopy W/Cntrl Bleeding","code_information":[{"code":"75000047","type":"CDM"},{"code":"750","type":"RC"},{"code":"44366","type":"HCPCS"}],"standard_charges":[{"gross_charge":2594.0,"discounted_cash":2178.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dx Bronchoscope/Brush","code_information":[{"code":"75000048","type":"CDM"},{"code":"750","type":"RC"},{"code":"31623","type":"HCPCS"}],"standard_charges":[{"gross_charge":5117.0,"discounted_cash":4298.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronchoscopy W/Markers","code_information":[{"code":"75000049","type":"CDM"},{"code":"750","type":"RC"},{"code":"31626","type":"HCPCS"}],"standard_charges":[{"gross_charge":15127.0,"discounted_cash":12706.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Navigational Bronchoscopy","code_information":[{"code":"75000050","type":"CDM"},{"code":"750","type":"RC"},{"code":"31627","type":"HCPCS"}],"standard_charges":[{"gross_charge":2799.0,"discounted_cash":2351.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronchoscopy/Lung Bx Addl","code_information":[{"code":"75000051","type":"CDM"},{"code":"750","type":"RC"},{"code":"31632","type":"HCPCS"}],"standard_charges":[{"gross_charge":2228.0,"discounted_cash":1871.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Stomach Surgery Procedure","code_information":[{"code":"75000052","type":"CDM"},{"code":"750","type":"RC"},{"code":"43999","type":"HCPCS"}],"standard_charges":[{"gross_charge":3569.0,"discounted_cash":2997.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Us Fine Needle Bx/Aspir","code_information":[{"code":"75000053","type":"CDM"},{"code":"750","type":"RC"},{"code":"43238","type":"HCPCS"}],"standard_charges":[{"gross_charge":6883.0,"discounted_cash":5781.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronchoscopy With Ultrasound (Ebus) 1Or2 Station","code_information":[{"code":"75000054","type":"CDM"},{"code":"750","type":"RC"},{"code":"31652","type":"HCPCS"}],"standard_charges":[{"gross_charge":9380.0,"discounted_cash":7879.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronchoscopy With Ultrasound (Ebus) 3Or More Station","code_information":[{"code":"75000055","type":"CDM"},{"code":"750","type":"RC"},{"code":"31653","type":"HCPCS"}],"standard_charges":[{"gross_charge":9380.0,"discounted_cash":7879.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd With Balloon Dilatation >30Mm","code_information":[{"code":"75000056","type":"CDM"},{"code":"750","type":"RC"},{"code":"43233","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":4956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Endoscopic Ultrasound With Pseudocyst Drainage","code_information":[{"code":"75000057","type":"CDM"},{"code":"750","type":"RC"},{"code":"43240","type":"HCPCS"}],"standard_charges":[{"gross_charge":10780.0,"discounted_cash":9055.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc (Egd) Enteroscopy With Biopsy","code_information":[{"code":"75000058","type":"CDM"},{"code":"750","type":"RC"},{"code":"44361","type":"HCPCS"}],"standard_charges":[{"gross_charge":5124.0,"discounted_cash":4304.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc (Egd) Enteroscopy With Snare Polypectomy","code_information":[{"code":"75000059","type":"CDM"},{"code":"750","type":"RC"},{"code":"44364","type":"HCPCS"}],"standard_charges":[{"gross_charge":5124.0,"discounted_cash":4304.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc (Colon) Enteroscopy","code_information":[{"code":"75000060","type":"CDM"},{"code":"750","type":"RC"},{"code":"44376","type":"HCPCS"}],"standard_charges":[{"gross_charge":5124.0,"discounted_cash":4304.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc (Colon) Enteroscopy With Biopsy","code_information":[{"code":"75000061","type":"CDM"},{"code":"750","type":"RC"},{"code":"44377","type":"HCPCS"}],"standard_charges":[{"gross_charge":5124.0,"discounted_cash":4304.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc (Colon) Enteroscopy With Control Of Bleeding","code_information":[{"code":"75000062","type":"CDM"},{"code":"750","type":"RC"},{"code":"44378","type":"HCPCS"}],"standard_charges":[{"gross_charge":5124.0,"discounted_cash":4304.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc (Colon) Endoscopic Ultrasound Sigmoidoscopy/Biopsy/Fna","code_information":[{"code":"75000063","type":"CDM"},{"code":"750","type":"RC"},{"code":"45342","type":"HCPCS"}],"standard_charges":[{"gross_charge":9168.0,"discounted_cash":7701.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc 24 Hour Ph Study (Reflux Test)","code_information":[{"code":"75000064","type":"CDM"},{"code":"750","type":"RC"},{"code":"91034","type":"HCPCS"}],"standard_charges":[{"gross_charge":2052.0,"discounted_cash":1723.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Same Phys/Qhp Initial 15 Mins 5/> Yrs","code_information":[{"code":"75000065","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1151.0,"discounted_cash":966.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Same Phys/Qhp Each Addl 15 Mins","code_information":[{"code":"75000066","type":"CDM"},{"code":"750","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Flexiable Sigmoidoscopy With Submucosal Injection","code_information":[{"code":"75000067","type":"CDM"},{"code":"750","type":"RC"},{"code":"45335","type":"HCPCS"}],"standard_charges":[{"gross_charge":3713.0,"discounted_cash":3118.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Flexiable Sigmoidoscopy With Dilatation","code_information":[{"code":"75000068","type":"CDM"},{"code":"750","type":"RC"},{"code":"45340","type":"HCPCS"}],"standard_charges":[{"gross_charge":4880.0,"discounted_cash":4099.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Esophagogastric Duodenoscopy Submucosal Injection","code_information":[{"code":"75000069","type":"CDM"},{"code":"750","type":"RC"},{"code":"43236","type":"HCPCS"}],"standard_charges":[{"gross_charge":3826.0,"discounted_cash":3213.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Endoscopic Stent Placement W/Wire& Dilation","code_information":[{"code":"75000070","type":"CDM"},{"code":"750","type":"RC"},{"code":"43266","type":"HCPCS"}],"standard_charges":[{"gross_charge":21547.0,"discounted_cash":18099.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronchoscopy W/Removal Foreign Body","code_information":[{"code":"75000071","type":"CDM"},{"code":"750","type":"RC"},{"code":"31635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3308.0,"discounted_cash":2778.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sigmoidoscopy Flx W/Rmvl Foreign Body","code_information":[{"code":"75000072","type":"CDM"},{"code":"750","type":"RC"},{"code":"45332","type":"HCPCS"}],"standard_charges":[{"gross_charge":4660.0,"discounted_cash":3914.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tracheobrnchsc Thru Est Trachs Inc","code_information":[{"code":"75000073","type":"CDM"},{"code":"750","type":"RC"},{"code":"31615","type":"HCPCS"}],"standard_charges":[{"gross_charge":3010.0,"discounted_cash":2528.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy Flexible With Band Ligation(S)","code_information":[{"code":"75000075","type":"CDM"},{"code":"750","type":"RC"},{"code":"45398","type":"HCPCS"}],"standard_charges":[{"gross_charge":4660.0,"discounted_cash":3914.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sigmoidoscopy Flx With With Band Ligation(S)","code_information":[{"code":"75000076","type":"CDM"},{"code":"750","type":"RC"},{"code":"45350","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.0,"discounted_cash":4278.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy Stoma W/Submucosal Injection","code_information":[{"code":"75000077","type":"CDM"},{"code":"750","type":"RC"},{"code":"44404","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.0,"discounted_cash":4278.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy Stoma W/Biopsy Single/Multiple","code_information":[{"code":"75000078","type":"CDM"},{"code":"750","type":"RC"},{"code":"44389","type":"HCPCS"}],"standard_charges":[{"gross_charge":5093.0,"discounted_cash":4278.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ercp Balloon Dilate Biliary/Panc Duct/Ampulla Ea","code_information":[{"code":"75000079","type":"CDM"},{"code":"750","type":"RC"},{"code":"43277","type":"HCPCS"}],"standard_charges":[{"gross_charge":12682.0,"discounted_cash":10652.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Us Guided Transmural Injxn/Fiducial Marker","code_information":[{"code":"75000080","type":"CDM"},{"code":"750","type":"RC"},{"code":"43253","type":"HCPCS"}],"standard_charges":[{"gross_charge":6598.0,"discounted_cash":5542.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Gi Transit & Pres Meas Wireless Capsule W/Interp","code_information":[{"code":"75000081","type":"CDM"},{"code":"750","type":"RC"},{"code":"91112","type":"HCPCS"}],"standard_charges":[{"gross_charge":3584.0,"discounted_cash":3010.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Perq Replacement Gtube Not Req Revj Gstrst Trc","code_information":[{"code":"75000082","type":"CDM"},{"code":"750","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":1012.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Inject Si Joint Arthrgrphy&/Anes/Steroid W/Ima","code_information":[{"code":"75000083","type":"CDM"},{"code":"750","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":605.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Endoscopic Papilla Cannulation Bile/Pancreatic","code_information":[{"code":"75000084","type":"CDM"},{"code":"750","type":"RC"},{"code":"43273","type":"HCPCS"}],"standard_charges":[{"gross_charge":3673.0,"discounted_cash":3085.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ercp Destruction/Lithotripsy Calculi Any Method","code_information":[{"code":"75000085","type":"CDM"},{"code":"750","type":"RC"},{"code":"43265","type":"HCPCS"}],"standard_charges":[{"gross_charge":19927.0,"discounted_cash":16738.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colorectal Scrn; Hi Risk Ind","code_information":[{"code":"75000088","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"gross_charge":4353.0,"discounted_cash":3656.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colon Ca Scrn Not Hi Rsk Ind","code_information":[{"code":"75000089","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"gross_charge":3246.0,"discounted_cash":2726.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Dilation Gastric/Duodenal Stricture","code_information":[{"code":"75000090","type":"CDM"},{"code":"750","type":"RC"},{"code":"43245","type":"HCPCS"}],"standard_charges":[{"gross_charge":7558.0,"discounted_cash":6348.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sgmdsc Flx W/Dcmprn W/Plmt Dcmprn Tube","code_information":[{"code":"75000091","type":"CDM"},{"code":"750","type":"RC"},{"code":"45337","type":"HCPCS"}],"standard_charges":[{"gross_charge":3774.0,"discounted_cash":3170.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Esophagoscopy Flexible Removal Foreign Body","code_information":[{"code":"75000092","type":"CDM"},{"code":"750","type":"RC"},{"code":"43215","type":"HCPCS"}],"standard_charges":[{"gross_charge":7561.0,"discounted_cash":6351.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy Flx W/Endoscopic Mucosal Resection","code_information":[{"code":"75000093","type":"CDM"},{"code":"750","type":"RC"},{"code":"45390","type":"HCPCS"}],"standard_charges":[{"gross_charge":11579.0,"discounted_cash":9726.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Edg Us Exam Surgical Alter Stom Duodenum/Jejunum","code_information":[{"code":"75000094","type":"CDM"},{"code":"750","type":"RC"},{"code":"43259","type":"HCPCS"}],"standard_charges":[{"gross_charge":7561.0,"discounted_cash":6351.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Hc Anoscopy W/Rmvl Lesion Cautery","code_information":[{"code":"75000095","type":"CDM"},{"code":"750","type":"RC"},{"code":"46610","type":"HCPCS"}],"standard_charges":[{"gross_charge":11297.0,"discounted_cash":9489.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Brnschsc Tndsc Ebus Dx/Tx Intervention Perph Les","code_information":[{"code":"75000096","type":"CDM"},{"code":"750","type":"RC"},{"code":"31654","type":"HCPCS"}],"standard_charges":[{"gross_charge":2451.0,"discounted_cash":2058.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Colonoscopy Flexible With Decompression","code_information":[{"code":"75000097","type":"CDM"},{"code":"750","type":"RC"},{"code":"45393","type":"HCPCS"}],"standard_charges":[{"gross_charge":4960.0,"discounted_cash":4166.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Intrmural Needle Aspir/Biop Altered Anatomy","code_information":[{"code":"75000098","type":"CDM"},{"code":"750","type":"RC"},{"code":"43242","type":"HCPCS"}],"standard_charges":[{"gross_charge":7560.0,"discounted_cash":6350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Laryngoscopy W/Wo Tracheoscopy Aspiration","code_information":[{"code":"75000099","type":"CDM"},{"code":"750","type":"RC"},{"code":"31515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1913.0,"discounted_cash":1606.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Laryngoscopy W/Wo Tracheoscopy Dx Except Newborn","code_information":[{"code":"75000100","type":"CDM"},{"code":"750","type":"RC"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":7238.0,"discounted_cash":6079.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Enteroscopy > 2Nd Prtn W/Plmt Prq Tube","code_information":[{"code":"75000101","type":"CDM"},{"code":"750","type":"RC"},{"code":"44372","type":"HCPCS"}],"standard_charges":[{"gross_charge":7879.0,"discounted_cash":6618.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronchoscopy W/Excision Tumor","code_information":[{"code":"75000102","type":"CDM"},{"code":"750","type":"RC"},{"code":"31640","type":"HCPCS"}],"standard_charges":[{"gross_charge":14153.0,"discounted_cash":11888.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bronchoscopy W/Ther Aspir Trachbrncl Tree 1St","code_information":[{"code":"75000103","type":"CDM"},{"code":"750","type":"RC"},{"code":"31645","type":"HCPCS"}],"standard_charges":[{"gross_charge":6894.0,"discounted_cash":5790.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Egd Ablate Tumor Polyp/Lesion W/Dilation& Wire","code_information":[{"code":"75000104","type":"CDM"},{"code":"750","type":"RC"},{"code":"43270","type":"HCPCS"}],"standard_charges":[{"gross_charge":7383.0,"discounted_cash":6201.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Sigmoidoscopy Flx Ndsc Us Xm","code_information":[{"code":"75000105","type":"CDM"},{"code":"750","type":"RC"},{"code":"45341","type":"HCPCS"}],"standard_charges":[{"gross_charge":3668.0,"discounted_cash":3081.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colsc Flx W/Ndsc Us Xm Rctm Et Al Lmtd&Adj Strux","code_information":[{"code":"75000106","type":"CDM"},{"code":"750","type":"RC"},{"code":"45391","type":"HCPCS"}],"standard_charges":[{"gross_charge":4793.0,"discounted_cash":4026.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Sigmoidoscopy Flx Ablation Tumor Polyp/Oth Les","code_information":[{"code":"75000107","type":"CDM"},{"code":"750","type":"RC"},{"code":"45346","type":"HCPCS"}],"standard_charges":[{"gross_charge":4793.0,"discounted_cash":4026.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Anoscopy W/Bx Single/Multiple","code_information":[{"code":"75000108","type":"CDM"},{"code":"750","type":"RC"},{"code":"46606","type":"HCPCS"}],"standard_charges":[{"gross_charge":4451.0,"discounted_cash":3738.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ca Screen;Flexi Sigmoidscope","code_information":[{"code":"75000109","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0104","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.0,"discounted_cash":2860.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ileoscopy Stoma W/Bx Single/Multiple","code_information":[{"code":"75000110","type":"CDM"},{"code":"750","type":"RC"},{"code":"44382","type":"HCPCS"}],"standard_charges":[{"gross_charge":3474.0,"discounted_cash":2918.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Ercp W/Biopsy Single/Multiple","code_information":[{"code":"75000111","type":"CDM"},{"code":"750","type":"RC"},{"code":"43261","type":"HCPCS"}],"standard_charges":[{"gross_charge":13223.0,"discounted_cash":11107.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bile Tract Surgery Procedure","code_information":[{"code":"75000112","type":"CDM"},{"code":"750","type":"RC"},{"code":"47999","type":"HCPCS"}],"standard_charges":[{"gross_charge":3474.0,"discounted_cash":2918.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Esophagoscopy Flexible Transoral Diagnostic","code_information":[{"code":"75000113","type":"CDM"},{"code":"750","type":"RC"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3474.0,"discounted_cash":2918.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Colonoscopy Stoma Control Bleeding","code_information":[{"code":"75000114","type":"CDM"},{"code":"750","type":"RC"},{"code":"44391","type":"HCPCS"}],"standard_charges":[{"gross_charge":4451.0,"discounted_cash":3738.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Prepare Fecal Microbiota For Instillation","code_information":[{"code":"75000115","type":"CDM"},{"code":"750","type":"RC"},{"code":"G0455","type":"HCPCS"}],"standard_charges":[{"gross_charge":3474.0,"discounted_cash":2918.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colsc Flx W/Us Guid Ndl Aspir/Bx W/Us Rctm Et Al","code_information":[{"code":"75000116","type":"CDM"},{"code":"750","type":"RC"},{"code":"45392","type":"HCPCS"}],"standard_charges":[{"gross_charge":4451.0,"discounted_cash":3738.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Enteroscopy > 2Nd Prtn W/Rmvl Lesion Cautery","code_information":[{"code":"75000117","type":"CDM"},{"code":"750","type":"RC"},{"code":"44365","type":"HCPCS"}],"standard_charges":[{"gross_charge":6974.0,"discounted_cash":5858.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Esophagoscopy Flexible Transoral Ultrasound Exam","code_information":[{"code":"75000118","type":"CDM"},{"code":"750","type":"RC"},{"code":"43231","type":"HCPCS"}],"standard_charges":[{"gross_charge":6974.0,"discounted_cash":5858.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Colonoscopy Through Stoma With Decompression","code_information":[{"code":"75000119","type":"CDM"},{"code":"750","type":"RC"},{"code":"44408","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.0,"discounted_cash":2860.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Esophagoscopy Flex Transoral Lesion Ablation","code_information":[{"code":"75000120","type":"CDM"},{"code":"750","type":"RC"},{"code":"43229","type":"HCPCS"}],"standard_charges":[{"gross_charge":13223.0,"discounted_cash":11107.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Egd Transoral Endoscopic Mucosal Resection","code_information":[{"code":"75000121","type":"CDM"},{"code":"750","type":"RC"}],"standard_charges":[{"gross_charge":7431.0,"discounted_cash":6242.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy Flx With Endoscopic Stent Placement","code_information":[{"code":"75000122","type":"CDM"},{"code":"750","type":"RC"},{"code":"45389","type":"HCPCS"}],"standard_charges":[{"gross_charge":21722.0,"discounted_cash":18246.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Colonoscopy Stoma W/Endoscopic Mucosal Rescj","code_information":[{"code":"75000123","type":"CDM"},{"code":"750","type":"RC"},{"code":"44403","type":"HCPCS"}],"standard_charges":[{"gross_charge":4475.0,"discounted_cash":3759.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Esophagoscopy Flex Balloon Dilat <30 Mm Diam","code_information":[{"code":"75000124","type":"CDM"},{"code":"750","type":"RC"},{"code":"43220","type":"HCPCS"}],"standard_charges":[{"gross_charge":6676.0,"discounted_cash":5607.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ndsc Eval Intstinal Pouch Dx W/Collj Spec Spx","code_information":[{"code":"75000125","type":"CDM"},{"code":"750","type":"RC"},{"code":"44385","type":"HCPCS"}],"standard_charges":[{"gross_charge":3261.0,"discounted_cash":2739.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Enteroscopy > 2Nd Prtn Abltj Lesion","code_information":[{"code":"75000126","type":"CDM"},{"code":"750","type":"RC"},{"code":"44369","type":"HCPCS"}],"standard_charges":[{"gross_charge":7078.0,"discounted_cash":5945.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sgmdsc Flx With Endoscopic Mucosal Resection","code_information":[{"code":"75000127","type":"CDM"},{"code":"750","type":"RC"},{"code":"45349","type":"HCPCS"}],"standard_charges":[{"gross_charge":10443.0,"discounted_cash":8772.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dilation Esoph Unguided Sound/Bougie 1/Mult Pass","code_information":[{"code":"75000128","type":"CDM"},{"code":"750","type":"RC"},{"code":"43450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3524.0,"discounted_cash":2960.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Esophgl Balo Distension Dx Std W/Provocation","code_information":[{"code":"75000129","type":"CDM"},{"code":"750","type":"RC"},{"code":"91040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2064.0,"discounted_cash":1733.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sigmoidoscopy Flx Placement Of Endoscopic Stent","code_information":[{"code":"75000130","type":"CDM"},{"code":"750","type":"RC"},{"code":"45347","type":"HCPCS"}],"standard_charges":[{"gross_charge":21299.0,"discounted_cash":17891.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Unlisted Procedure Colon","code_information":[{"code":"75000131","type":"CDM"},{"code":"750","type":"RC"},{"code":"45399","type":"HCPCS"}],"standard_charges":[{"gross_charge":3377.0,"discounted_cash":2836.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Same Phys/Qhp <5 Yrs","code_information":[{"code":"75000132","type":"CDM"},{"code":"750","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":893.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Other Phys/Qhp Initial 15 Mins &Lt<5 Yrs","code_information":[{"code":"75000133","type":"CDM"},{"code":"750","type":"RC"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":1374.0,"discounted_cash":1154.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Other Phys/Qhp Initial 15 Mins 5/> Yrs","code_information":[{"code":"75000134","type":"CDM"},{"code":"750","type":"RC"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":1218.0,"discounted_cash":1023.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Mod Sed Other Phys/Qhp Each Addl 15 Mins","code_information":[{"code":"75000135","type":"CDM"},{"code":"750","type":"RC"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":551.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ercp Tumor/Polyp/Lesion Ablation W/Dilation&Wire","code_information":[{"code":"75000136","type":"CDM"},{"code":"750","type":"RC"},{"code":"43278","type":"HCPCS"}],"standard_charges":[{"gross_charge":12621.0,"discounted_cash":10601.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Small Bowel Endoscopy","code_information":[{"code":"75000137","type":"CDM"},{"code":"750","type":"RC"},{"code":"44373","type":"HCPCS"}],"standard_charges":[{"gross_charge":7148.0,"discounted_cash":6004.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Laryngoscopy Foreign Body Rmvl Micro/Telescope","code_information":[{"code":"75000138","type":"CDM"},{"code":"750","type":"RC"},{"code":"31531","type":"HCPCS"}],"standard_charges":[{"gross_charge":14069.0,"discounted_cash":11817.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Proctosgmdsc Rgd Dx W/Wo Collj Spec Br/Wa Spx","code_information":[{"code":"75000139","type":"CDM"},{"code":"750","type":"RC"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":3433.0,"discounted_cash":2883.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Esophagoscp Rig Transoral Hypopharynx Crv Esoph","code_information":[{"code":"75000140","type":"CDM"},{"code":"750","type":"RC"},{"code":"43180","type":"HCPCS"}],"standard_charges":[{"gross_charge":22000.0,"discounted_cash":18480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Transoral Lower Esophageal Myotomy","code_information":[{"code":"75000141","type":"CDM"},{"code":"750","type":"RC"},{"code":"43497","type":"HCPCS"}],"standard_charges":[{"gross_charge":21411.0,"discounted_cash":17985.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Unlisted Dx Gi Procedure","code_information":[{"code":"75000142","type":"CDM"},{"code":"750","type":"RC"},{"code":"91299","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":493.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Eeg Extended Monitoring 61-119 Mins","code_information":[{"code":"76000023","type":"CDM"},{"code":"760","type":"RC"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":1108.0,"discounted_cash":930.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Aep Neurodiagnostic Interpretation And Report","code_information":[{"code":"76000038","type":"CDM"},{"code":"760","type":"RC"},{"code":"92653","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.0,"discounted_cash":838.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Custodial Care","code_information":[{"code":"76000039","type":"CDM"},{"code":"760","type":"RC"},{"code":"A9270","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.14,"discounted_cash":97.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Hourly Observation Charge","code_information":[{"code":"76200000","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.67,"discounted_cash":101.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Direct Observation Charge","code_information":[{"code":"76200003","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Observation Carve-Out Therapy","code_information":[{"code":"76200006","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":71.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Observation Carve-Out Radiology","code_information":[{"code":"76200007","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":71.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Observation Carve-Out Dialysis","code_information":[{"code":"76200008","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":71.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Observation Carve-Out Radiation Therapy","code_information":[{"code":"76200009","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":71.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Observation Carve-Out Chemotherapy","code_information":[{"code":"76200010","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":71.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Observation Carve-Out Wound Care","code_information":[{"code":"76200011","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":71.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Observation Carve-Out Stress Test","code_information":[{"code":"76200012","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":71.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Observation Carve-Out Medical Infusion","code_information":[{"code":"76200013","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":71.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Adm Influenza Vaccine","code_information":[{"code":"77100000","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Adm Pneumococcal Vaccine","code_information":[{"code":"77100001","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Administration Of Hepatitis B Vaccine","code_information":[{"code":"77100002","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dialysis Acute I/P","code_information":[{"code":"80100000","type":"CDM"},{"code":"801","type":"RC"},{"code":"90999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1492.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dialysis Maint I/P","code_information":[{"code":"80100001","type":"CDM"},{"code":"801","type":"RC"},{"code":"90999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1492.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dialysis Maint-I/P","code_information":[{"code":"80100002","type":"CDM"},{"code":"801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1492.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dialysis One Evaluation","code_information":[{"code":"80100003","type":"CDM"},{"code":"801","type":"RC"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":732.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dialysis Repeated Evaluation","code_information":[{"code":"80100004","type":"CDM"},{"code":"801","type":"RC"},{"code":"90947","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":295.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dialysis Acute O/P","code_information":[{"code":"82100000","type":"CDM"},{"code":"821","type":"RC"},{"code":"90999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1492.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dialysis Maint O/P","code_information":[{"code":"82100001","type":"CDM"},{"code":"821","type":"RC"},{"code":"90999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1492.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Fetal Non-Stress Test","code_information":[{"code":"92000000","type":"CDM"},{"code":"920","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":786.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Extracranial Bilat Study","code_information":[{"code":"92000001","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.0,"discounted_cash":984.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":973.0,"discounted_cash":817.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Extracranial Uni/Ltd Study","code_information":[{"code":"92000002","type":"CDM"},{"code":"920","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":322.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Intracranial Complete Study","code_information":[{"code":"92000003","type":"CDM"},{"code":"920","type":"RC"},{"code":"93886","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":551.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Upr/L Xtremity Art 2 Levels","code_information":[{"code":"92000004","type":"CDM"},{"code":"920","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.0,"discounted_cash":580.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":464.0,"discounted_cash":389.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Upr/Lxtr Art Stdy 3+ Lvls","code_information":[{"code":"92000005","type":"CDM"},{"code":"920","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":878.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":715.0,"discounted_cash":600.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Lwr Xtr Vasc Stdy Bilat","code_information":[{"code":"92000006","type":"CDM"},{"code":"920","type":"RC"},{"code":"93924","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":777.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Lower Extremity Study; Bilateral","code_information":[{"code":"92000007","type":"CDM"},{"code":"920","type":"RC"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":2001.0,"discounted_cash":1680.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1201.0,"discounted_cash":1008.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Lower Extremity Study; Unilateral","code_information":[{"code":"92000008","type":"CDM"},{"code":"920","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"discounted_cash":1034.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":763.0,"discounted_cash":640.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Upper Extremity Study; Bilateral","code_information":[{"code":"92000009","type":"CDM"},{"code":"920","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2001.0,"discounted_cash":1680.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1201.0,"discounted_cash":1008.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Upper Extremity Study; Unilateral","code_information":[{"code":"92000010","type":"CDM"},{"code":"920","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"discounted_cash":1034.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":763.0,"discounted_cash":640.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Extremity Study; Bilateral","code_information":[{"code":"92000011","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2112.0,"discounted_cash":1774.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1267.0,"discounted_cash":1064.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Extremity Study; Unilateral","code_information":[{"code":"92000012","type":"CDM"},{"code":"920","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":1092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":780.0,"discounted_cash":655.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vascular Study; Complete","code_information":[{"code":"92000013","type":"CDM"},{"code":"920","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":2052.0,"discounted_cash":1723.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1231.0,"discounted_cash":1034.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vascular Study; Limited","code_information":[{"code":"92000014","type":"CDM"},{"code":"920","type":"RC"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":2052.0,"discounted_cash":1723.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1231.0,"discounted_cash":1034.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vascular Study Aorta; Complete","code_information":[{"code":"92000015","type":"CDM"},{"code":"920","type":"RC"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":2093.0,"discounted_cash":1758.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":1256.0,"discounted_cash":1055.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Vascular Study Aorta; Limited","code_information":[{"code":"92000016","type":"CDM"},{"code":"920","type":"RC"},{"code":"93979","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":995.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":733.0,"discounted_cash":615.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Doppler Flow Testing","code_information":[{"code":"92000017","type":"CDM"},{"code":"920","type":"RC"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":444.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":397.0,"discounted_cash":333.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Car Seat/Bed Testing W/Interp & Report 60 Min","code_information":[{"code":"92000019","type":"CDM"},{"code":"920","type":"RC"},{"code":"94780","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":97.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Car Seat/Bed Testng W/Interp & Report Addl 30Min","code_information":[{"code":"92000020","type":"CDM"},{"code":"920","type":"RC"},{"code":"94781","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Breath Hydrogen/ Methane Test","code_information":[{"code":"92000021","type":"CDM"},{"code":"920","type":"RC"},{"code":"91065","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":466.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Dup-Scan Hemo Compl Bi Std","code_information":[{"code":"92000024","type":"CDM"},{"code":"920","type":"RC"},{"code":"93985","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":765.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":729.0,"discounted_cash":612.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Dup-Scan Hemo Compl Uni Std","code_information":[{"code":"92000025","type":"CDM"},{"code":"920","type":"RC"},{"code":"93986","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":368.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":339.0,"discounted_cash":284.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Car Bed Test Inft Thru 12 Mo 60 Min","code_information":[{"code":"92000026","type":"CDM"},{"code":"920","type":"RC"},{"code":"94780","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":380.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Duplex Penile Scan","code_information":[{"code":"92100000","type":"CDM"},{"code":"921","type":"RC"},{"code":"93981","type":"HCPCS"}],"standard_charges":[{"gross_charge":1661.0,"discounted_cash":1395.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":963.0,"discounted_cash":808.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Outpatient Default Fee Schedule 56365"}]},{"description":"Hc Speech/Lang Therapy Group","code_information":[{"code":"94000000","type":"CDM"},{"code":"940","type":"RC"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Hydra Initial =< 1Hr","code_information":[{"code":"94000001","type":"CDM"},{"code":"940","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":700.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Hydration Ea Add'l Hr","code_information":[{"code":"94000002","type":"CDM"},{"code":"940","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":307.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Thera/Proph/Diag Initial","code_information":[{"code":"94000003","type":"CDM"},{"code":"940","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":648.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Iv Infusion Thera/Proph/Diag Add-On","code_information":[{"code":"94000004","type":"CDM"},{"code":"940","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":284.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx/Proph/Dg Addl Seq Iv Inf","code_information":[{"code":"94000005","type":"CDM"},{"code":"940","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":295.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther/Diag Concurrent Inf","code_information":[{"code":"94000006","type":"CDM"},{"code":"940","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":288.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Ther/Proph/Diag Inj Sc/Im","code_information":[{"code":"94000007","type":"CDM"},{"code":"940","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":129.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Thera/Diag Inj-Iv Push Sing/Initl","code_information":[{"code":"94000008","type":"CDM"},{"code":"940","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx/Pro/Dx Inj New Drug Addon","code_information":[{"code":"94000009","type":"CDM"},{"code":"940","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tx/Pro/Dx Inj Same Drug Adon","code_information":[{"code":"94000010","type":"CDM"},{"code":"940","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":273.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chemo Hormon Antineoplastic Sq/Im","code_information":[{"code":"94000011","type":"CDM"},{"code":"940","type":"RC"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":383.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Chemo Prolong Infuse W/Pump","code_information":[{"code":"94000012","type":"CDM"},{"code":"940","type":"RC"},{"code":"G0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Portable Pump Filling And Maint","code_information":[{"code":"94000013","type":"CDM"},{"code":"940","type":"RC"},{"code":"96521","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":629.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Irrigate Implanted Venous Device","code_information":[{"code":"94000014","type":"CDM"},{"code":"940","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Therapeutic Phlebotomy","code_information":[{"code":"94000015","type":"CDM"},{"code":"940","type":"RC"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":317.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tavr/Tavi Open Fem Artery Appr","code_information":[{"code":"94000016","type":"CDM"},{"code":"940","type":"RC"},{"code":"33362","type":"HCPCS"}],"standard_charges":[{"gross_charge":27193.0,"discounted_cash":22842.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tavr/Tavi Open Axillary Artery","code_information":[{"code":"94000017","type":"CDM"},{"code":"940","type":"RC"},{"code":"33363","type":"HCPCS"}],"standard_charges":[{"gross_charge":27193.0,"discounted_cash":22842.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tavr/Tavi Open Iliac Artery Appr","code_information":[{"code":"94000018","type":"CDM"},{"code":"940","type":"RC"},{"code":"33364","type":"HCPCS"}],"standard_charges":[{"gross_charge":27193.0,"discounted_cash":22842.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tavr/Tavi Transaortic Approach","code_information":[{"code":"94000019","type":"CDM"},{"code":"940","type":"RC"},{"code":"33365","type":"HCPCS"}],"standard_charges":[{"gross_charge":25737.0,"discounted_cash":21619.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tavr/Tavi W/Perc Periph Art/Ven","code_information":[{"code":"94000020","type":"CDM"},{"code":"940","type":"RC"},{"code":"33367","type":"HCPCS"}],"standard_charges":[{"gross_charge":25737.0,"discounted_cash":21619.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tavr/Tavi W/Open Periph Art/Ven","code_information":[{"code":"94000021","type":"CDM"},{"code":"940","type":"RC"},{"code":"33368","type":"HCPCS"}],"standard_charges":[{"gross_charge":27193.0,"discounted_cash":22842.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tavr/Tavi W/Central Art/Ven Cannu","code_information":[{"code":"94000022","type":"CDM"},{"code":"940","type":"RC"},{"code":"33369","type":"HCPCS"}],"standard_charges":[{"gross_charge":25737.0,"discounted_cash":21619.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Actinotherapy Ultraviolet Light","code_information":[{"code":"94000023","type":"CDM"},{"code":"940","type":"RC"},{"code":"96900","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":110.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Casirivi And Imdevi Infusion","code_information":[{"code":"94000031","type":"CDM"},{"code":"940","type":"RC"},{"code":"M0243","type":"HCPCS"}],"standard_charges":[{"gross_charge":1506.0,"discounted_cash":1265.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Bamlan And Etesev Infusion","code_information":[{"code":"94000039","type":"CDM"},{"code":"940","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.0,"discounted_cash":1054.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Peripheral Arterial Disease Rehab Per Session","code_information":[{"code":"94000050","type":"CDM"},{"code":"940","type":"RC"},{"code":"93668","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":207.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sotrovimab Infusion","code_information":[{"code":"94000052","type":"CDM"},{"code":"940","type":"RC"},{"code":"M0247","type":"HCPCS"}],"standard_charges":[{"gross_charge":1903.0,"discounted_cash":1598.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sotrovimab Inf, Home Admin","code_information":[{"code":"94000053","type":"CDM"},{"code":"940","type":"RC"},{"code":"M0248","type":"HCPCS"}],"standard_charges":[{"gross_charge":3171.0,"discounted_cash":2663.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tixagev And Cilgav, Inj","code_information":[{"code":"94000054","type":"CDM"},{"code":"771","type":"RC"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":165.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tixagev And Cilgav, Inj Hm","code_information":[{"code":"94000055","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0221","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":262.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Bebtelovimab Injection","code_information":[{"code":"94000057","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0222","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":350.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Bebtelovimab Injection Home","code_information":[{"code":"94000058","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0223","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":544.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Admn Sarscov2 Vacc 1 Dose","code_information":[{"code":"94000079","type":"CDM"},{"code":"771","type":"RC"},{"code":"90480","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nutrition Therapy Initial Ind 15M","code_information":[{"code":"94200001","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nutrition Therp Follow Up Ind 15M","code_information":[{"code":"94200002","type":"CDM"},{"code":"942","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nutrition Therapy Group Each 30 Min","code_information":[{"code":"94200003","type":"CDM"},{"code":"942","type":"RC"},{"code":"97804","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Diabetes Management Training Indiv Per 30 Min","code_information":[{"code":"94200004","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Diab Manage Trn Ind/Group","code_information":[{"code":"94200005","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Self-Mgmt Educ & Train 1 Pt 30Min","code_information":[{"code":"94200006","type":"CDM"},{"code":"942","type":"RC"},{"code":"98960","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":93.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pro Phone Call 5-10 Min","code_information":[{"code":"94200007","type":"CDM"},{"code":"942","type":"RC"},{"code":"98966","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pro Phone Call 11-20 Min","code_information":[{"code":"94200008","type":"CDM"},{"code":"942","type":"RC"},{"code":"98967","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pro Phone Call 21-30 Min","code_information":[{"code":"94200009","type":"CDM"},{"code":"942","type":"RC"},{"code":"98968","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Preventive Counseling Indiv 15Min","code_information":[{"code":"94200010","type":"CDM"},{"code":"942","type":"RC"},{"code":"99401","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":154.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"},{"gross_charge":183.0,"discounted_cash":153.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bh Hb Provider Based Technical Fee Schedule  219"}]},{"description":"Hc Tobacco Use Cessation Intermediate 3-10 Minutes","code_information":[{"code":"94200011","type":"CDM"},{"code":"942","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Tobacco Use Cessation Intensive >10 Minutes","code_information":[{"code":"94200012","type":"CDM"},{"code":"942","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":105.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prevent Med Counsel&/Risk Factor Redj Spx 30 Min","code_information":[{"code":"94200013","type":"CDM"},{"code":"942","type":"RC"},{"code":"99402","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":236.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prevent Med Counsel&/Risk Factor Redj Spx 45 Min","code_information":[{"code":"94200014","type":"CDM"},{"code":"942","type":"RC"},{"code":"99403","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":297.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Prevent Med Counsel&/Risk Factor Redj Spx 60 Min","code_information":[{"code":"94200015","type":"CDM"},{"code":"942","type":"RC"},{"code":"99404","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":372.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Medical Nutrition Indiv In","code_information":[{"code":"94200016","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Med Nutrition Indiv Subseq","code_information":[{"code":"94200017","type":"CDM"},{"code":"942","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Medical Nutrition Group","code_information":[{"code":"94200018","type":"CDM"},{"code":"942","type":"RC"},{"code":"97804","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Diab Manage Trn Per Indiv","code_information":[{"code":"94200019","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":120.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Telemedicine Diab Manage Trn Ind/Group","code_information":[{"code":"94200020","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nonphysician Telephone Assessment 5-10 Min","code_information":[{"code":"94200021","type":"CDM"},{"code":"942","type":"RC"},{"code":"98966","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nonphysician Telephone Assessment 11-20 Min","code_information":[{"code":"94200022","type":"CDM"},{"code":"942","type":"RC"},{"code":"98967","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Nonphysician Telephone Assessment 21-30 Min","code_information":[{"code":"94200023","type":"CDM"},{"code":"942","type":"RC"},{"code":"98968","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cardiac Rehab/Monitor Outpatient","code_information":[{"code":"94300000","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":207.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Phys/Qhp Svcs Op Pulm Rehab Wo Cont Oximtry Mntr","code_information":[{"code":"94800001","type":"CDM"},{"code":"948","type":"RC"},{"code":"94625","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Phys/Qhp Svcs Op Pulm Rehab W/Cont Oximtry Mntr","code_information":[{"code":"94800002","type":"CDM"},{"code":"948","type":"RC"},{"code":"94626","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Multiple Sleep Latency Test","code_information":[{"code":"96000001","type":"CDM"},{"code":"740","type":"RC"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":3526.0,"discounted_cash":2961.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Sleep Apnea Over Night","code_information":[{"code":"96000002","type":"CDM"},{"code":"740","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":6976.0,"discounted_cash":5859.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Cpap Follow-Up","code_information":[{"code":"96000003","type":"CDM"},{"code":"740","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":7945.0,"discounted_cash":6673.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Pr Anesthetist (Crna)","code_information":[{"code":"96400001","type":"CDM"},{"code":"964","type":"RC"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Maint. Cardiopulmonary Rehab X3","code_information":[{"code":"99000000","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":40.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc Maintenance Cardiopulmonary Rehab","code_information":[{"code":"99000001","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Hc  Sca Test- Echo Peds Fu/Limited","code_information":[{"code":"99000002","type":"CDM"},{"code":"990","type":"RC"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Bayhealth Main Default Fee Schedule 56364"}]},{"description":"Chemical cautery tissue","code_information":[{"code":"17250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.58,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.71,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":145.06,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.26,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.4,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.1,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":252.71,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":252.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.26,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.04,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":199.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.98,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":276.75,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":276.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":332.43,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.53,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.37,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":224.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":280.58,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.53,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":327.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":447.13,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":447.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Mohs 1 stage h/n/hf/g","code_information":[{"code":"17311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.09,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":579.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Mohs Addl Stage","code_information":[{"code":"17312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.63,"maximum":308.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":308.63}]}]},{"description":"Destruct lesion 15 or more","code_information":[{"code":"17111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.96,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruct b9 lesion 1-14","code_information":[{"code":"17110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.83,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.72,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":871.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":596.47,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":596.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":457.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Destroy premal lesions 15/>","code_information":[{"code":"17004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.5,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Destruct premalg les 2-14","code_information":[{"code":"17003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.29,"maximum":3.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.29}]}]},{"description":"Destruct premalg lesion","code_information":[{"code":"17000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.47,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Escharotomy addl incision","code_information":[{"code":"16036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.55,"maximum":134.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.55}]}]},{"description":"Incision of burn scab initi","code_information":[{"code":"16035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":319.34,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Dress/debrid p-thick burn l","code_information":[{"code":"16030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.74,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Dress/debrid p-thick burn m","code_information":[{"code":"16025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.07,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Dress/debrid p-thick burn s","code_information":[{"code":"16020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.0,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Initial treatment of burn(s)","code_information":[{"code":"16000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.77,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15958","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1916.8,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1916.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1918.66,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1918.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1667.82,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1667.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1515.37,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1515.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1485.1,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1485.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1054.41,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1054.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2635.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1685.28,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1685.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15944","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1544.67,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1544.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1565.81,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1565.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1174.54,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1174.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1619.17,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1619.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1465.51,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1465.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1908.04,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1908.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1626.13,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1440.22,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1440.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1165.35,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1165.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tail bone ulcer","code_information":[{"code":"15922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1319.67,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1319.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tail bone ulcer","code_information":[{"code":"15920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1052.01,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1052.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Test for blood flow in graft","code_information":[{"code":"15860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.9,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Removal sutr&stapl xreq anes","code_information":[{"code":"15854","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.28,"maximum":23.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.28}]}]},{"description":"Removal sutr/stapl xreq anes","code_information":[{"code":"15853","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.42,"maximum":18.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.42}]}]},{"description":"Dressing change not for burn","code_information":[{"code":"15852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.62,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Remove sutures diff surgeon","code_information":[{"code":"15851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.56,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skin and muscle repair face","code_information":[{"code":"15845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1756.01,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1756.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Nerve palsy microsurg graft","code_information":[{"code":"15842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4427.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Nerve palsy muscle graft","code_information":[{"code":"15841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2928.32,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2928.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Nerve palsy fascial graft","code_information":[{"code":"15840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1656.61,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1656.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin & tissue","code_information":[{"code":"15839","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1222.17,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1222.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin fat pad","code_information":[{"code":"15838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1077.28,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1077.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin arm/hand","code_information":[{"code":"15837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.49,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1187.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin arm","code_information":[{"code":"15836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1319.78,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1319.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin buttck","code_information":[{"code":"15835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1540.6,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1540.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin hip","code_information":[{"code":"15834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1478.34,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1478.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin leg","code_information":[{"code":"15833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1451.15,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin thigh","code_information":[{"code":"15832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1534.39,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1534.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc Skin Abd","code_information":[{"code":"15830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.03,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1938.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Revision of upper eyelid","code_information":[{"code":"15823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":898.62,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":898.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of upper eyelid","code_information":[{"code":"15822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":651.12,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":651.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower eyelid","code_information":[{"code":"15821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":898.57,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":898.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower eyelid","code_information":[{"code":"15820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.95,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Abrasion lesions add-on","code_information":[{"code":"15787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.89,"maximum":27.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.89}]}]},{"description":"Abrasion lesion single","code_information":[{"code":"15786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.68,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion suprfl any site","code_information":[{"code":"15783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":590.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion other than face","code_information":[{"code":"15782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.06,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion segmental face","code_information":[{"code":"15781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":692.37,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":692.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion total face","code_information":[{"code":"15780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1094.92,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1094.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Impl absrb msh/prsth dly cls","code_information":[{"code":"15778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":640.24,"maximum":640.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":640.24}]}]},{"description":"Acellular derm matrix implt","code_information":[{"code":"15777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":349.92,"maximum":349.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.92}]}]},{"description":"Gfrg autol fat lipo ea addl","code_information":[{"code":"15774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":235.95,"maximum":235.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.95}]}]},{"description":"Grfg autol fat lipo 25 cc/<","code_information":[{"code":"15773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":831.73,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":831.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Grfg autol fat lipo ea addl","code_information":[{"code":"15772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.6,"maximum":243.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.6}]}]},{"description":"Grfg autol fat lipo 50 cc/<","code_information":[{"code":"15771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":849.82,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":849.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Derma-fat-fascia graft","code_information":[{"code":"15770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1114.39,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1114.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Grfg autol soft tiss dir exc","code_information":[{"code":"15769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":794.49,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":794.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Composite skin graft","code_information":[{"code":"15760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1151.26,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1151.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Free fascial flap microvasc","code_information":[{"code":"15758","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3694.29,"maximum":3694.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3694.29}]}]},{"description":"Free skin flap microvasc","code_information":[{"code":"15757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3709.04,"maximum":3709.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3709.04}]}]},{"description":"Free myo/skin flap microvasc","code_information":[{"code":"15756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3732.71,"maximum":3732.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3732.71}]}]},{"description":"Neurovascular pedicle flap","code_information":[{"code":"15750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1539.55,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1539.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Island pedicle flap graft","code_information":[{"code":"15740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1390.48,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1390.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-skin graft leg","code_information":[{"code":"15738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2076.32,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2076.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-skin graft arm","code_information":[{"code":"15736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2002.61,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2002.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-skin graft trunk","code_information":[{"code":"15734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2467.93,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2467.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Musc myoq/fscq flp h&n pedcl","code_information":[{"code":"15733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1691.27,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1691.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Forehead Flap w/Vasc Pedicle","code_information":[{"code":"15731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1640.05,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1640.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Mdfc flap w/prsrv vasc pedcl","code_information":[{"code":"15730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1497.52,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1497.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Transfer skin pedicle flap","code_information":[{"code":"15650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.49,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":670.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap eye/nos/ear/lip","code_information":[{"code":"15630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.24,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Cult skin graft t/a/l +%","code_information":[{"code":"15152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":235.91,"maximum":235.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.91}]}]},{"description":"Cult skin grft t/a/l addl","code_information":[{"code":"15151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.45,"maximum":177.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.45}]}]},{"description":"Cult skin grft t/arm/leg","code_information":[{"code":"15150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1053.51,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1053.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Derm autograft f/n/hf/g add","code_information":[{"code":"15136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.62,"maximum":146.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.62}]}]},{"description":"Derm autograft face/nck/hf/g","code_information":[{"code":"15135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1247.9,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1247.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Derm autograft t/a/l add-on","code_information":[{"code":"15131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.62,"maximum":146.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.62}]}]},{"description":"Derm autograft trnk/arm/leg","code_information":[{"code":"15130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":988.0,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":988.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skn splt a-grft f/n/hf/g add","code_information":[{"code":"15121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.99,"maximum":213.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.99}]}]},{"description":"Skn splt a-grft fac/nck/hf/g","code_information":[{"code":"15120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1137.86,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1137.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Epidrm a-grft f/n/hf/g addl","code_information":[{"code":"15116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":224.98,"maximum":224.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":224.98}]}]},{"description":"Epidrm a-grft face/nck/hf/g","code_information":[{"code":"15115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.43,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1154.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Epidrm autogrft t/a/l add-on","code_information":[{"code":"15111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.1,"maximum":166.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166.1}]}]},{"description":"Epidrm autogrft trnk/arm/leg","code_information":[{"code":"15110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1175.44,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1175.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skin splt grft t/a/l add-on","code_information":[{"code":"15101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.18,"maximum":180.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180.18}]}]},{"description":"Skin splt grft trnk/arm/leg","code_information":[{"code":"15100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1180.37,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1180.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skin pinch graft","code_information":[{"code":"15050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.35,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Harvest cultured skin graft","code_information":[{"code":"15040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.03,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Wnd prep f/n/hf/g addl cm","code_information":[{"code":"15005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.01,"maximum":146.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.01}]}]},{"description":"Wound prep f/n/hf/g","code_information":[{"code":"15004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":426.31,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Wound prep addl 100 cm","code_information":[{"code":"15003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.46,"maximum":72.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.46}]}]},{"description":"Wound prep trk/arm/leg","code_information":[{"code":"15002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.77,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":359.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Filleted finger/toe flap","code_information":[{"code":"14350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1098.9,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1098.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr addl 30 sq cm/<","code_information":[{"code":"14302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.61,"maximum":350.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.61}]}]},{"description":"Tis trnfr any 30.1-60 sq cm","code_information":[{"code":"14301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1430.4,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1430.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr e/n/e/l10.1-30sqcm","code_information":[{"code":"14061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1347.87,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1347.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr e/n/e/l 10 sq cm/<","code_information":[{"code":"14060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1097.02,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1097.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr f/c/c/m/n/a/g/h/f","code_information":[{"code":"14041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1257.4,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1257.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr f/c/c/m/n/a/g/h/f","code_information":[{"code":"14040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1030.3,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1030.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr s/a/l 10.1-30 sqcm","code_information":[{"code":"14021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1170.64,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1170.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr s/a/l 10 sq cm/<","code_information":[{"code":"14020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":937.56,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":937.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr trunk 10.1-30sqcm","code_information":[{"code":"14001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1079.09,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1079.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr trunk 10 sq cm/<","code_information":[{"code":"14000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":836.16,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":836.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Late closure of wound","code_information":[{"code":"13160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1314.34,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1314.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr e/n/e/l addl 5cm/<","code_information":[{"code":"13153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.65,"maximum":223.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.65}]}]},{"description":"Cmplx rpr e/n/e/l 2.6-7.5 cm","code_information":[{"code":"13152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":547.37,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":547.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr e/n/e/l 1.1-2.5 cm","code_information":[{"code":"13151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":455.54,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":455.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.65,"maximum":203.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":203.65}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":494.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":397.12,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":397.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr s/a/l addl 5 cm/>","code_information":[{"code":"13122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.7,"maximum":133.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.7}]}]},{"description":"Cmplx rpr s/a/l 2.6-7.5 cm","code_information":[{"code":"13121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":422.85,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":422.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr s/a/l 1.1-2.5 cm","code_information":[{"code":"13120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":377.87,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":377.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr trunk addl 5cm/<","code_information":[{"code":"13102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.73,"maximum":116.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.73}]}]},{"description":"Cmplx rpr trunk 2.6-7.5 cm","code_information":[{"code":"13101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.53,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr trunk 1.1-2.5 cm","code_information":[{"code":"13100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.41,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm >30.0 cm","code_information":[{"code":"12057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":691.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 20.1-30.0","code_information":[{"code":"12056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":633.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 12.6-20 cm","code_information":[{"code":"12055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":495.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 7.6-12.5cm","code_information":[{"code":"12054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.59,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 5.1-7.5 cm","code_information":[{"code":"12053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.97,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 2.6-5.0 cm","code_information":[{"code":"12052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.29,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 2.5 cm/<","code_information":[{"code":"12051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.06,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit >30.0cm","code_information":[{"code":"12047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.81,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit20.1-30","code_information":[{"code":"12046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":524.18,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":524.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit12.6-20","code_information":[{"code":"12045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":448.25,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":448.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit7.6-12.5","code_information":[{"code":"12044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.78,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit2.6-7.5","code_information":[{"code":"12042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.31,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit 2.5cm/<","code_information":[{"code":"12041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":239.93,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":239.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/tr/ext >30.0 cm","code_information":[{"code":"12037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.53,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":538.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 20.1-30","code_information":[{"code":"12036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":465.03,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":465.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 12.6-20","code_information":[{"code":"12035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":397.64,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":397.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/tr/ext 7.6-12.5","code_information":[{"code":"12034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":337.52,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":337.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 2.6-7.5","code_information":[{"code":"12032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":313.48,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":313.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 2.5 cm/<","code_information":[{"code":"12031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.12,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Closure of split wound","code_information":[{"code":"12021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.51,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Closure of split wound","code_information":[{"code":"12020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.65,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m >30.0 cm","code_information":[{"code":"12018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fe/e/en/l/m 20.1-30.0 cm","code_information":[{"code":"12017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.83,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":250.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fe/e/en/l/m 12.6-20.0 cm","code_information":[{"code":"12016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.8,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 7.6-12.5 cm","code_information":[{"code":"12015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.29,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 5.1-7.5 cm","code_information":[{"code":"12014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.15,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 2.6-5.0 cm","code_information":[{"code":"12013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.38,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 2.5 cm/<","code_information":[{"code":"12011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.05,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trnk >30.0 cm","code_information":[{"code":"12007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/a/gen/trk20.1-30.0cm","code_information":[{"code":"12006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.3,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/a/gen/trk12.6-20.0cm","code_information":[{"code":"12005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.84,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trk7.6-12.5cm","code_information":[{"code":"12004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.44,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trnk2.6-7.5cm","code_information":[{"code":"12002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.99,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trnk 2.5cm/<","code_information":[{"code":"12001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.08,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Remove drug implant device","code_information":[{"code":"11982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.92,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Remove contraceptive capsule","code_information":[{"code":"11976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.65,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Remove tissue expander(s)","code_information":[{"code":"11971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":917.8,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":917.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Replace tissue expander","code_information":[{"code":"11970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":932.11,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":932.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Insert tissue expander(s)","code_information":[{"code":"11960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1683.85,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1683.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Tx contour defects >10.0 cc","code_information":[{"code":"11954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.68,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Tx contour defects 5.1-10cc","code_information":[{"code":"11952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.83,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Tx contour defects 1.1-5.0cc","code_information":[{"code":"11951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.82,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Tx contour defects 1 cc/<","code_information":[{"code":"11950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.55,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Correct skin color ea 20.0cm","code_information":[{"code":"11922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.35,"maximum":46.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.35}]}]},{"description":"Correct skn color 6.1-20.0cm","code_information":[{"code":"11921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.63,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Correct skin color 6.0 cm/<","code_information":[{"code":"11920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":187.35,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Inject skin lesions >7","code_information":[{"code":"11901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.79,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Inject skin lesions <=w 7","code_information":[{"code":"11900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.08,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst compl","code_information":[{"code":"11772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.25,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst exten","code_information":[{"code":"11771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":745.28,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":745.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst simple","code_information":[{"code":"11770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.74,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":304.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Excision of nail fold toe","code_information":[{"code":"11765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.83,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of nail bed","code_information":[{"code":"11762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.5,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of nail bed","code_information":[{"code":"11760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.06,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy nail unit","code_information":[{"code":"11755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.09,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nail bed","code_information":[{"code":"11750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.66,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Drain blood from under nail","code_information":[{"code":"11740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.96,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove nail plate add-on","code_information":[{"code":"11732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.4,"maximum":27.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.4}]}]},{"description":"Removal of nail plate","code_information":[{"code":"11730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.1,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Debride nail 6 or more","code_information":[{"code":"11721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.9,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Debride nail 1-5","code_information":[{"code":"11720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.54,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Trim nail(s) any number","code_information":[{"code":"11719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.07,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg >4 cm","code_information":[{"code":"11646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":636.34,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":636.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 3.1-4","code_information":[{"code":"11644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":461.86,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":461.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 2.1-3","code_information":[{"code":"11643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.04,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 1.1-2","code_information":[{"code":"11642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":298.82,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.6-1","code_information":[{"code":"11641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.24,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.5cm<","code_information":[{"code":"11640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":208.75,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":208.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg >4 cm","code_information":[{"code":"11626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":476.98,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":476.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 3.1-4","code_information":[{"code":"11624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.91,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 2.1-3","code_information":[{"code":"11623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":343.59,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 1.1-2","code_information":[{"code":"11622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.14,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 0.6-1","code_information":[{"code":"11621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.4,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp mal+marg 0.5/<","code_information":[{"code":"11620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.73,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg >4 cm","code_information":[{"code":"11606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":517.83,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":517.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 3.1-4 cm","code_information":[{"code":"11604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":349.54,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 2.1-3 cm","code_information":[{"code":"11603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":317.43,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 1.1-2 cm","code_information":[{"code":"11602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":265.62,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 0.6-1 cm","code_information":[{"code":"11601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.28,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 0.5 cm/<","code_information":[{"code":"11600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.13,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":582.09,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":582.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":476.7,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":476.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.68,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":548.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":418.26,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":418.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":551.75,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":551.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":436.2,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg >4 cm","code_information":[{"code":"11446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":526.14,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":526.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 3.1-4 cm","code_information":[{"code":"11444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.48,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 2.1-3 cm","code_information":[{"code":"11443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.96,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 1.1-2 cm","code_information":[{"code":"11442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.52,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 0.6-1 cm","code_information":[{"code":"11441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":220.1,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 0.5 cm/<","code_information":[{"code":"11440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.49,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg >4 cm","code_information":[{"code":"11426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.35,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 3.1-4","code_information":[{"code":"11424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.27,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 2.1-3","code_information":[{"code":"11423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.11,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 1.1-2","code_information":[{"code":"11422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.12,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":226.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.6-1","code_information":[{"code":"11421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.49,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.5/<","code_information":[{"code":"11420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":136.79,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg >4.0 cm","code_information":[{"code":"11406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":411.19,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":411.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 3.1-4 cm","code_information":[{"code":"11404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":273.89,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 2.1-3cm/<","code_information":[{"code":"11403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.86,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 1.1-2 cm","code_information":[{"code":"11402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.26,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":191.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 0.6-1 cm","code_information":[{"code":"11401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.88,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 0.5 cm<","code_information":[{"code":"11400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.89,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.22,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.78,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.68,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.77,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.77,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.61,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.33,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.79,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.87,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.76,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":84.1,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.2,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Remove skin tags add-on","code_information":[{"code":"11201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.23,"maximum":26.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.23}]}]},{"description":"Removal of skin tags <w/15","code_information":[{"code":"11200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.92,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Incal bx skn ea sep/addl","code_information":[{"code":"11107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.7,"maximum":49.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.7}]}]},{"description":"Incal bx skn single les","code_information":[{"code":"11106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.28,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Punch bx skin ea sep/addl","code_information":[{"code":"11105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.49,"maximum":41.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.49}]}]},{"description":"Punch bx skin single lesion","code_information":[{"code":"11104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.46,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Tangntl bx skin ea sep/addl","code_information":[{"code":"11103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.51,"maximum":35.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.51}]}]},{"description":"Tangntl bx skin single les","code_information":[{"code":"11102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.22,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Trim skin lesions over 4","code_information":[{"code":"11057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.06,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Trim skin lesions 2 to 4","code_information":[{"code":"11056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.16,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Trim skin lesion","code_information":[{"code":"11055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.19,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Deb bone add-on","code_information":[{"code":"11047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.58,"maximum":157.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.58}]}]},{"description":"Deb musc/fascia add-on","code_information":[{"code":"11046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.38,"maximum":88.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.38}]}]},{"description":"Deb subq tissue add-on","code_information":[{"code":"11045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.42,"maximum":40.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.42}]}]},{"description":"Deb bone 20 sq cm/<","code_information":[{"code":"11044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":367.25,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":367.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Deb musc/fascia 20 sq cm/<","code_information":[{"code":"11043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":252.07,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":252.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Deb subq tissue 20 sq cm/<","code_information":[{"code":"11042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.31,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Deb skin bone at fx site","code_information":[{"code":"11012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.54,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":679.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Debride skin musc at fx site","code_information":[{"code":"11011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":488.74,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Debride skin at fx site","code_information":[{"code":"11010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.89,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Remove mesh from abd wall","code_information":[{"code":"11008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":441.54,"maximum":441.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":441.54}]}]},{"description":"Debride genit/per/abdom wall","code_information":[{"code":"11006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1138.96,"maximum":1138.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1138.96}]}]},{"description":"Debride abdom wall","code_information":[{"code":"11005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1253.63,"maximum":1253.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1253.63}]}]},{"description":"Debride genitalia & perineum","code_information":[{"code":"11004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.21,"maximum":922.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":922.21}]}]},{"description":"Debride infected skin add-on","code_information":[{"code":"11001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.07,"maximum":24.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.07}]}]},{"description":"Debride infected skin","code_information":[{"code":"11000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.84,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Complex drainage wound","code_information":[{"code":"10180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.92,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":295.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Puncture drainage of lesion","code_information":[{"code":"10160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.67,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hematoma/fluid","code_information":[{"code":"10140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.2,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Mohs 1 stage t/a/l","code_information":[{"code":"17313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":520.04,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":520.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Mohs addl stage t/a/l","code_information":[{"code":"17314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":284.66,"maximum":284.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.66}]}]},{"description":"Mohs surg addl block","code_information":[{"code":"17315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.88,"maximum":80.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.88}]}]},{"description":"Cryotherapy of skin","code_information":[{"code":"17340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Skin peel therapy","code_information":[{"code":"17360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.91,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of breast lesion","code_information":[{"code":"19000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.38,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Drain breast lesion add-on","code_information":[{"code":"19001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.39,"maximum":33.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.39}]}]},{"description":"Incision of breast lesion","code_information":[{"code":"19020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.35,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":519.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Injection for breast x-ray","code_information":[{"code":"19030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.54,"maximum":122.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.54}]}]},{"description":"Bx breast 1st lesion strtctc","code_information":[{"code":"19081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":263.66,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast add lesion strtctc","code_information":[{"code":"19082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.86,"maximum":131.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.86}]}]},{"description":"Bx breast 1st lesion us imag","code_information":[{"code":"19083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.83,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast add lesion us imag","code_information":[{"code":"19084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.7,"maximum":124.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.7}]}]},{"description":"Bx breast 1st lesion mr imag","code_information":[{"code":"19085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":290.03,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":290.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast add lesion mr imag","code_information":[{"code":"19086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.48,"maximum":144.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.48}]}]},{"description":"Bx breast percut w/o image","code_information":[{"code":"19100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.66,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of breast open","code_information":[{"code":"19101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":369.34,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":369.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Cryosurg ablate fa each","code_information":[{"code":"19105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":343.42,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Nipple exploration","code_information":[{"code":"19110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":586.62,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":586.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Excise breast duct fistula","code_information":[{"code":"19112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":539.18,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":539.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast lesion","code_information":[{"code":"19120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":694.03,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":694.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Excision breast lesion","code_information":[{"code":"19125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":767.42,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":767.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Excision addl breast lesion","code_information":[{"code":"19126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.24,"maximum":260.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.24}]}]},{"description":"Perq device breast 1st imag","code_information":[{"code":"19281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.72,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Perq device breast ea imag","code_information":[{"code":"19282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.38,"maximum":79.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.38}]}]},{"description":"Perq dev breast 1st strtctc","code_information":[{"code":"19283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.28,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast add strtctc","code_information":[{"code":"19284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.86,"maximum":79.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.86}]}]},{"description":"Perq dev breast 1st us imag","code_information":[{"code":"19285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.68,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast add us imag","code_information":[{"code":"19286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.84,"maximum":67.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.84}]}]},{"description":"Perq dev breast 1st mr guide","code_information":[{"code":"19287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.49,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast add mr guide","code_information":[{"code":"19288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.31,"maximum":102.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.31}]}]},{"description":"Prep tum cav iort prtl mast","code_information":[{"code":"19294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.8,"maximum":267.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.8}]}]},{"description":"Place po breast cath for rad","code_information":[{"code":"19296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":344.0,"maximum":42635.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13672.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":344.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9297.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37955.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42635.34,"additional_payer_notes":"APC"}]}]},{"description":"Place breast cath for rad","code_information":[{"code":"19297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":152.46,"maximum":152.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.46}]}]},{"description":"Place breast rad tube/caths","code_information":[{"code":"19298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":527.52,"maximum":71886.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15368.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23052.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":527.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15675.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63996.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71886.41,"additional_payer_notes":"APC"}]}]},{"description":"Partial Mastectomy","code_information":[{"code":"19301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1088.63,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1088.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"P-Mastectomy w/LN Removal","code_information":[{"code":"19302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1495.52,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1495.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Mast simple complete","code_information":[{"code":"19303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1581.57,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1581.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Mast radical","code_information":[{"code":"19305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1887.12,"maximum":1887.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1887.12}]}]},{"description":"Mast rad urban type","code_information":[{"code":"19306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2012.46,"maximum":2012.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2012.46}]}]},{"description":"Mast mod rad","code_information":[{"code":"19307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1942.65,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1942.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Suspension of breast","code_information":[{"code":"19316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1310.0,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1310.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of large breast","code_information":[{"code":"19318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1805.53,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1805.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Enlarge breast with implant","code_information":[{"code":"19325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1020.8,"maximum":42635.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13672.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1020.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9297.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37955.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42635.34,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast implant","code_information":[{"code":"19328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":920.04,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":920.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal of implant material","code_information":[{"code":"19330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1069.97,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1069.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Immediate breast prosthesis","code_information":[{"code":"19340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1257.06,"maximum":42635.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13672.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1257.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9297.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37955.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42635.34,"additional_payer_notes":"APC"}]}]},{"description":"Delayed breast prosthesis","code_information":[{"code":"19342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1260.61,"maximum":42635.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13672.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1260.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9297.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37955.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42635.34,"additional_payer_notes":"APC"}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1116.15,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1116.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1919.44,"maximum":71886.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15368.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23052.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1919.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15675.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63996.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71886.41,"additional_payer_notes":"APC"}]}]},{"description":"Breast reconstr w/lat flap","code_information":[{"code":"19361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2566.19,"maximum":2566.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2566.19}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4460.51,"maximum":4460.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4460.51}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2913.51,"maximum":2913.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2913.51}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3560.23,"maximum":3560.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3560.23}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3308.38,"maximum":3308.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3308.38}]}]},{"description":"Surgery of breast capsule","code_information":[{"code":"19370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1113.49,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1113.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast capsule","code_information":[{"code":"19371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1181.08,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1181.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Revise breast reconstruction","code_information":[{"code":"19380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.83,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1336.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Design custom breast implant","code_information":[{"code":"19396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.83,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound neck","code_information":[{"code":"20100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":601.46,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":984.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound chest","code_information":[{"code":"20101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":344.35,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":344.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound abdomen","code_information":[{"code":"20102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.23,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound extremity","code_information":[{"code":"20103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.67,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Excise epiphyseal bar","code_information":[{"code":"20150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.76,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Muscle biopsy","code_information":[{"code":"20200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.72,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Deep muscle biopsy","code_information":[{"code":"20205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.47,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy muscle","code_information":[{"code":"20206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.42,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":141.6,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":210.48,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy open superficial","code_information":[{"code":"20240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.5,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy open deep","code_information":[{"code":"20245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":560.69,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":560.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Open bone biopsy","code_information":[{"code":"20250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":649.45,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":649.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Open bone biopsy","code_information":[{"code":"20251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":713.96,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Injection of sinus tract","code_information":[{"code":"20500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.39,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Inject sinus tract for x-ray","code_information":[{"code":"20501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.6,"maximum":58.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.6}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":245.66,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":411.74,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":411.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Ther injection carp tunnel","code_information":[{"code":"20526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.23,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Inj dupuytren cord w/enzyme","code_information":[{"code":"20527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.42,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Inj tendon sheath/ligament","code_information":[{"code":"20550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.91,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Inj tendon origin/insertion","code_information":[{"code":"20551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.88,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Inj trigger point 1/2 muscl","code_information":[{"code":"20552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.56,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Inject trigger points 3/>","code_information":[{"code":"20553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.76,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Place ndl musc/tis for rt","code_information":[{"code":"20555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":557.55,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":557.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap f/c/c/n/ax/g/h/f","code_information":[{"code":"15620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.73,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":542.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap arms/legs","code_information":[{"code":"15610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.41,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap trunk","code_information":[{"code":"15600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.21,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Pedicle e/n/e/l/ntroral","code_information":[{"code":"15576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1070.52,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1070.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Pedcle fh/ch/ch/m/n/ax/g/h/f","code_information":[{"code":"15574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1192.23,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1192.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skin pedicle flap arms/legs","code_information":[{"code":"15572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1216.63,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1216.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Skin pedicle flap trunk","code_information":[{"code":"15570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1200.6,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1200.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skn sub grft f/n/hf/g ch add","code_information":[{"code":"15278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.98,"maximum":90.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.98}]}]},{"description":"Skn sub grft f/n/hf/g child","code_information":[{"code":"15277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":363.77,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":363.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skin sub graft f/n/hf/g addl","code_information":[{"code":"15276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.46,"maximum":40.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.46}]}]},{"description":"Skin sub graft face/nk/hf/g","code_information":[{"code":"15275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.12,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Skn sub grft t/a/l child add","code_information":[{"code":"15274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.41,"maximum":71.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.41}]}]},{"description":"Skin sub grft t/arm/lg child","code_information":[{"code":"15273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.76,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":315.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skin sub graft t/a/l add-on","code_information":[{"code":"15272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.33,"maximum":27.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.33}]}]},{"description":"Skin sub graft trnk/arm/leg","code_information":[{"code":"15271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.55,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Skin full graft add-on","code_information":[{"code":"15261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.84,"maximum":219.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.84}]}]},{"description":"Skin full graft een & lips","code_information":[{"code":"15260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1394.74,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1394.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skin full graft add-on","code_information":[{"code":"15241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.04,"maximum":174.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.04}]}]},{"description":"Skin full grft face/genit/hf","code_information":[{"code":"15240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1312.72,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1312.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skin full graft add-on","code_information":[{"code":"15221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.32,"maximum":112.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.32}]}]},{"description":"Skin full graft sclp/arm/leg","code_information":[{"code":"15220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1005.33,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1005.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Skin full graft trunk add-on","code_information":[{"code":"15201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.28,"maximum":124.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.28}]}]},{"description":"Skin full graft trunk","code_information":[{"code":"15200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1109.96,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1109.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Cult epiderm grft f/n/hfg +%","code_information":[{"code":"15157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.69,"maximum":266.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.69}]}]},{"description":"Cult skin grft f/n/hfg add","code_information":[{"code":"15156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.91,"maximum":244.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.91}]}]},{"description":"Cult skin graft f/n/hf/g","code_information":[{"code":"15155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1203.46,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1203.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Ndl insj w/o njx 1 or 2 musc","code_information":[{"code":"20560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.66,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Ndl insj w/o njx 3+ musc","code_information":[{"code":"20561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.46,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.91,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.1,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.22,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.17,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.64,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate/inj ganglion cyst","code_information":[{"code":"20612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.65,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of bone cyst","code_information":[{"code":"20615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":263.95,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Insert and remove bone pin","code_information":[{"code":"20650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":279.97,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":279.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Apply rem fixation device","code_information":[{"code":"20660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.91,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":394.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Application of head brace","code_information":[{"code":"20661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":863.99,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":863.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Application of pelvis brace","code_information":[{"code":"20662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":875.41,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":875.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Application of thigh brace","code_information":[{"code":"20663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":806.81,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":806.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Application of halo","code_information":[{"code":"20664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1488.19,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1488.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of fixation device","code_information":[{"code":"20665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.22,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Removal of support implant","code_information":[{"code":"20670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.69,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of support implant","code_information":[{"code":"20680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":697.25,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":697.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Apply bone fixation device","code_information":[{"code":"20690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":991.62,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":991.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Apply bone fixation device","code_information":[{"code":"20692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1876.5,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1876.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Adjust bone fixation device","code_information":[{"code":"20693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":752.14,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":752.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove bone fixation device","code_information":[{"code":"20694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":574.22,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":574.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Comp multiplane ext fixation","code_information":[{"code":"20696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1920.35,"maximum":141540.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30259.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45389.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1920.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30865.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":126005.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141540.83,"additional_payer_notes":"APC"}]}]},{"description":"Comp ext fixate strut change","code_information":[{"code":"20697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1793.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2752.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Mnl prep&insj dp rx dlvr dev","code_information":[{"code":"20700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":136.86,"maximum":136.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.86}]}]},{"description":"Rmvl deep rx delivery device","code_information":[{"code":"20701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":104.14,"maximum":104.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.14}]}]},{"description":"Mnl prep&insj imed rx dev","code_information":[{"code":"20702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":233.24,"maximum":233.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.24}]}]},{"description":"Rmvl imed rx delivery device","code_information":[{"code":"20703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":171.07,"maximum":171.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171.07}]}]},{"description":"Mnl prep&insj i-artic rx dev","code_information":[{"code":"20704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":245.22,"maximum":245.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.22}]}]},{"description":"Rmvl i-artic rx delivery dev","code_information":[{"code":"20705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.7,"maximum":202.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.7}]}]},{"description":"Replantation arm complete","code_information":[{"code":"20802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4507.69,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4507.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Replant forearm complete","code_information":[{"code":"20805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5351.04,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5351.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Replantation hand complete","code_information":[{"code":"20808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6450.58,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6450.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1793.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3374.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1793.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Replantation thumb complete","code_information":[{"code":"20824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1793.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3381.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Replantation thumb complete","code_information":[{"code":"20827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1793.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2998.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Replantation foot complete","code_information":[{"code":"20838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4573.89,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4573.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone for graft","code_information":[{"code":"20900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.53,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":295.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone for graft","code_information":[{"code":"20902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":448.63,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":448.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove cartilage for graft","code_information":[{"code":"20910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":799.05,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Remove cartilage for graft","code_information":[{"code":"20912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.7,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":798.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of fascia for graft","code_information":[{"code":"20920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":663.76,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":663.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of fascia for graft","code_information":[{"code":"20922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":828.1,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":828.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tendon for graft","code_information":[{"code":"20924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":842.78,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":842.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Sp bone algrft struct add-on","code_information":[{"code":"20931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.85,"maximum":180.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180.85}]}]},{"description":"Osteoart algrft w/surf & b1","code_information":[{"code":"20932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1229.22,"maximum":1229.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1229.22}]}]},{"description":"Hemicrt intrclry algrft prtl","code_information":[{"code":"20933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1127.37,"maximum":1127.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1127.37}]}]},{"description":"Intercalary algrft compl","code_information":[{"code":"20934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1228.17,"maximum":1228.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1228.17}]}]},{"description":"Sp bone agrft morsel add-on","code_information":[{"code":"20937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":272.94,"maximum":272.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":272.94}]}]},{"description":"Sp bone agrft struct add-on","code_information":[{"code":"20938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":298.3,"maximum":298.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.3}]}]},{"description":"Bone marrow aspir bone grfg","code_information":[{"code":"20939","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.16,"maximum":114.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.16}]}]},{"description":"Fluid pressure muscle","code_information":[{"code":"20950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.51,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Fibula bone graft microvasc","code_information":[{"code":"20955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3998.08,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3998.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Iliac bone graft microvasc","code_information":[{"code":"20956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4334.55,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4334.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Mt bone graft microvasc","code_information":[{"code":"20957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4515.28,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4515.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Other bone graft microvasc","code_information":[{"code":"20962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4399.8,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4399.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft microvasc","code_information":[{"code":"20969","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4436.76,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4436.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft iliac crest","code_information":[{"code":"20970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4677.67,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4677.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft metatarsal","code_information":[{"code":"20972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4663.01,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft great toe","code_information":[{"code":"20973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4922.43,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4922.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Electrical bone stimulation","code_information":[{"code":"20974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.03,"maximum":234.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.03,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":208.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":234.02,"additional_payer_notes":"APC"}]}]},{"description":"Electrical bone stimulation","code_information":[{"code":"20975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.6,"maximum":293.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":293.6}]}]},{"description":"Us bone stimulation","code_information":[{"code":"20979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Ablate bone tumor(s) perq","code_information":[{"code":"20982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":596.16,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":596.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Ablate bone tumor(s) perq","code_information":[{"code":"20983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":557.1,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":557.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Cptr-asst dir ms px","code_information":[{"code":"20985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":235.95,"maximum":235.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.95}]}]},{"description":"Incision of jaw joint","code_information":[{"code":"21010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1222.88,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1222.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Exc face les sc <2 cm","code_information":[{"code":"21011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":436.45,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc face les sbq 2 cm/>","code_information":[{"code":"21012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":564.39,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":564.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc face tum deep < 2 cm","code_information":[{"code":"21013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.02,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":666.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx dprsd malar fracture","code_information":[{"code":"21360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":870.27,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":870.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx complx malar fx","code_information":[{"code":"21365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1787.98,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1787.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx complx malar w/grft","code_information":[{"code":"21366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2103.03,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2103.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx transantral","code_information":[{"code":"21385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1209.74,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1209.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx periorbital","code_information":[{"code":"21386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1146.84,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1146.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx combined","code_information":[{"code":"21387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.64,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1263.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit periorbtl implt","code_information":[{"code":"21390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1315.57,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1315.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit periorbt w/grft","code_information":[{"code":"21395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1656.45,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1656.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx orbit w/o manipulj","code_information":[{"code":"21400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.99,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":285.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx orbit w/manipulj","code_information":[{"code":"21401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":551.72,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":551.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx w/o implant","code_information":[{"code":"21406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":968.94,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":968.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx w/implant","code_information":[{"code":"21407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1072.16,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1072.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx orbit fx w/bone grft","code_information":[{"code":"21408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1489.55,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1489.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":902.78,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":902.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1044.72,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1044.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1311.24,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1311.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1141.1,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1141.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1177.92,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1177.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2850.87,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2850.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2320.8,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2320.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat craniofacial fracture","code_information":[{"code":"21436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3351.77,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3351.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat dental ridge fracture","code_information":[{"code":"21440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":976.84,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Treat dental ridge fracture","code_information":[{"code":"21445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1022.75,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1022.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":601.46,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":786.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1049.51,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1049.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":735.91,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":735.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1499.73,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1499.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":821.31,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":821.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1701.36,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1701.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1890.72,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1890.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1335.13,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1335.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1920.14,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1920.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reset dislocated jaw","code_information":[{"code":"21480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.79,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Reset dislocated jaw","code_information":[{"code":"21485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1258.11,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1258.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Repair dislocated jaw","code_information":[{"code":"21490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1317.09,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1317.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Interdental wiring","code_information":[{"code":"21497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":964.13,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":964.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Drain neck/chest lesion","code_information":[{"code":"21501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":563.58,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":563.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Drain chest lesion","code_information":[{"code":"21502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":838.28,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":838.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"21510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.29,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of neck/chest","code_information":[{"code":"21550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.67,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck les sc 3 cm/>","code_information":[{"code":"21552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":743.26,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":743.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck tum deep 5 cm/>","code_information":[{"code":"21554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1210.79,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1210.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck les sc < 3 cm","code_information":[{"code":"21555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":512.61,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":512.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck tum deep < 5 cm","code_information":[{"code":"21556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":878.37,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":878.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect neck thorax tumor<5cm","code_information":[{"code":"21557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1571.57,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1571.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect neck tumor 5 cm/>","code_information":[{"code":"21558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2202.88,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2202.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of rib","code_information":[{"code":"21600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":951.2,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":951.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Exc chest wall tumor w/ribs","code_information":[{"code":"21601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1875.5,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1875.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc ch wal tum w/o lymphadec","code_information":[{"code":"21602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2527.51,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2527.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Exc ch wal tum w/lymphadec","code_information":[{"code":"21603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2740.97,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2740.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of rib","code_information":[{"code":"21610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2010.75,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2010.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rib","code_information":[{"code":"21615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1022.73,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1022.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rib and nerves","code_information":[{"code":"21616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1165.5,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1165.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of sternum","code_information":[{"code":"21620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":829.23,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":829.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Sternal debridement","code_information":[{"code":"21627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":906.83,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":906.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Extensive sternum surgery","code_information":[{"code":"21630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2166.82,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2166.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Hyoid myotomy & suspension","code_information":[{"code":"21685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1615.79,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1615.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.83,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle/rib","code_information":[{"code":"21705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.27,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":866.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":894.53,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":894.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":908.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of sternum","code_information":[{"code":"21740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1672.64,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1672.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of sternum separation","code_information":[{"code":"21750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1105.13,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1105.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Optx of rib fx w/fixj scope","code_information":[{"code":"21811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":963.87,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":963.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Exc face tum deep 2 cm/>","code_information":[{"code":"21014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":865.16,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":865.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect face/scalp tum < 2 cm","code_information":[{"code":"21015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1158.62,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1158.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect face/scalp tum 2 cm/>","code_information":[{"code":"21016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1656.59,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1656.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Excision of bone lower jaw","code_information":[{"code":"21025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1106.56,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1106.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excision of facial bone(s)","code_information":[{"code":"21026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":725.64,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":725.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Contour of face bone lesion","code_information":[{"code":"21029","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1039.79,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1039.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excise max/zygoma b9 tumor","code_information":[{"code":"21030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.99,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove exostosis mandible","code_information":[{"code":"21031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.75,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Remove exostosis maxilla","code_information":[{"code":"21032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.01,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excise max/zygoma mal tumor","code_information":[{"code":"21034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1849.32,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1849.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excise mandible lesion","code_information":[{"code":"21040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":603.14,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":603.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of jaw bone lesion","code_information":[{"code":"21044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1421.94,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Extensive jaw surgery","code_information":[{"code":"21045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1971.4,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1971.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove mandible cyst complex","code_information":[{"code":"21046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1624.67,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1624.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excise lwr jaw cyst w/repair","code_information":[{"code":"21047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1998.7,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1998.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove maxilla cyst complex","code_information":[{"code":"21048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1646.22,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1646.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excis uppr jaw cyst w/repair","code_information":[{"code":"21049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1897.29,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1897.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of jaw joint","code_information":[{"code":"21050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1420.19,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1420.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove jaw joint cartilage","code_information":[{"code":"21060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1288.46,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove coronoid process","code_information":[{"code":"21070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1007.73,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1007.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Mnpj of tmj w/anesth","code_information":[{"code":"21073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.98,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1180.63,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1180.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2890.83,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2890.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1949.5,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1949.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2192.2,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2192.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2009.44,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2009.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1862.74,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1862.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1719.62,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1719.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1987.61,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1987.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":804.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2132.43,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2132.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2132.43,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2132.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Maxillofacial fixation","code_information":[{"code":"21100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.25,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":599.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Interdental fixation","code_information":[{"code":"21110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1153.81,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1153.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Injection jaw joint x-ray","code_information":[{"code":"21116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.17,"maximum":72.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.17}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":833.36,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":833.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":882.39,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":882.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1228.84,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1228.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1382.0,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1382.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Augmentation lower jaw bone","code_information":[{"code":"21125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1112.25,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1112.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Augmentation lower jaw bone","code_information":[{"code":"21127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.72,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1284.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1244.21,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1244.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1511.8,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1511.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21139","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1793.22,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-1 piece w/o graft","code_information":[{"code":"21141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2185.91,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2185.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-2 piece w/o graft","code_information":[{"code":"21142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2243.32,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2243.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-3/> piece w/o graft","code_information":[{"code":"21143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2312.21,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2312.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-1 piece w/ graft","code_information":[{"code":"21145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2540.34,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2540.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-2 piece w/ graft","code_information":[{"code":"21146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.21,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2653.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort i-3/> piece w/ graft","code_information":[{"code":"21147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2789.91,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2789.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort ii anterior intrusion","code_information":[{"code":"21150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2685.55,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2685.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort ii w/bone grafts","code_information":[{"code":"21151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2955.79,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2955.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort iii w/o lefort i","code_information":[{"code":"21154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3183.24,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3183.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort iii w/ lefort i","code_information":[{"code":"21155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3530.45,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3530.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort iii w/fhdw/o lefort i","code_information":[{"code":"21159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4230.28,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4230.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lefort iii w/fhd w/ lefort i","code_information":[{"code":"21160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4586.83,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4586.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct orbit/forehead","code_information":[{"code":"21172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3488.56,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3488.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct orbit/forehead","code_information":[{"code":"21175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3619.16,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3619.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct entire forehead","code_information":[{"code":"21179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2496.58,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2496.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct entire forehead","code_information":[{"code":"21180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2787.67,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2787.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Contour cranial bone lesion","code_information":[{"code":"21181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1226.88,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1226.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cranial bone","code_information":[{"code":"21182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3471.14,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3471.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cranial bone","code_information":[{"code":"21183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3774.24,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3774.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cranial bone","code_information":[{"code":"21184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4057.71,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4057.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of midface","code_information":[{"code":"21188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2583.15,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2583.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconst lwr jaw w/o graft","code_information":[{"code":"21193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2020.6,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2020.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconst lwr jaw w/graft","code_information":[{"code":"21194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2334.94,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2334.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconst lwr jaw w/o fixation","code_information":[{"code":"21195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2191.01,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2191.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconst lwr jaw w/fixation","code_information":[{"code":"21196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2340.77,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2340.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstr lwr jaw segment","code_information":[{"code":"21198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1661.12,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1661.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstr Lwr Jaw W/Advance","code_information":[{"code":"21199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1671.47,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1671.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct upper jaw bone","code_information":[{"code":"21206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1609.03,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1609.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Augmentation of facial bones","code_information":[{"code":"21208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1225.98,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1225.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of facial bones","code_information":[{"code":"21209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":994.52,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":994.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Face bone graft","code_information":[{"code":"21210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1264.63,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1264.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lower jaw bone graft","code_information":[{"code":"21215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1314.97,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1314.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Rib cartilage graft","code_information":[{"code":"21230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1230.64,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1230.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Ear cartilage graft","code_information":[{"code":"21235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":943.78,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":943.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw joint","code_information":[{"code":"21240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1729.55,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1729.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw joint","code_information":[{"code":"21242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1664.07,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1664.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw joint","code_information":[{"code":"21243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2658.32,"maximum":141540.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30259.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45389.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2658.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30865.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":126005.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141540.83,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of lower jaw","code_information":[{"code":"21244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1648.85,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1648.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1552.36,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1552.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1396.1,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1396.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct lower jaw bone","code_information":[{"code":"21247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2591.63,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2591.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1317.95,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1317.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw","code_information":[{"code":"21249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.27,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct lower jaw bone","code_information":[{"code":"21255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2186.2,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2186.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of orbit","code_information":[{"code":"21256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2047.27,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2047.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2246.42,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2246.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3979.46,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3979.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3680.29,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3680.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2626.86,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2626.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye sockets","code_information":[{"code":"21268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.59,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Augmentation cheek bone","code_information":[{"code":"21270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.92,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1237.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision orbitofacial bones","code_information":[{"code":"21275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1391.98,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1391.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"21280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":966.91,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"21282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":659.43,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":659.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Revision of jaw muscle/bone","code_information":[{"code":"21295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.19,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Revision of jaw muscle/bone","code_information":[{"code":"21296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.0,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx nose fx w/o stablj","code_information":[{"code":"21315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.66,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx nose fx w/ stablj","code_information":[{"code":"21320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.03,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Open tx nose fx uncomplicatd","code_information":[{"code":"21325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":730.22,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":730.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Open tx nose fx w/skele fixj","code_information":[{"code":"21330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":878.13,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":878.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Open tx nose & septal fx","code_information":[{"code":"21335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1177.06,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1177.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Open tx septal fx w/wo stabj","code_information":[{"code":"21336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1046.27,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1046.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx septal&nose fx","code_information":[{"code":"21337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":502.45,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":502.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Open nasoethmoid fx w/o fixj","code_information":[{"code":"21338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1104.87,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1104.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Open nasoethmoid fx w/ fixj","code_information":[{"code":"21339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1248.99,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1248.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Perq tx nasoethmoid fx","code_information":[{"code":"21340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1245.33,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1245.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Open tx dprsd front sinus fx","code_information":[{"code":"21343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1787.67,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1787.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Open tx compl front sinus fx","code_information":[{"code":"21344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2286.53,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2286.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx nose/jaw fx","code_information":[{"code":"21345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1060.65,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1060.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx nasomax fx w/fixj","code_information":[{"code":"21346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1652.59,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1652.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx nasomax fx multple","code_information":[{"code":"21347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1708.58,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1708.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx nasomax fx w/graft","code_information":[{"code":"21348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1798.84,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1798.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Perq tx malar fracture","code_information":[{"code":"21355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":544.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":544.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Opn tx dprsd zygomatic arch","code_information":[{"code":"21356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":668.35,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":668.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":623.34,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":623.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder les sc 3 cm/>","code_information":[{"code":"23071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.73,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":700.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder tum deep 5 cm/>","code_information":[{"code":"23073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1157.59,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1157.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder les sc < 3 cm","code_information":[{"code":"23075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":550.06,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":550.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder tum deep < 5 cm","code_information":[{"code":"23076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":909.79,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":909.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect shoulder tumor < 5 cm","code_information":[{"code":"23077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1866.34,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1866.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect shoulder tumor 5 cm/>","code_information":[{"code":"23078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2375.07,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2375.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of shoulder joint","code_information":[{"code":"23100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":853.08,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":853.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder joint surgery","code_information":[{"code":"23101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":769.92,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":769.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder joint lining","code_information":[{"code":"23105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1073.76,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1073.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of collarbone joint","code_information":[{"code":"23106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.52,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":846.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Explore treat shoulder joint","code_information":[{"code":"23107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1111.92,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal collar bone","code_information":[{"code":"23120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":986.03,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of collar bone","code_information":[{"code":"23125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.04,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1187.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder bone part","code_information":[{"code":"23130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.13,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":933.2,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":933.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1163.66,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1163.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1047.53,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1117.37,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1117.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1332.37,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1332.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1138.51,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1138.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove collar bone lesion","code_information":[{"code":"23170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":948.46,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":948.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder blade lesion","code_information":[{"code":"23172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":958.24,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":958.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"23174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1279.41,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1279.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove collar bone lesion","code_information":[{"code":"23180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1155.31,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1155.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder blade lesion","code_information":[{"code":"23182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1126.91,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1126.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"23184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1235.48,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1235.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of scapula","code_information":[{"code":"23190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.91,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":965.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of head of humerus","code_information":[{"code":"23195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.9,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Resect clavicle tumor","code_information":[{"code":"23200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2484.68,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2484.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Resect scapula tumor","code_information":[{"code":"23210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2911.23,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2911.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Resect prox humerus tumor","code_information":[{"code":"23220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3187.05,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3187.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder foreign body","code_information":[{"code":"23330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":280.68,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder fb deep","code_information":[{"code":"23333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.18,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":798.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1762.13,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1762.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.37,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Injection for shoulder x-ray","code_information":[{"code":"23350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.95,"maximum":80.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.95}]}]},{"description":"Muscle transfer shoulder/arm","code_information":[{"code":"23395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2127.83,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2127.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Muscle transfers","code_information":[{"code":"23397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1883.4,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1883.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of shoulder blade","code_information":[{"code":"23400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1615.24,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1615.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tendon & muscle","code_information":[{"code":"23405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1024.39,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1024.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incise tendon(s) & muscle(s)","code_information":[{"code":"23406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1227.26,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1227.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair rotator cuff acute","code_information":[{"code":"23410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1364.8,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1364.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair rotator cuff chronic","code_information":[{"code":"23412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.16,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1418.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Release of shoulder ligament","code_information":[{"code":"23415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1171.68,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1171.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of shoulder","code_information":[{"code":"23420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1622.69,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1622.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair biceps tendon","code_information":[{"code":"23430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1240.67,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1240.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove/transplant tendon","code_information":[{"code":"23440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1260.26,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1260.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1570.12,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1570.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1611.25,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1611.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1807.5,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1807.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1768.42,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1768.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1852.73,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1852.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1857.03,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1857.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct shoulder joint","code_information":[{"code":"23470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1979.61,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1979.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct shoulder joint","code_information":[{"code":"23472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2382.33,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2382.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Revis reconst shoulder joint","code_information":[{"code":"23473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2648.38,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2648.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revis reconst shoulder joint","code_information":[{"code":"23474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2858.17,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2858.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of collar bone","code_information":[{"code":"23480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.86,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1366.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of collar bone","code_information":[{"code":"23485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1581.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1581.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce clavicle","code_information":[{"code":"23490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1432.25,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1432.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce shoulder bones","code_information":[{"code":"23491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1687.06,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1687.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":574.34,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":574.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1167.07,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1167.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1597.96,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat sternum fracture","code_information":[{"code":"21820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.02,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat sternum fracture","code_information":[{"code":"21825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.57,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.04,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":631.55,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":631.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc back les sc < 3 cm","code_information":[{"code":"21930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":607.33,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":607.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc back les sc 3 cm/>","code_information":[{"code":"21931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":781.8,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":781.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc back tum deep < 5 cm","code_information":[{"code":"21932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1103.08,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1103.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc back tum deep 5 cm/>","code_information":[{"code":"21933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1221.15,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1221.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect back tum < 5 cm","code_information":[{"code":"21935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1677.89,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1677.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect back tum 5 cm/>","code_information":[{"code":"21936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2322.3,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2322.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"I&d p-spine c/t/cerv-thor","code_information":[{"code":"22010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1621.2,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1621.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"I&d abscess p-spine l/s/ls","code_information":[{"code":"22015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1580.4,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1580.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove part of neck vertebra","code_information":[{"code":"22100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1583.07,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1583.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove part thorax vertebra","code_information":[{"code":"22101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1484.31,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1484.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove part lumbar vertebra","code_information":[{"code":"22102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.42,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1263.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove extra spine segment","code_information":[{"code":"22103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.24,"maximum":217.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.24}]}]},{"description":"Remove part of neck vertebra","code_information":[{"code":"22110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1757.56,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove part thorax vertebra","code_information":[{"code":"22112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1899.66,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1899.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove part lumbar vertebra","code_information":[{"code":"22114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1899.66,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1899.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove extra spine segment","code_information":[{"code":"22116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.39,"maximum":232.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.39}]}]},{"description":"Incis spine 3 column thorac","code_information":[{"code":"22206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4051.2,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4051.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incis spine 3 column lumbar","code_information":[{"code":"22207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3948.4,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3948.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incis spine 3 column adl seg","code_information":[{"code":"22208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":963.98,"maximum":963.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":963.98}]}]},{"description":"Incis 1 vertebral seg cerv","code_information":[{"code":"22210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2960.17,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2960.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg thorac","code_information":[{"code":"22212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2517.27,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2517.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg lumbar","code_information":[{"code":"22214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2513.65,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2513.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incis addl spine segment","code_information":[{"code":"22216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":592.52,"maximum":592.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":592.52}]}]},{"description":"Incis w/discectomy cervical","code_information":[{"code":"22220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2699.48,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2699.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy thoracic","code_information":[{"code":"22222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2932.91,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2932.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy lumbar","code_information":[{"code":"22224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2626.38,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2626.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise extra spine segment","code_information":[{"code":"22226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":587.76,"maximum":587.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":587.76}]}]},{"description":"Closed tx vert fx w/o manj","code_information":[{"code":"22310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":499.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx vert fx w/manj","code_information":[{"code":"22315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1306.1,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1306.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat odontoid fx w/o graft","code_information":[{"code":"22318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2741.44,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2741.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat odontoid fx w/graft","code_information":[{"code":"22319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3044.52,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3044.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat spine fracture","code_information":[{"code":"22325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2462.74,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2462.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat neck spine fracture","code_information":[{"code":"22326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2509.08,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2509.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat thorax spine fracture","code_information":[{"code":"22327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2557.64,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2557.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat each add spine fx","code_information":[{"code":"22328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.96,"maximum":460.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.96}]}]},{"description":"Manipulation of spine","code_information":[{"code":"22505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.29,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Perq cervicothoracic inject","code_information":[{"code":"22510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":705.32,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Perq lumbosacral injection","code_information":[{"code":"22511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":664.33,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":664.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Vertebroplasty addl inject","code_information":[{"code":"22512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":336.09,"maximum":336.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.09}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":831.31,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":831.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":776.73,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.25,"maximum":353.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.25}]}]},{"description":"Lat thorax spine fusion","code_information":[{"code":"22532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2962.55,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2962.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Lat lumbar spine fusion","code_information":[{"code":"22533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2747.56,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2747.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Lat thor/lumb addl seg","code_information":[{"code":"22534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.18,"maximum":589.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.18}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3265.69,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3265.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fuse&remov bel c2","code_information":[{"code":"22551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2809.76,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2809.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Addl neck spine fusion","code_information":[{"code":"22552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":646.91,"maximum":646.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":646.91}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2093.97,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2093.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Thorax spine fusion","code_information":[{"code":"22556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2787.5,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2787.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2517.51,"maximum":141540.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30259.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45389.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2517.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30865.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":126005.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141540.83,"additional_payer_notes":"APC"}]}]},{"description":"Additional spinal fusion","code_information":[{"code":"22585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.47,"maximum":528.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":528.47}]}]},{"description":"Prescrl fuse w/ instr l5-s1","code_information":[{"code":"22586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3376.83,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3376.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Spine & skull spinal fusion","code_information":[{"code":"22590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2646.52,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2646.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Neck spinal fusion","code_information":[{"code":"22595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2528.34,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2528.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2169.47,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2169.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Thorax spine fusion","code_information":[{"code":"22610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2135.91,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2135.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2610.86,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2610.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Spine fusion extra segment","code_information":[{"code":"22614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":638.84,"maximum":638.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":638.84}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2590.96,"maximum":141540.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30259.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45389.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2590.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30865.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":126005.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141540.83,"additional_payer_notes":"APC"}]}]},{"description":"Spine fusion extra segment","code_information":[{"code":"22632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":523.39,"maximum":523.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":523.39}]}]},{"description":"Lumbar spine fusion combined","code_information":[{"code":"22633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2991.02,"maximum":141540.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30259.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45389.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2991.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30865.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":126005.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141540.83,"additional_payer_notes":"APC"}]}]},{"description":"Spine fusion extra segment","code_information":[{"code":"22634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":790.94,"maximum":790.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":790.94}]}]},{"description":"Post fusion <=6 vert seg","code_information":[{"code":"22800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2268.58,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2268.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion 7-12 vert seg","code_information":[{"code":"22802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3474.13,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3474.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion 13/> vert seg","code_information":[{"code":"22804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3987.42,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3987.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 2-3 vert seg","code_information":[{"code":"22808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2999.82,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2999.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 4-7 vert seg","code_information":[{"code":"22810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3304.73,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 8/> vert seg","code_information":[{"code":"22812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3621.57,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3621.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Kyphectomy 1-2 segments","code_information":[{"code":"22818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3533.76,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3533.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Kyphectomy 3 or more","code_information":[{"code":"22819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4066.94,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4066.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of spinal fusion","code_information":[{"code":"22830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1369.65,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1369.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1230.53,"maximum":1230.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1230.53}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1245.23,"maximum":1245.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1245.23}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1334.26,"maximum":1334.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.26}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1609.25,"maximum":1609.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1609.25}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1184.28,"maximum":1184.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1184.28}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1233.59,"maximum":1233.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1233.59}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1300.67,"maximum":1300.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1300.67}]}]},{"description":"Insert pelv fixation device","code_information":[{"code":"22848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":586.66,"maximum":586.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":586.66}]}]},{"description":"Reinsert spinal fixation","code_information":[{"code":"22849","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2161.56,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2161.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1227.65,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1227.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1181.56,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1181.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Insj biomechanical device","code_information":[{"code":"22853","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":420.52,"maximum":420.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":420.52}]}]},{"description":"Insj biomechanical device","code_information":[{"code":"22854","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":547.48,"maximum":547.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":547.48}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1835.54,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1835.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Cerv artific diskectomy","code_information":[{"code":"22856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2682.32,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2682.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar Artif Diskectomy","code_information":[{"code":"22857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2877.59,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2877.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Second level cer diskectomy","code_information":[{"code":"22858","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":827.69,"maximum":827.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":827.69}]}]},{"description":"Insj biomechanical device","code_information":[{"code":"22859","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":546.96,"maximum":546.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":546.96}]}]},{"description":"Revise cerv artific disc","code_information":[{"code":"22861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3839.2,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3839.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Revise Lumbar Artif Disc","code_information":[{"code":"22862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3840.91,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3840.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove cerv artif disc","code_information":[{"code":"22864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3429.43,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3429.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove Lumb Artif Disc","code_information":[{"code":"22865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3750.87,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3750.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Insj stablj dev w/dcmprn","code_information":[{"code":"22867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1756.3,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1756.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Insj stablj dev w/dcmprn","code_information":[{"code":"22868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.44,"maximum":394.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":394.44}]}]},{"description":"Insj stablj dev w/o dcmprn","code_information":[{"code":"22869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":710.48,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":710.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Insj stablj dev w/o dcmprn","code_information":[{"code":"22870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.92,"maximum":190.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.92}]}]},{"description":"Exc abdl tum deep < 5 cm","code_information":[{"code":"22900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":941.4,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":941.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc abdl tum deep 5 cm/>","code_information":[{"code":"22901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1105.13,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1105.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc abd les sc < 3 cm","code_information":[{"code":"22902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":557.0,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":557.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc abd les sc 3 cm/>","code_information":[{"code":"22903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":732.21,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":732.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Radical resect abd tumor<5cm","code_information":[{"code":"22904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1719.93,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1719.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect abd tumor 5 cm/>","code_information":[{"code":"22905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2194.34,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2194.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of calcium deposits","code_information":[{"code":"23000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.51,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Release shoulder joint","code_information":[{"code":"23020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.98,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1154.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder lesion","code_information":[{"code":"23030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.59,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder bursa","code_information":[{"code":"23031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":372.7,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":372.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder bone lesion","code_information":[{"code":"23035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1136.36,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1136.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory shoulder surgery","code_information":[{"code":"23040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1196.49,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1196.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory shoulder surgery","code_information":[{"code":"23044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":936.54,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":936.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":263.23,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":540.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":864.91,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":864.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1395.22,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1395.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1369.44,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1369.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1796.43,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1796.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1803.71,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1803.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":586.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":805.67,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1192.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1192.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":993.47,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":993.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1136.91,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1136.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.58,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":691.92,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":691.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1104.77,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1104.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1224.72,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1224.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":709.94,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":709.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1096.06,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1096.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of elbow joint","code_information":[{"code":"24800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1390.65,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1390.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of elbow joint","code_information":[{"code":"24802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1665.82,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1665.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of upper arm","code_information":[{"code":"24900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1275.63,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1275.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of upper arm","code_information":[{"code":"24920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1224.65,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1224.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.13,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1290.06,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1290.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Amputate upper arm & implant","code_information":[{"code":"24931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1546.64,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1546.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of amputation","code_information":[{"code":"24935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2018.2,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2018.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tendon sheath","code_information":[{"code":"25000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":586.86,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":586.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Incise flexor carpi radialis","code_information":[{"code":"25001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":592.93,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":592.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 1 space","code_information":[{"code":"25020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1207.89,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1207.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 1 space","code_information":[{"code":"25023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2148.43,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2148.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1296.13,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1296.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1793.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2032.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of forearm lesion","code_information":[{"code":"25028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1129.36,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1129.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of forearm bursa","code_information":[{"code":"25031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":623.92,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":623.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat forearm bone lesion","code_information":[{"code":"25035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":989.86,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":989.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat wrist joint","code_information":[{"code":"25040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":938.99,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":938.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.97,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":626.75,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":626.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm les sc 3 cm/>","code_information":[{"code":"25071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.56,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm tum deep 3 cm/>","code_information":[{"code":"25073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":898.48,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":898.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm les sc < 3 cm","code_information":[{"code":"25075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":530.53,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":530.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm tum deep < 3 cm","code_information":[{"code":"25076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.41,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":871.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect forearm/wrist tum<3cm","code_information":[{"code":"25077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1421.82,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect forarm/wrist tum 3cm>","code_information":[{"code":"25078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1929.11,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1929.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Incision of wrist capsule","code_information":[{"code":"25085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":757.09,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":757.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of wrist joint","code_information":[{"code":"25100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":592.9,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":592.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat wrist joint","code_information":[{"code":"25101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":687.26,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":687.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"25105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":822.83,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":822.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint cartilage","code_information":[{"code":"25107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1043.86,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1043.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Excise tendon forearm/wrist","code_information":[{"code":"25109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":903.64,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":903.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":586.0,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":586.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":552.69,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":552.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Reremove wrist tendon lesion","code_information":[{"code":"25112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":662.23,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":662.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1270.63,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1270.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1018.33,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1018.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Excise wrist tendon sheath","code_information":[{"code":"25118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":649.19,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":649.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.57,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":846.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of forearm lesion","code_information":[{"code":"25120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.69,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":845.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1001.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1001.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1007.78,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1007.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist lesion","code_information":[{"code":"25130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":764.57,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove & graft wrist lesion","code_information":[{"code":"25135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":945.65,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":945.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove & graft wrist lesion","code_information":[{"code":"25136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":839.5,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":839.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove forearm bone lesion","code_information":[{"code":"25145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":878.15,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":878.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":955.17,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":955.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"25151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":983.05,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":983.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect radius/ulnar tumor","code_information":[{"code":"25170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2422.63,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2422.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist bone","code_information":[{"code":"25210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":832.14,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":832.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist bones","code_information":[{"code":"25215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1041.37,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"25230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":733.05,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":733.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":727.62,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":727.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Injection for wrist x-ray","code_information":[{"code":"25246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.13,"maximum":118.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.13}]}]},{"description":"Remove forearm foreign body","code_information":[{"code":"25248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":701.94,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":701.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":898.88,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":898.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1202.87,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1202.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate wrist w/anesthes","code_information":[{"code":"25259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":711.49,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":711.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.36,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1065.41,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1065.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1260.45,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1260.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":833.78,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":833.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":940.87,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":940.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1117.23,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1117.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon sheath","code_information":[{"code":"25275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1128.53,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1128.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise wrist/forearm tendon","code_information":[{"code":"25280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":952.04,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":952.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incise wrist/forearm tendon","code_information":[{"code":"25290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.47,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release wrist/forearm tendon","code_information":[{"code":"25295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":887.72,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":887.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tendons at wrist","code_information":[{"code":"25300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1158.52,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1158.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tendons at wrist","code_information":[{"code":"25301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1079.0,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1079.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Transplant forearm tendon","code_information":[{"code":"25310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1194.7,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1194.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Transplant forearm tendon","code_information":[{"code":"25312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1202.05,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1202.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise palsy hand tendon(s)","code_information":[{"code":"25315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.06,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1284.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise palsy hand tendon(s)","code_information":[{"code":"25316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1524.73,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1524.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/revise wrist joint","code_information":[{"code":"25320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1658.04,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1658.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise wrist joint","code_information":[{"code":"25332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1411.28,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1411.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of hand","code_information":[{"code":"25335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1571.04,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1571.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct ulna/radioulnar","code_information":[{"code":"25337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1487.85,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1487.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of radius","code_information":[{"code":"25350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1129.72,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1129.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of radius","code_information":[{"code":"25355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1278.04,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1278.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ulna","code_information":[{"code":"25360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1100.08,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1100.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius & ulna","code_information":[{"code":"25365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1525.82,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1525.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius or ulna","code_information":[{"code":"25370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1684.15,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1684.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius & ulna","code_information":[{"code":"25375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1586.28,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1586.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shorten radius or ulna","code_information":[{"code":"25390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.49,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1284.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen radius or ulna","code_information":[{"code":"25391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1654.95,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1654.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Shorten radius & ulna","code_information":[{"code":"25392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1683.8,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1683.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen radius & ulna","code_information":[{"code":"25393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1870.72,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1870.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair carpal bone shorten","code_information":[{"code":"25394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1311.21,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1311.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair radius or ulna","code_information":[{"code":"25400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1337.85,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1337.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius or ulna","code_information":[{"code":"25405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.62,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair radius & ulna","code_information":[{"code":"25415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1608.17,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1608.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius & ulna","code_information":[{"code":"25420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1932.22,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1932.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius or ulna","code_information":[{"code":"25425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1601.04,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius & ulna","code_information":[{"code":"25426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1859.84,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1859.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Vasc graft into carpal bone","code_information":[{"code":"25430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1226.14,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1226.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair nonunion carpal bone","code_information":[{"code":"25431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1316.12,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1316.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1203.51,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1203.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":414.21,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":414.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":624.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":966.98,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1051.88,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1051.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":556.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.48,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1080.24,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1080.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder blade fx","code_information":[{"code":"23570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":420.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder blade fx","code_information":[{"code":"23575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":649.95,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":649.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat scapula fracture","code_information":[{"code":"23585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1618.91,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1618.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":545.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":726.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":726.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1470.95,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1470.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2041.51,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2041.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":448.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.33,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.26,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1305.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":517.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":690.3,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":981.29,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":981.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":683.2,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":683.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1454.67,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1454.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":847.78,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":847.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1548.74,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1548.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of shoulder","code_information":[{"code":"23700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.67,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":327.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of shoulder joint","code_information":[{"code":"23800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1703.98,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of shoulder joint","code_information":[{"code":"23802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2127.0,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2127.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of arm & girdle","code_information":[{"code":"23900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2287.95,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2287.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Amputation at shoulder joint","code_information":[{"code":"23920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1862.99,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1862.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"23921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":793.24,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of arm lesion","code_information":[{"code":"23930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.75,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":359.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of arm bursa","code_information":[{"code":"23931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.78,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Drain arm/elbow bone lesion","code_information":[{"code":"23935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":863.54,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":863.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory elbow surgery","code_information":[{"code":"24000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":806.96,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":806.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release elbow joint","code_information":[{"code":"24006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1195.98,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1195.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":269.18,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.65,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":712.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc arm/elbow les sc 3 cm/>","code_information":[{"code":"24071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.33,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":676.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Ex arm/elbow tum deep 5 cm/>","code_information":[{"code":"24073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1152.71,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1152.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc arm/elbow les sc < 3 cm","code_information":[{"code":"24075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":552.29,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":552.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Ex arm/elbow tum deep < 5 cm","code_information":[{"code":"24076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.31,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect arm/elbow tum < 5 cm","code_information":[{"code":"24077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1693.87,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1693.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect arm/elbow tum 5 cm/>","code_information":[{"code":"24079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2188.61,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2188.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy elbow joint lining","code_information":[{"code":"24100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":709.42,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":709.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat elbow joint","code_information":[{"code":"24101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":847.85,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":847.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow joint lining","code_information":[{"code":"24102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1034.29,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1034.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of elbow bursa","code_information":[{"code":"24105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":610.75,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":610.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"24110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":993.05,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":993.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1232.28,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1232.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1430.66,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1430.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow lesion","code_information":[{"code":"24120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":898.48,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":898.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1045.91,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1045.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1091.68,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1091.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of head of radius","code_information":[{"code":"24130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":864.15,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":864.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm bone lesion","code_information":[{"code":"24134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1250.18,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1250.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove radius bone lesion","code_information":[{"code":"24136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1061.22,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1061.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow bone lesion","code_information":[{"code":"24138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1155.09,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1155.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of arm bone","code_information":[{"code":"24140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1176.25,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1176.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"24145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":997.54,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":997.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of elbow","code_information":[{"code":"24147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1055.17,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1055.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Radical resection of elbow","code_information":[{"code":"24149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.72,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1963.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Resect distal humerus tumor","code_information":[{"code":"24150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2547.9,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2547.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Resect radius tumor","code_information":[{"code":"24152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2220.95,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2220.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of elbow joint","code_information":[{"code":"24155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1417.04,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1417.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow joint implant","code_information":[{"code":"24160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2079.37,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2079.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove radius head implant","code_information":[{"code":"24164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1211.6,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1211.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.96,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.52,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":674.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Injection for elbow x-ray","code_information":[{"code":"24220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.75,"maximum":107.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.75}]}]},{"description":"Manipulate elbow w/anesth","code_information":[{"code":"24300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":748.21,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":748.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Muscle/tendon transfer","code_information":[{"code":"24301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1252.54,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1252.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Arm tendon lengthening","code_information":[{"code":"24305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":974.41,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":974.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm tendon","code_information":[{"code":"24310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":791.46,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":791.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of arm tendon","code_information":[{"code":"24320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1302.55,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1302.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm muscles","code_information":[{"code":"24330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1200.68,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1200.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm muscles","code_information":[{"code":"24331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1310.74,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1310.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Tenolysis triceps","code_information":[{"code":"24332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1035.49,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1035.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of biceps tendon","code_information":[{"code":"24340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1015.75,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1015.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair arm tendon/muscle","code_information":[{"code":"24341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1254.94,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1254.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ruptured tendon","code_information":[{"code":"24342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1290.89,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1290.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repr elbow lat ligmnt w/tiss","code_information":[{"code":"24343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1201.65,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1201.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow lat ligmnt","code_information":[{"code":"24344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1838.66,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1838.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repr elbw med ligmnt w/tissu","code_information":[{"code":"24345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1190.25,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1190.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow med ligmnt","code_information":[{"code":"24346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1838.66,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1838.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow perc","code_information":[{"code":"24357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":694.35,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":694.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow w/deb open","code_information":[{"code":"24358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":893.6,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":893.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow deb/attch open","code_information":[{"code":"24359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1111.08,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1501.87,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1501.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1674.51,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1674.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1760.06,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1760.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Replace elbow joint","code_information":[{"code":"24363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2393.67,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2393.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct head of radius","code_information":[{"code":"24365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1074.33,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1074.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct head of radius","code_information":[{"code":"24366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1140.0,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1140.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise reconst elbow joint","code_information":[{"code":"24370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2538.31,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2538.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise reconst elbow joint","code_information":[{"code":"24371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2909.8,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2909.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1380.32,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1380.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1756.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1756.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1760.47,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1760.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of humerus","code_information":[{"code":"24430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1753.16,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1753.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair humerus with graft","code_information":[{"code":"24435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1795.91,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1795.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of elbow joint","code_information":[{"code":"24470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1126.03,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1126.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of forearm","code_information":[{"code":"24495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1505.9,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1505.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce humerus","code_information":[{"code":"24498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1436.7,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1436.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":574.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":768.13,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":768.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1466.51,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1466.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1428.01,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1428.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":602.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":970.07,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":970.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1314.55,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1314.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1546.12,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1546.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.81,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":507.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":842.07,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":842.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1210.6,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1210.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1229.02,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1229.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1005.66,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1005.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1313.24,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1313.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.12,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":309.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Drain hand tendon sheath","code_information":[{"code":"26020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":935.49,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":935.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of palm bursa","code_information":[{"code":"26025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":703.58,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":703.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of palm bursas","code_information":[{"code":"26030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":827.31,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":827.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand bone lesion","code_information":[{"code":"26034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":929.42,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":929.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1438.41,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1438.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":943.92,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":943.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":536.97,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":536.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.24,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":798.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft wrist bone","code_information":[{"code":"25440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.96,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1284.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.21,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1561.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1353.54,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1353.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1311.72,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1311.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1382.96,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1382.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1206.41,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1206.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Wrist replacement","code_information":[{"code":"25446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1943.79,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1943.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Repair wrist joints","code_information":[{"code":"25447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1338.07,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1338.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint implant","code_information":[{"code":"25449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1716.55,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1716.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of wrist joint","code_information":[{"code":"25450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.75,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of wrist joint","code_information":[{"code":"25455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1222.34,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1222.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce radius","code_information":[{"code":"25490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1202.29,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1202.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce ulna","code_information":[{"code":"25491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1236.05,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1236.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce radius and ulna","code_information":[{"code":"25492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1509.44,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1509.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":447.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":784.44,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":784.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1125.05,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1125.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":925.85,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":925.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.61,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1322.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.3,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":422.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1051.44,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1051.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":449.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":787.92,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1134.72,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1134.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1509.99,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1509.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":561.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.68,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":866.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Distal Radial","code_information":[{"code":"25606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1125.84,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1125.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Rad Extra-Articul","code_information":[{"code":"25607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1244.64,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1244.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Rad Intra-Articul","code_information":[{"code":"25608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1386.46,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1386.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Radial 3+ Frag","code_information":[{"code":"25609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1757.37,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":491.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":762.42,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":762.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1205.93,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1205.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":491.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":724.41,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":724.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":960.44,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":960.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":526.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Pin ulnar styloid fracture","code_information":[{"code":"25651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":828.64,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":828.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture ulnar styloid","code_information":[{"code":"25652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1049.89,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1049.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1016.85,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Pin radioulnar dislocation","code_information":[{"code":"25671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":904.21,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":904.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":707.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1057.69,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist fracture","code_information":[{"code":"25680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":900.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist fracture","code_information":[{"code":"25685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1229.53,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1229.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":834.45,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":834.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1063.45,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1063.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of wrist joint","code_information":[{"code":"25800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1223.41,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1223.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of wrist joint","code_information":[{"code":"25805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1413.06,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1413.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of wrist joint","code_information":[{"code":"25810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1449.94,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1449.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hand bones","code_information":[{"code":"25820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1084.42,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1084.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fuse hand bones with graft","code_information":[{"code":"25825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1323.07,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1323.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion radioulnar jnt/ulna","code_information":[{"code":"25830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1695.18,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1695.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1204.56,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1204.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1172.94,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1172.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1031.29,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1147.29,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1147.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1931.37,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1931.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1215.46,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1215.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1076.09,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1076.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1186.13,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1186.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of hand","code_information":[{"code":"25927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1421.57,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Total hip arthroplasty","code_information":[{"code":"27130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2119.95,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2119.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Total hip arthroplasty","code_information":[{"code":"27132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2752.8,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2752.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3129.61,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3129.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2414.7,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2414.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2507.89,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2507.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Transplant femur ridge","code_information":[{"code":"27140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1491.59,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1491.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip bone","code_information":[{"code":"27146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2116.38,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2116.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip bone","code_information":[{"code":"27147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2414.4,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2414.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip bones","code_information":[{"code":"27151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2607.84,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2607.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip bones","code_information":[{"code":"27156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2808.3,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of pelvis","code_information":[{"code":"27158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2310.35,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2310.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of neck of femur","code_information":[{"code":"27161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2019.37,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2019.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip prosthesis","code_information":[{"code":"27090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1377.27,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1377.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip prosthesis","code_information":[{"code":"27091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2626.4,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2626.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Injection for hip x-ray","code_information":[{"code":"27093","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.92,"maximum":110.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.92}]}]},{"description":"Injection for hip x-ray","code_information":[{"code":"27095","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.18,"maximum":133.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.18}]}]},{"description":"Inject sacroiliac joint","code_information":[{"code":"27096","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":136.58,"maximum":136.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.58}]}]},{"description":"Revision of hip tendon","code_information":[{"code":"27097","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1142.95,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1142.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Transfer tendon to pelvis","code_information":[{"code":"27098","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1164.11,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1164.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of abdominal muscle","code_information":[{"code":"27100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1384.69,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1384.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of spinal muscle","code_information":[{"code":"27105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1449.56,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1449.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of iliopsoas muscle","code_information":[{"code":"27110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1612.48,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1612.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of iliopsoas muscle","code_information":[{"code":"27111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1502.92,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1502.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of hip socket","code_information":[{"code":"27120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2146.36,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2146.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of hip socket","code_information":[{"code":"27122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1826.07,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1826.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Partial hip replacement","code_information":[{"code":"27125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1873.53,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1873.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Great toe-hand transfer","code_information":[{"code":"26551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5397.96,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5397.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Single transfer toe-hand","code_information":[{"code":"26553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5361.99,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5361.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Double transfer toe-hand","code_information":[{"code":"26554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6241.81,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6241.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Positional change of finger","code_information":[{"code":"26555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2277.13,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2277.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Toe joint transfer","code_information":[{"code":"26556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5579.12,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5579.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1047.41,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1618.82,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1618.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2272.05,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2272.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Correct metacarpal flaw","code_information":[{"code":"26565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1176.92,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1176.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Correct finger deformity","code_information":[{"code":"26567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.23,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1187.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen metacarpal/finger","code_information":[{"code":"26568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1527.42,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1527.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand deformity","code_information":[{"code":"26580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2540.76,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2540.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct extra finger","code_information":[{"code":"26587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1737.99,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1737.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger deformity","code_information":[{"code":"26590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1793.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2357.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair muscles of hand","code_information":[{"code":"26591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":805.32,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release muscles of hand","code_information":[{"code":"26593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1062.86,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1062.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Excision constricting tissue","code_information":[{"code":"26596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1353.8,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1353.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":497.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":511.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":847.87,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":847.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":812.89,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":812.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":970.29,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":970.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb dislocation","code_information":[{"code":"26641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":675.07,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":675.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":816.55,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":816.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1056.19,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1056.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":542.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.77,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":721.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Pin hand dislocation","code_information":[{"code":"26676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":862.82,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":862.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":973.29,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":973.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1043.75,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1043.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":539.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":678.23,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Pin knuckle dislocation","code_information":[{"code":"26706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.78,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":966.43,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":523.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":802.48,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1001.38,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1001.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":383.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":574.03,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":574.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1242.81,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1242.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":474.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Pin finger fracture each","code_information":[{"code":"26756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":717.51,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":717.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":849.89,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":849.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.91,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Pin finger dislocation","code_information":[{"code":"26776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":761.61,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":761.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":926.14,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":926.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Thumb fusion with graft","code_information":[{"code":"26820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1369.27,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1369.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of thumb","code_information":[{"code":"26841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1274.6,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1274.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Thumb fusion with graft","code_information":[{"code":"26842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1373.06,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1373.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hand joint","code_information":[{"code":"26843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1288.72,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of hand joint","code_information":[{"code":"26844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1419.38,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1419.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle","code_information":[{"code":"26850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1212.2,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1212.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle with graft","code_information":[{"code":"26852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1378.43,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1378.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger joint","code_information":[{"code":"26860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1008.9,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1008.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger jnt add-on","code_information":[{"code":"26861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.24,"maximum":166.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166.24}]}]},{"description":"Fusion/graft of finger joint","code_information":[{"code":"26862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1265.08,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1265.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fuse/graft added joint","code_information":[{"code":"26863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.13,"maximum":370.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":370.13}]}]},{"description":"Amputate metacarpal bone","code_information":[{"code":"26910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1259.07,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1259.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1162.83,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1162.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1130.01,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1130.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvis lesion","code_information":[{"code":"26990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1126.55,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1126.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvis bursa","code_information":[{"code":"26991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":873.6,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"26992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.25,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":650.34,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":650.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":901.78,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":901.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1004.57,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1004.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1205.3,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1205.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendons","code_information":[{"code":"27006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1190.18,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1190.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip/thigh fascia","code_information":[{"code":"27025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1557.86,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1557.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Buttock fasciotomy","code_information":[{"code":"27027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1465.69,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1465.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hip joint","code_information":[{"code":"27030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1552.77,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1552.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of hip joint","code_information":[{"code":"27033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1614.27,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1614.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Denervation of hip joint","code_information":[{"code":"27035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1864.29,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1864.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Excision of hip joint/muscle","code_information":[{"code":"27036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1691.42,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1691.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":330.21,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":330.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1175.09,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1175.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip pelvis les sc 3 cm/>","code_information":[{"code":"27043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":780.18,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":780.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelv tum deep 5 cm/>","code_information":[{"code":"27045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1216.76,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1216.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelvis les sc < 3 cm","code_information":[{"code":"27047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":601.78,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelv tum deep < 5 cm","code_information":[{"code":"27048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1021.51,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1021.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip/pelv tum < 5 cm","code_information":[{"code":"27049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2353.44,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2353.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of sacroiliac joint","code_information":[{"code":"27050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":686.47,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":686.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of hip joint","code_information":[{"code":"27052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":973.48,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":973.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip joint lining","code_information":[{"code":"27054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1151.05,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1151.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Buttock fasciotomy w/dbrdmt","code_information":[{"code":"27057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.82,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip/pelv tum 5 cm/>","code_information":[{"code":"27059","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2988.4,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2988.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ischial bursa","code_information":[{"code":"27060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":785.13,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":785.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/bursa","code_information":[{"code":"27062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.81,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip bone les super","code_information":[{"code":"27065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":878.82,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":878.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip bone les deep","code_information":[{"code":"27066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1365.11,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1365.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft hip bone lesion","code_information":[{"code":"27067","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1719.71,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1719.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Part remove hip bone super","code_information":[{"code":"27070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1449.56,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1449.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Part removal hip bone deep","code_information":[{"code":"27071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1600.01,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1600.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tumor","code_information":[{"code":"27075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3422.94,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3422.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tum incl acetabul","code_information":[{"code":"27076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4130.21,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4130.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tum w/innom bone","code_information":[{"code":"27077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4603.67,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4603.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Rsect hip tum incl femur","code_information":[{"code":"27078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3376.05,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3376.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tail bone","code_information":[{"code":"27080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":847.45,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":847.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.32,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1025.66,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1025.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee tum deep <5cm","code_information":[{"code":"27328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1036.65,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1036.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect thigh/knee tum < 5 cm","code_information":[{"code":"27329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1719.79,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1719.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy knee joint lining","code_information":[{"code":"27330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":713.24,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat knee joint","code_information":[{"code":"27331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":804.2,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":804.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cartilage","code_information":[{"code":"27332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1083.49,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1083.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cartilage","code_information":[{"code":"27333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":990.33,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":990.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee joint lining","code_information":[{"code":"27334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1149.97,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1149.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee joint lining","code_information":[{"code":"27335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1278.61,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1278.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee les sc 3 cm/>","code_information":[{"code":"27337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.18,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":700.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee tum dep 5cm/>","code_information":[{"code":"27339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1252.85,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1252.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kneecap bursa","code_information":[{"code":"27340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":633.75,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":633.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cyst","code_information":[{"code":"27345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":821.62,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":821.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incise finger tendon sheath","code_information":[{"code":"26055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":494.95,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":494.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":429.4,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":429.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat hand joint","code_information":[{"code":"26070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":546.87,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":546.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":573.48,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":573.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":675.69,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":675.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy hand joint lining","code_information":[{"code":"26100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":576.5,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":576.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.29,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":551.65,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":551.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand les sc 1.5 cm/>","code_information":[{"code":"26111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.46,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand tum deep 1.5 cm/>","code_information":[{"code":"26113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":920.49,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":920.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand les sc < 1.5 cm","code_information":[{"code":"26115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":562.12,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":562.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand tum deep < 1.5 cm","code_information":[{"code":"26116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":884.51,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":884.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect hand tumor < 3 cm","code_information":[{"code":"26117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1247.66,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1247.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect hand tumor 3 cm/>","code_information":[{"code":"26118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1751.94,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1751.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1008.06,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1008.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1405.0,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1405.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":439.35,"maximum":439.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.35}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"26130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.06,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":933.47,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":933.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":856.18,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":856.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Tendon excision palm/finger","code_information":[{"code":"26145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":870.79,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":870.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Remove tendon sheath lesion","code_information":[{"code":"26160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":535.37,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":535.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of palm tendon each","code_information":[{"code":"26170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":689.01,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":689.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of finger tendon","code_information":[{"code":"26180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":762.38,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":762.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Remove finger bone","code_information":[{"code":"26185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":942.66,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":942.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Remove hand bone lesion","code_information":[{"code":"26200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.35,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"26205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1015.44,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1015.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of finger lesion","code_information":[{"code":"26210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":757.49,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":757.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft finger lesion","code_information":[{"code":"26215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":951.77,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":951.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of hand bone","code_information":[{"code":"26230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":842.59,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":842.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":830.12,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":830.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":746.12,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":746.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Extensive hand surgery","code_information":[{"code":"26250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.25,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect prox finger tumor","code_information":[{"code":"26260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1328.74,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1328.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect distal finger tumor","code_information":[{"code":"26262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1058.45,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1058.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of implant from hand","code_information":[{"code":"26320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":591.47,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":591.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate finger w/anesth","code_information":[{"code":"26340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":610.37,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":610.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Manipulat palm cord post inj","code_information":[{"code":"26341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1228.07,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1228.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1367.7,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1367.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1331.62,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1331.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1487.02,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1487.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.5,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1638.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1289.86,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1289.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1502.92,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1502.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1446.25,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1446.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise hand/finger tendon","code_information":[{"code":"26390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1444.56,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1444.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.52,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand tendon","code_information":[{"code":"26410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.67,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1175.01,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1175.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Excision hand/finger tendon","code_information":[{"code":"26415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1398.59,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1398.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Graft hand or finger tendon","code_information":[{"code":"26416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1514.54,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1514.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1026.56,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1026.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1217.57,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1217.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":849.61,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":849.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1310.76,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1310.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.83,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":897.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":939.37,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":939.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1145.41,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1145.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of tendons","code_information":[{"code":"26437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1099.96,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1099.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release palm/finger tendon","code_information":[{"code":"26440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1067.57,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1067.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Release palm & finger tendon","code_information":[{"code":"26442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1635.4,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1635.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release hand/finger tendon","code_information":[{"code":"26445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":992.4,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":992.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release forearm/hand tendon","code_information":[{"code":"26449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1177.2,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1177.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of palm tendon","code_information":[{"code":"26450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":768.11,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":768.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":762.64,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":762.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Incise hand/finger tendon","code_information":[{"code":"26460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":746.36,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":746.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1090.16,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1090.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1072.91,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1072.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Tendon lengthening","code_information":[{"code":"26476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1059.29,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1059.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Tendon shortening","code_information":[{"code":"26477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1035.67,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1035.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of hand tendon","code_information":[{"code":"26478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1087.0,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1087.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shortening of hand tendon","code_information":[{"code":"26479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1113.22,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1113.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Transplant hand tendon","code_information":[{"code":"26480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1195.8,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1195.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Transplant/graft hand tendon","code_information":[{"code":"26483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1432.01,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1432.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Transplant palm tendon","code_information":[{"code":"26485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1375.86,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1375.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Transplant/graft palm tendon","code_information":[{"code":"26489","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1583.56,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1583.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise thumb tendon","code_information":[{"code":"26490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1383.95,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1383.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Tendon transfer with graft","code_information":[{"code":"26492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1529.86,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1529.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon/muscle transfer","code_information":[{"code":"26494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1389.41,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1389.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise thumb tendon","code_information":[{"code":"26496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.54,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Finger tendon transfer","code_information":[{"code":"26497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1491.88,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1491.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Finger tendon transfer","code_information":[{"code":"26498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1941.8,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1941.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of finger","code_information":[{"code":"26499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1437.87,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1437.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1133.41,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1244.55,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1244.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release thumb contracture","code_information":[{"code":"26508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1112.82,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1112.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Thumb tendon transfer","code_information":[{"code":"26510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1056.43,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1056.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joint","code_information":[{"code":"26516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1228.05,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1228.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joints","code_information":[{"code":"26517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1429.68,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1429.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joints","code_information":[{"code":"26518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1446.63,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1446.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Release knuckle contracture","code_information":[{"code":"26520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1116.54,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1116.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release finger contracture","code_information":[{"code":"26525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1124.68,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1124.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Revise knuckle joint","code_information":[{"code":"26530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.38,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise knuckle with implant","code_information":[{"code":"26531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1063.6,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1063.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint","code_information":[{"code":"26535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":745.1,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":745.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise/implant finger joint","code_information":[{"code":"26536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1234.16,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1234.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint","code_information":[{"code":"26540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.47,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1154.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1381.19,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1381.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1192.1,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1192.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct finger joint","code_information":[{"code":"26545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1209.03,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1209.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair nonunion hand","code_information":[{"code":"26546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1725.93,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1725.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct finger joint","code_information":[{"code":"26548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1321.21,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1321.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Construct thumb replacement","code_information":[{"code":"26550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2710.36,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2710.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision/fixation of femur","code_information":[{"code":"27165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2262.98,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft femur head/neck","code_information":[{"code":"27170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1935.73,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1935.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1112.65,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1112.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1533.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1533.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1849.91,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1849.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1533.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1533.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise head/neck of femur","code_information":[{"code":"27179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1624.98,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1624.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1857.56,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1857.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of femur epiphysis","code_information":[{"code":"27185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1200.68,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1200.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce hip bones","code_information":[{"code":"27187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1653.9,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1653.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Clsd tx pelvic ring fx","code_information":[{"code":"27197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.29,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Clsd tx pelvic ring fx","code_information":[{"code":"27198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":522.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat tail bone fracture","code_information":[{"code":"27200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":330.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat tail bone fracture","code_information":[{"code":"27202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":882.32,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":882.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat pelvic fracture(s)","code_information":[{"code":"27215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":994.19,"maximum":994.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":994.19}]}]},{"description":"Treat pelvic ring fracture","code_information":[{"code":"27216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1470.72,"maximum":1470.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1470.72}]}]},{"description":"Treat pelvic ring fracture","code_information":[{"code":"27217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1381.6,"maximum":1381.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1381.6}]}]},{"description":"Treat pelvic ring fracture","code_information":[{"code":"27218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1895.64,"maximum":1895.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1895.64}]}]},{"description":"Treat hip socket fracture","code_information":[{"code":"27220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":692.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip socket fracture","code_information":[{"code":"27222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1628.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1628.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip wall fracture","code_information":[{"code":"27226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1743.42,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1743.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip fracture(s)","code_information":[{"code":"27227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2722.35,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2722.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip fracture(s)","code_information":[{"code":"27228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3089.56,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3089.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":806.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1210.72,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1210.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1505.35,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1505.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1973.83,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1973.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.48,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1586.9,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1586.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2030.98,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2030.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2028.31,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2028.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1236.97,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1236.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":293.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1240.31,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1240.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1558.64,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1558.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2101.2,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2101.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":397.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":598.9,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":598.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.28,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2548.35,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2548.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":707.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":972.6,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":972.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Cltx thigh fx","code_information":[{"code":"27267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":740.59,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":740.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Cltx thigh fx w/mnpj","code_information":[{"code":"27268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":915.3,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":915.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Optx thigh fx","code_information":[{"code":"27269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2049.1,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2049.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Manipulation of hip joint","code_information":[{"code":"27275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.06,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":309.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Arthrd si jt prq wo tfxj dev","code_information":[{"code":"27278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":784.63,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":784.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Arthrodesis sacroiliac joint","code_information":[{"code":"27279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1330.3,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of sacroiliac joint","code_information":[{"code":"27280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2256.2,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2256.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of pubic bones","code_information":[{"code":"27282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1431.56,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1431.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hip joint","code_information":[{"code":"27284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2639.71,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2639.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hip joint","code_information":[{"code":"27286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2707.0,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2707.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of leg at hip","code_information":[{"code":"27290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2678.49,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2678.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of leg at hip","code_information":[{"code":"27295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2068.64,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2068.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Drain thigh/knee lesion","code_information":[{"code":"27301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":849.99,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":849.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"27303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1072.71,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1072.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incise thigh tendon & fascia","code_information":[{"code":"27305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":812.45,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":812.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendon","code_information":[{"code":"27306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":576.97,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":576.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":688.51,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":688.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of knee joint","code_information":[{"code":"27310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1223.6,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1223.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":290.96,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":290.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":689.13,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":689.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Neurectomy hamstring","code_information":[{"code":"27325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.35,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Neurectomy popliteal","code_information":[{"code":"27326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":879.2,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":879.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee les sc < 3 cm","code_information":[{"code":"27327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":526.06,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":526.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of thigh muscle","code_information":[{"code":"27386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1423.23,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1423.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendon","code_information":[{"code":"27390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.56,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":972.43,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":972.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1193.01,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1193.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendon","code_information":[{"code":"27393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":843.66,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":843.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendons","code_information":[{"code":"27394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1097.73,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1097.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendons","code_information":[{"code":"27395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1468.6,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1468.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Transplant of thigh tendon","code_information":[{"code":"27396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.25,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Transplants of thigh tendons","code_information":[{"code":"27397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1525.7,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1525.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise thigh muscles/tendons","code_information":[{"code":"27400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1164.68,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1164.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee cartilage","code_information":[{"code":"27403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1080.88,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1080.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligament","code_information":[{"code":"27405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1130.0,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1130.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligament","code_information":[{"code":"27407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1331.28,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1331.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligaments","code_information":[{"code":"27409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1607.01,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1607.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Autochondrocyte implant knee","code_information":[{"code":"27412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2721.42,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2721.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral knee allograft","code_information":[{"code":"27415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2273.01,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2273.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral knee autograft","code_information":[{"code":"27416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1628.88,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1628.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair degenerated kneecap","code_information":[{"code":"27418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1360.41,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1360.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of unstable kneecap","code_information":[{"code":"27420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1246.55,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1246.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of unstable kneecap","code_information":[{"code":"27422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1241.61,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1241.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision/removal of kneecap","code_information":[{"code":"27424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1251.81,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1251.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Lat retinacular release open","code_information":[{"code":"27425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":766.51,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1181.97,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1181.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.39,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2095.13,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2095.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of thigh muscles","code_information":[{"code":"27430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.76,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1237.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of knee joint","code_information":[{"code":"27435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1347.14,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1347.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise kneecap","code_information":[{"code":"27437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1105.99,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1105.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise kneecap with implant","code_information":[{"code":"27438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1400.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1400.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1330.87,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1373.37,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1373.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1450.79,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1450.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1360.85,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1360.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2073.95,"maximum":2073.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2073.95}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1898.71,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1898.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Total knee arthroplasty","code_information":[{"code":"27447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2117.25,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2117.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh","code_information":[{"code":"27448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1379.38,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1379.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh","code_information":[{"code":"27450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1669.9,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1669.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of thigh bone","code_information":[{"code":"27454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2139.81,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of knee","code_information":[{"code":"27455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1593.78,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1593.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of knee","code_information":[{"code":"27457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1584.42,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1584.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Shortening of thigh bone","code_information":[{"code":"27465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2063.62,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2063.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh bone","code_information":[{"code":"27466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1961.65,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1961.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Shorten/lengthen thighs","code_information":[{"code":"27468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2216.59,"maximum":2216.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2216.59}]}]},{"description":"Repair of thigh","code_information":[{"code":"27470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1954.0,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1954.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of thigh","code_information":[{"code":"27472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2091.9,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2091.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1109.77,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1109.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1225.72,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1225.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1526.51,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1526.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1124.96,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1124.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise/replace knee joint","code_information":[{"code":"27486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2319.66,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2319.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise/replace knee joint","code_information":[{"code":"27487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2886.33,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2886.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee prosthesis","code_information":[{"code":"27488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1987.3,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1987.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce thigh","code_information":[{"code":"27495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1871.31,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1871.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":924.38,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":924.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":973.1,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":973.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1102.52,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1102.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1173.97,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1173.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":837.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1253.97,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1253.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1333.73,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1333.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2213.84,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2213.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1601.94,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1126.82,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1126.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1135.03,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1135.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1642.95,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1642.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2033.1,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2033.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1596.58,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1596.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1159.09,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1159.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1473.86,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1473.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap fracture","code_information":[{"code":"27520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":518.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap fracture","code_information":[{"code":"27524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1256.85,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1256.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":497.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":976.79,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.24,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1483.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1967.17,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1967.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture(s)","code_information":[{"code":"27538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1358.1,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1358.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":796.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1065.52,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1065.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1448.34,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1448.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1722.95,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1722.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1958.31,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1958.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":582.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":830.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1485.07,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1485.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of knee joint","code_information":[{"code":"27570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":259.43,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":259.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee cyst","code_information":[{"code":"27347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":887.0,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":887.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kneecap","code_information":[{"code":"27350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1095.57,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1095.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion","code_information":[{"code":"27355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1022.01,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1022.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/graft","code_information":[{"code":"27356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.12,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1237.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/graft","code_information":[{"code":"27357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1360.25,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1360.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/fixation","code_information":[{"code":"27358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":446.78,"maximum":446.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":446.78}]}]},{"description":"Partial removal leg bone(s)","code_information":[{"code":"27360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1494.83,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1494.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect thigh/knee tum 5 cm/>","code_information":[{"code":"27364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2578.9,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2578.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect femur/knee tumor","code_information":[{"code":"27365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3377.64,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3377.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Njx cntrst kne arthg/ct/mri","code_information":[{"code":"27369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.55,"maximum":65.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.55}]}]},{"description":"Removal of foreign body","code_information":[{"code":"27372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":671.5,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":671.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair of kneecap tendon","code_information":[{"code":"27380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1036.51,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1036.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft kneecap tendon","code_information":[{"code":"27381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1363.96,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1363.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of thigh muscle","code_information":[{"code":"27385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.33,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg bone lesion","code_information":[{"code":"27607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":994.02,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":994.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat ankle joint","code_information":[{"code":"27610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1075.11,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1075.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of ankle joint","code_information":[{"code":"27612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":959.03,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":959.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.09,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":687.08,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":687.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect leg/ankle tum < 5 cm","code_information":[{"code":"27615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1671.09,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1671.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect leg/ankle tum 5 cm/>","code_information":[{"code":"27616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2057.38,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2057.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum < 3 cm","code_information":[{"code":"27618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":510.54,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":510.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum deep <5 cm","code_information":[{"code":"27619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":776.46,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat ankle joint","code_information":[{"code":"27620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":751.3,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":751.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove ankle joint lining","code_information":[{"code":"27625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.18,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":950.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove ankle joint lining","code_information":[{"code":"27626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1019.83,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1019.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Application of figure eight","code_information":[{"code":"29049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.46,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tendon lesion","code_information":[{"code":"27630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":601.07,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle les sc 3 cm/>","code_information":[{"code":"27632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":681.54,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":681.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum dep 5 cm/>","code_information":[{"code":"27634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1111.63,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Remove lower leg bone lesion","code_information":[{"code":"27635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":962.44,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":962.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft leg bone lesion","code_information":[{"code":"27637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1250.07,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1250.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft leg bone lesion","code_information":[{"code":"27638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1240.54,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1240.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of tibia","code_information":[{"code":"27640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1373.46,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1373.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of fibula","code_information":[{"code":"27641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1092.21,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1092.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect tibia tumor","code_information":[{"code":"27645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2911.23,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2911.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect fibula tumor","code_information":[{"code":"27646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2532.58,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2532.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect talus/calcaneus tum","code_information":[{"code":"27647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1640.33,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1640.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Injection for ankle x-ray","code_information":[{"code":"27648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":84.05,"maximum":84.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84.05}]}]},{"description":"Repair achilles tendon","code_information":[{"code":"27650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1098.47,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1098.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft achilles tendon","code_information":[{"code":"27652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1108.75,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1108.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of achilles tendon","code_information":[{"code":"27654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1195.34,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1195.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair leg fascia defect","code_information":[{"code":"27656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":565.34,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":565.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":620.16,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":787.44,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.06,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":696.22,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":696.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg tendons","code_information":[{"code":"27675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":828.67,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":828.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg tendons","code_information":[{"code":"27676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1017.09,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1017.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Release of lower leg tendon","code_information":[{"code":"27680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.37,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release of lower leg tendons","code_information":[{"code":"27681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":850.33,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":850.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower leg tendon","code_information":[{"code":"27685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":777.42,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendons","code_information":[{"code":"27686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":884.63,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":884.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of calf tendon","code_information":[{"code":"27687","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.21,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendon","code_information":[{"code":"27690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1066.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1066.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendon","code_information":[{"code":"27691","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1238.31,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1238.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise additional leg tendon","code_information":[{"code":"27692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.45,"maximum":167.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.45}]}]},{"description":"Repair of ankle ligament","code_information":[{"code":"27695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":812.36,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":812.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligaments","code_information":[{"code":"27696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":913.17,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":913.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligament","code_information":[{"code":"27698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1061.84,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1061.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ankle joint","code_information":[{"code":"27700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1188.13,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1188.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct ankle joint","code_information":[{"code":"27702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1592.94,"maximum":141540.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30259.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45389.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1592.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30865.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":126005.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141540.83,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction ankle joint","code_information":[{"code":"27703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1842.46,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1842.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle implant","code_information":[{"code":"27704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":941.7,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":941.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tibia","code_information":[{"code":"27705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1236.02,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1236.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of fibula","code_information":[{"code":"27707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":680.8,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":680.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tibia & fibula","code_information":[{"code":"27709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1887.26,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1887.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of lower leg","code_information":[{"code":"27712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1828.69,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1828.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower leg","code_information":[{"code":"27715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1776.48,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1776.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair of tibia","code_information":[{"code":"27720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1451.6,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of tibia","code_information":[{"code":"27722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1489.81,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1489.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of tibia","code_information":[{"code":"27724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2069.49,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2069.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of lower leg","code_information":[{"code":"27725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2017.03,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2017.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair fibula nonunion","code_information":[{"code":"27726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1588.73,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1588.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of lower leg","code_information":[{"code":"27727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.09,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of tibia epiphysis","code_information":[{"code":"27730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":986.62,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of fibula epiphysis","code_information":[{"code":"27732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":765.42,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg epiphyses","code_information":[{"code":"27734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1101.56,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1101.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg epiphyses","code_information":[{"code":"27740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1183.77,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1183.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg epiphyses","code_information":[{"code":"27742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1297.6,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1297.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce tibia","code_information":[{"code":"27745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1220.96,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1220.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":553.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27752","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":827.1,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":827.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.57,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27758","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1490.54,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1490.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1654.57,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1654.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Cltx medial ankle fx","code_information":[{"code":"27760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":529.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Cltx med ankle fx w/mnpj","code_information":[{"code":"27762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":743.26,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":743.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Optx medial ankle fx","code_information":[{"code":"27766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1012.54,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1012.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Cltx post ankle fx","code_information":[{"code":"27767","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":502.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Cltx post ankle fx w/mnpj","code_information":[{"code":"27768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":762.07,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":762.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Optx post ankle fx","code_information":[{"code":"27769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1210.32,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1210.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":491.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":687.61,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":687.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1184.61,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1184.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":491.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1073.26,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1073.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":525.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":726.93,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":726.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1270.32,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1270.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":505.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.67,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1444.65,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1444.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1627.27,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1627.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":524.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":834.4,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":834.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1412.33,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1412.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1854.49,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1854.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2187.15,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2187.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg joint","code_information":[{"code":"27829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1170.31,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1170.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":696.23,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":696.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1268.59,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1268.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":657.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":828.97,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":828.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1205.2,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1205.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1322.04,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1322.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of ankle joint","code_information":[{"code":"27860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":273.11,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of ankle joint open","code_information":[{"code":"27870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.56,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tibiofibular joint","code_information":[{"code":"27871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1146.69,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1146.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1464.53,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1464.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1355.65,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1355.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":966.17,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":951.86,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":951.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1064.55,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1064.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of foot at ankle","code_information":[{"code":"27888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":935.82,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":935.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of foot at ankle","code_information":[{"code":"27889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1049.12,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1049.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":898.95,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":898.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1029.56,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1029.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1355.08,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1355.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bursa of foot","code_information":[{"code":"28001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.65,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of foot infection","code_information":[{"code":"28002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":230.32,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of foot infection","code_information":[{"code":"28003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.74,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot bone lesion","code_information":[{"code":"28005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":948.04,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":948.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot fascia","code_information":[{"code":"28008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":491.34,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":491.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":348.69,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":348.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendons","code_information":[{"code":"28011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":468.34,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":468.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of foot joint","code_information":[{"code":"28020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":602.92,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":602.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of foot joint","code_information":[{"code":"28022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":546.08,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":546.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of toe joint","code_information":[{"code":"28024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.76,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":518.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of tibia nerve","code_information":[{"code":"28035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":604.16,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":604.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum sc 1.5 cm/>","code_information":[{"code":"28039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":558.41,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":558.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum dep 1.5cm/>","code_information":[{"code":"28041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.62,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum sc < 1.5 cm","code_information":[{"code":"28043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":433.88,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":433.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum deep <1.5cm","code_information":[{"code":"28045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":581.35,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":581.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect foot/toe tumor < 3 cm","code_information":[{"code":"28046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1171.92,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1171.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Resect foot/toe tumor 3 cm/>","code_information":[{"code":"28047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1716.84,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1716.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of foot joint lining","code_information":[{"code":"28050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":465.27,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":465.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of foot joint lining","code_information":[{"code":"28052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":425.5,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of toe joint lining","code_information":[{"code":"28054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":391.48,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":391.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Neurectomy foot","code_information":[{"code":"28055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":648.03,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":648.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal foot fascia","code_information":[{"code":"28060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.59,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":599.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot fascia","code_information":[{"code":"28062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.83,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":679.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot joint lining","code_information":[{"code":"28070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":576.71,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":576.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot joint lining","code_information":[{"code":"28072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":543.2,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":543.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":637.74,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":637.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Excise foot tendon sheath","code_information":[{"code":"28086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.0,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":579.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Excise foot tendon sheath","code_information":[{"code":"28088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.22,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.54,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":515.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe lesions","code_information":[{"code":"28092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":455.41,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":455.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle/heel lesion","code_information":[{"code":"28100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.25,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1025.2,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1025.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":643.79,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":643.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":594.49,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":594.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.25,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.93,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe lesions","code_information":[{"code":"28108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":482.96,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":493.05,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":493.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":530.13,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":530.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":523.18,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":523.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.12,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of metatarsal heads","code_information":[{"code":"28114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1395.57,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1395.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot","code_information":[{"code":"28116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":865.8,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":865.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of heel bone","code_information":[{"code":"28118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":707.67,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":707.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of heel spur","code_information":[{"code":"28119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":607.37,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":607.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of ankle/heel","code_information":[{"code":"28120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":823.5,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":823.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":731.83,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":731.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":559.89,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":559.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.23,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle bone","code_information":[{"code":"28130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1043.81,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1043.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal of metatarsal","code_information":[{"code":"28140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":703.03,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":703.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe","code_information":[{"code":"28150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.58,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":439.26,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":446.3,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":446.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect tarsal tumor","code_information":[{"code":"28171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1832.18,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1832.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect metatarsal tumor","code_information":[{"code":"28173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1197.04,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1197.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect phalanx of toe tumor","code_information":[{"code":"28175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":778.42,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":778.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.39,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.47,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":518.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":606.23,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":606.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":545.42,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":545.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":718.0,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":718.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":534.37,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":534.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.53,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":508.11,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":615.58,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":615.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.47,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":443.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":671.3,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":671.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot tendon(s)","code_information":[{"code":"28230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":476.46,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":476.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":401.69,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":401.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot tendon","code_information":[{"code":"28234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":452.53,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":452.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":805.29,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Release of big toe","code_information":[{"code":"28240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":490.57,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":490.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot fascia","code_information":[{"code":"28250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":689.64,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":689.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":892.64,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":892.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1413.37,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1413.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot and ankle","code_information":[{"code":"28262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1844.94,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1844.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1142.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1142.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot contracture","code_information":[{"code":"28270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":558.7,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":558.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Release of toe joint each","code_information":[{"code":"28272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":418.33,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":418.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of toes","code_information":[{"code":"28280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.17,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":648.05,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":648.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.59,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":724.79,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":724.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Corrj halux rigdus w/o implt","code_information":[{"code":"28289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":770.23,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":770.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Corrj halux rigdus w/implt","code_information":[{"code":"28291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.63,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":811.03,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":811.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":994.86,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":994.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":857.75,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":857.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":994.69,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":994.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":842.92,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":842.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":991.5,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":991.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of heel bone","code_information":[{"code":"28300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1083.43,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1083.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of ankle bone","code_information":[{"code":"28302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1195.79,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1195.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of midfoot bones","code_information":[{"code":"28304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1023.42,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1023.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incise/graft midfoot bones","code_information":[{"code":"28305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1117.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1117.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":677.76,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":677.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":868.37,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":868.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":647.26,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":647.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsals","code_information":[{"code":"28309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1501.5,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1501.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of big toe","code_information":[{"code":"28310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":611.58,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":611.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revision of toe","code_information":[{"code":"28312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":592.78,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":592.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair deformity of toe","code_information":[{"code":"28313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":607.82,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":607.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Removal of sesamoid bone","code_information":[{"code":"28315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":544.65,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":544.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knee","code_information":[{"code":"27580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2431.87,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2431.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1276.04,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1276.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1601.11,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1601.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1105.51,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1105.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":834.23,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":834.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1165.35,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1165.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputate lower leg at knee","code_information":[{"code":"27598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1142.02,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1142.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":663.74,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":663.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.5,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":779.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":779.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Drain lower leg lesion","code_information":[{"code":"27603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":644.84,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":644.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Drain lower leg bursa","code_information":[{"code":"27604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":553.32,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":553.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Incision of achilles tendon","code_information":[{"code":"27605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.08,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":304.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Incision of achilles tendon","code_information":[{"code":"27606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.34,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation toe & metatarsal","code_information":[{"code":"28810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":696.99,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":696.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of toe","code_information":[{"code":"28820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.35,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":291.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial amputation of toe","code_information":[{"code":"28825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":284.25,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Hi enrgy eswt plantar fascia","code_information":[{"code":"28890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":369.68,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":369.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.91,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":330.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.71,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.41,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.43,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":289.97,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":289.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":181.22,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":279.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.91,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":313.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of shoulder cast","code_information":[{"code":"29055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":230.15,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of shoulder cast","code_information":[{"code":"29058","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.22,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of long arm cast","code_information":[{"code":"29065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.23,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of forearm cast","code_information":[{"code":"29075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.0,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Apply hand/wrist cast","code_information":[{"code":"29085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.7,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Apply finger cast","code_information":[{"code":"29086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.79,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Apply long arm splint","code_information":[{"code":"29105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.15,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.98,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":82.29,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Application of finger splint","code_information":[{"code":"29130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.46,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Application of finger splint","code_information":[{"code":"29131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.25,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of chest","code_information":[{"code":"29200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.09,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of shoulder","code_information":[{"code":"29240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.09,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of elbow or wrist","code_information":[{"code":"29260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.66,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of hand or finger","code_information":[{"code":"29280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.27,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Application of hip cast","code_information":[{"code":"29305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.45,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of hip casts","code_information":[{"code":"29325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.55,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.43,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.83,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Apply long leg cast brace","code_information":[{"code":"29358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":170.93,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":170.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.81,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.52,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.0,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.7,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Addition of walker to cast","code_information":[{"code":"29440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.44,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Apply rigid leg cast","code_information":[{"code":"29445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":161.21,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Application of leg cast","code_information":[{"code":"29450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":181.22,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Application long leg splint","code_information":[{"code":"29505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.64,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Application lower leg splint","code_information":[{"code":"29515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":82.83,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of hip","code_information":[{"code":"29520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.13,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of knee","code_information":[{"code":"29530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.59,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of ankle and/or ft","code_information":[{"code":"29540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.49,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of toes","code_information":[{"code":"29550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.09,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Application of paste boot","code_information":[{"code":"29580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.68,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Apply multlay comprs lwr leg","code_information":[{"code":"29581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.39,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Appl multlay comprs arm/hand","code_information":[{"code":"29584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.78,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.51,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.15,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.63,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Repair of body cast","code_information":[{"code":"29720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.39,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Windowing of cast","code_information":[{"code":"29730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.07,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Wedging of cast","code_information":[{"code":"29740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.78,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Wedging of clubfoot cast","code_information":[{"code":"29750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.39,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Jaw arthroscopy/surgery","code_information":[{"code":"29800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":889.72,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":889.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Jaw arthroscopy/surgery","code_information":[{"code":"29804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":984.47,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":984.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy dx","code_information":[{"code":"29805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":788.61,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":788.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1754.28,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1754.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1713.41,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1713.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":979.74,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":979.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":894.45,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":894.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":992.79,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":992.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":906.71,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":906.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":989.1,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":989.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1130.51,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1130.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":980.31,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":980.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":280.68,"maximum":280.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.68}]}]},{"description":"Arthroscop rotator cuff repr","code_information":[{"code":"29827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1768.18,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1768.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Arthroscopy biceps tenodesis","code_information":[{"code":"29828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1519.18,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1519.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy","code_information":[{"code":"29830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":769.4,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":769.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":829.47,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":829.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":855.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":855.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":981.38,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":981.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.58,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":871.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":995.02,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":995.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy","code_information":[{"code":"29840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":766.09,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":818.36,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.45,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":981.98,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":981.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":876.99,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":876.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":911.59,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":911.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Wrist endoscopy/surgery","code_information":[{"code":"29848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":862.61,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":862.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1045.96,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1045.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1546.55,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1546.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Tibial arthroscopy/surgery","code_information":[{"code":"29855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1300.51,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1300.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Tibial arthroscopy/surgery","code_information":[{"code":"29856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1649.0,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1649.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthroscopy dx","code_information":[{"code":"29860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1099.68,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1099.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/fb removal","code_information":[{"code":"29861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1157.28,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1157.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthr0 w/debridement","code_information":[{"code":"29862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1350.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1350.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthr0 w/synovectomy","code_information":[{"code":"29863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1357.11,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1357.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Autgrft implnt knee w/scope","code_information":[{"code":"29866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1750.57,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1750.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Allgrft implnt knee w/scope","code_information":[{"code":"29867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2120.46,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2120.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Meniscal trnspl knee w/scpe","code_information":[{"code":"29868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2754.7,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2754.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy dx","code_information":[{"code":"29870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":694.4,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":694.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/drainage","code_information":[{"code":"29871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":863.65,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":863.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":901.43,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":901.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":895.98,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":895.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":831.57,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":831.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1090.28,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1090.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.46,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1104.96,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1104.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":939.39,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":939.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":905.62,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":905.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1147.67,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1147.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1395.34,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1395.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1035.27,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1035.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.73,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1263.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1066.69,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1066.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1258.83,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1258.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1612.03,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1612.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2032.75,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2032.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1123.51,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1123.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1067.88,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1067.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Scope plantar fasciotomy","code_information":[{"code":"29893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":733.95,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":733.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":842.9,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":842.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":765.23,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.28,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":820.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":931.73,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":931.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1652.4,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1652.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy dx","code_information":[{"code":"29900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":850.21,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":850.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy surg","code_information":[{"code":"29901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":910.17,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":910.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy surg","code_information":[{"code":"29902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":964.13,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":964.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/fb rmvl","code_information":[{"code":"29904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1072.16,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1072.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/exc","code_information":[{"code":"29905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":854.46,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":854.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/deb","code_information":[{"code":"29906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1108.85,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1108.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/fusion","code_information":[{"code":"29907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1460.48,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1460.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/femoroplasty","code_information":[{"code":"29914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1649.59,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1649.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro acetabuloplasty","code_information":[{"code":"29915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1681.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1681.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/labral repair","code_information":[{"code":"29916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1683.35,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1683.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of nose lesion","code_information":[{"code":"30000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.04,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of nose lesion","code_information":[{"code":"30020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.61,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Intranasal biopsy","code_information":[{"code":"30100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.37,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose polyp(s)","code_information":[{"code":"30110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":220.63,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose polyp(s)","code_information":[{"code":"30115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":762.38,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":762.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of intranasal lesion","code_information":[{"code":"30117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.59,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of intranasal lesion","code_information":[{"code":"30118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.73,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1154.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":694.01,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":694.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose lesion","code_information":[{"code":"30124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":501.29,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose lesion","code_information":[{"code":"30125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1065.05,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1065.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excise inferior turbinate","code_information":[{"code":"30130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":680.99,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":680.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Resect inferior turbinate","code_information":[{"code":"30140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":292.96,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":292.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of nose","code_information":[{"code":"30150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.12,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose","code_information":[{"code":"30160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1330.66,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nose","code_information":[{"code":"30200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.68,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Nasal sinus therapy","code_information":[{"code":"30210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":170.95,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":170.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":338.48,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":338.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.84,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":798.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of nose","code_information":[{"code":"30400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2002.14,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2002.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of nose","code_information":[{"code":"30410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2307.92,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2307.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of nose","code_information":[{"code":"30420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2355.82,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2355.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1747.56,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1747.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2859.51,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2859.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1361.39,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2611.46,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2611.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair Nasal Stenosis","code_information":[{"code":"30465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1674.23,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1674.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Rpr nsl vlv collapse w/implt","code_information":[{"code":"30468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":277.68,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Rpr nsl vlv collapse w/rmdlg","code_information":[{"code":"30469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.0,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair of nasal septum","code_information":[{"code":"30520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1100.08,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1100.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair nasal defect","code_information":[{"code":"30540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1207.44,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1207.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair nasal defect","code_information":[{"code":"30545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1635.31,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1635.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Release of nasal adhesions","code_information":[{"code":"30560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.95,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Repair upper jaw fistula","code_information":[{"code":"30580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":767.18,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":767.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair mouth/nose fistula","code_information":[{"code":"30600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":645.84,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":645.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Intranasal reconstruction","code_information":[{"code":"30620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1093.11,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1093.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair nasal septum defect","code_information":[{"code":"30630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1092.09,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1092.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Ablate inf turbinate superf","code_information":[{"code":"30801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":245.26,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot bones","code_information":[{"code":"28320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1023.85,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1023.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair of metatarsals","code_information":[{"code":"28322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":960.43,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":960.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Resect enlarged toe tissue","code_information":[{"code":"28340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":678.3,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Resect enlarged toe","code_information":[{"code":"28341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":806.36,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":806.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair extra toe(s)","code_information":[{"code":"28344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":465.84,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":465.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair webbed toe(s)","code_information":[{"code":"28345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":603.16,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":603.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft foot","code_information":[{"code":"28360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1825.56,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1825.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":392.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":691.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":988.24,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":988.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat heel fracture","code_information":[{"code":"28415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1855.29,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1855.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat/graft heel fracture","code_information":[{"code":"28420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2145.59,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2145.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":360.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":561.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":561.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":831.88,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":831.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle fracture","code_information":[{"code":"28445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1733.38,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1733.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral talus autogrft","code_information":[{"code":"28446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2029.58,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2029.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":386.91,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":386.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture","code_information":[{"code":"28456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.2,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":622.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1072.35,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1072.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":654.9,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":654.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":936.82,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":936.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.84,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.02,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":464.22,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":464.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":825.85,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":825.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of toe fracture","code_information":[{"code":"28510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.8,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":206.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of toe fracture","code_information":[{"code":"28515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.02,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe fracture","code_information":[{"code":"28525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":671.76,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":671.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat sesamoid bone fracture","code_information":[{"code":"28530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.97,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat sesamoid bone fracture","code_information":[{"code":"28531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.49,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":304.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":464.82,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":464.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":598.0,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":598.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1081.45,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1081.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.19,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":660.95,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":660.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.54,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1187.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":524.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":669.68,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":669.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1375.6,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1375.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.38,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.25,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.84,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair toe dislocation","code_information":[{"code":"28645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":810.79,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":810.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.38,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.66,"maximum":1458.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1458.97,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":288.3,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of toe dislocation","code_information":[{"code":"28675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":690.04,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2016.11,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2016.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1562.85,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1562.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1293.01,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1293.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1203.6,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1203.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1293.5,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1293.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot bones","code_information":[{"code":"28737","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1138.72,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1138.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1021.92,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1021.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":954.32,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":954.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":561.19,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":561.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.53,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of midfoot","code_information":[{"code":"28800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":872.98,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":872.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Amputation thru metatarsal","code_information":[{"code":"28805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1162.21,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1162.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3420.77,"maximum":3420.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3420.77}]}]},{"description":"Removal of larynx & pharynx","code_information":[{"code":"31390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4566.72,"maximum":4566.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4566.72}]}]},{"description":"Reconstruct larynx & pharynx","code_information":[{"code":"31395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4785.95,"maximum":4785.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4785.95}]}]},{"description":"Revision of larynx","code_information":[{"code":"31400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1667.32,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1667.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of epiglottis","code_information":[{"code":"31420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1368.43,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1368.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Insert emergency airway","code_information":[{"code":"31500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.08,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Change of windpipe airway","code_information":[{"code":"31502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.27,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic laryngoscopy","code_information":[{"code":"31505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.74,"maximum":1041.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":333.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":926.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1041.22,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":199.61,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body larynx","code_information":[{"code":"31511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.84,"maximum":1041.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":333.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":926.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1041.22,"additional_payer_notes":"APC"}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":212.2,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":212.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy for aspiration","code_information":[{"code":"31515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.71,"maximum":2040.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":654.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1816.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2040.22,"additional_payer_notes":"APC"}]}]},{"description":"Dx laryngoscopy newborn","code_information":[{"code":"31520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.88,"maximum":2040.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":654.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1816.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2040.22,"additional_payer_notes":"APC"}]}]},{"description":"Dx laryngoscopy excl nb","code_information":[{"code":"31525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.38,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Dx laryngoscopy w/oper scope","code_information":[{"code":"31526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.99,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.74,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/fb removal","code_information":[{"code":"31530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.12,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":325.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/fb & op scope","code_information":[{"code":"31531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":344.3,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":344.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/biopsy","code_information":[{"code":"31535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.38,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/bx & op scope","code_information":[{"code":"31536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":343.19,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/exc of tumor","code_information":[{"code":"31540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.94,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Larynscop w/tumr exc + scope","code_information":[{"code":"31541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.9,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":428.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Remove vc lesion w/scope","code_information":[{"code":"31545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":588.33,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":588.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Remove vc lesion scope/graft","code_information":[{"code":"31546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":891.83,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2535.93,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2535.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.55,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2448.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2748.85,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2748.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty laryngeal sten","code_information":[{"code":"31554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2749.94,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2749.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscop w/arytenoidectom","code_information":[{"code":"31560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":509.12,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":509.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Larynscop remve cart + scop","code_information":[{"code":"31561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":555.05,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":555.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscope w/vc inj","code_information":[{"code":"31570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.72,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscop w/vc inj + scope","code_information":[{"code":"31571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":406.48,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":406.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/laser dstrj les","code_information":[{"code":"31572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.22,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/ther injection","code_information":[{"code":"31573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.83,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/njx augmentation","code_information":[{"code":"31574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.9,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic laryngoscopy","code_information":[{"code":"31575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.85,"maximum":1041.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":333.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":926.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1041.22,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.87,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/removal lesion","code_information":[{"code":"31578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.9,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy telescopic","code_information":[{"code":"31579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.92,"maximum":2040.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":654.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1816.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2040.22,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty laryngeal web","code_information":[{"code":"31580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2099.08,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2099.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty fx rdctj fixj","code_information":[{"code":"31584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2305.35,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2305.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty cricoid split","code_information":[{"code":"31587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1987.24,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1987.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoplasty medialization","code_information":[{"code":"31591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1813.24,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1813.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Cricotracheal resection","code_information":[{"code":"31592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2846.03,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2846.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":495.12,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":495.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":733.53,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":733.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.82,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":518.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":538.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1562.0,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1562.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Surgery/speech prosthesis","code_information":[{"code":"31611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":879.87,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":879.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Puncture/clear windpipe","code_information":[{"code":"31612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.12,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair windpipe opening","code_information":[{"code":"31613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":691.27,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":691.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Visualization of windpipe","code_information":[{"code":"31615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":189.83,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":189.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/wash","code_information":[{"code":"31622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.17,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/brush","code_information":[{"code":"31623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":212.32,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":212.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/lavage","code_information":[{"code":"31624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.55,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/biopsy(s)","code_information":[{"code":"31625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.57,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":250.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/markers","code_information":[{"code":"31626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":319.19,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Navigational bronchoscopy","code_information":[{"code":"31627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":154.31,"maximum":154.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":154.31}]}]},{"description":"Bronchoscopy/lung bx each","code_information":[{"code":"31628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":281.89,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":281.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy/needle bx each","code_information":[{"code":"31629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.36,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy dilate/fx repr","code_information":[{"code":"31630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":319.67,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy dilate w/stent","code_information":[{"code":"31631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.56,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy/lung bx addl","code_information":[{"code":"31632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.77,"maximum":77.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.77}]}]},{"description":"Bronchoscopy/needle bx addl","code_information":[{"code":"31633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.25,"maximum":101.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.25}]}]},{"description":"Bronch w/balloon occlusion","code_information":[{"code":"31634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":303.56,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":303.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/fb removal","code_information":[{"code":"31635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.15,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy bronch stents","code_information":[{"code":"31636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":349.94,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy stent add-on","code_information":[{"code":"31637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.03,"maximum":122.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.03}]}]},{"description":"Bronchoscopy revise stent","code_information":[{"code":"31638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.96,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":395.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/tumor excise","code_information":[{"code":"31640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.07,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy treat blockage","code_information":[{"code":"31641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":405.88,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":405.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Diag bronchoscope/catheter","code_information":[{"code":"31643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":272.64,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":272.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy clear airways","code_information":[{"code":"31645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.83,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy reclear airway","code_information":[{"code":"31646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.7,"maximum":2040.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":654.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1816.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2040.22,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve init insert","code_information":[{"code":"31647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.97,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve remov init","code_information":[{"code":"31648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":316.29,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":316.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve remov addl","code_information":[{"code":"31649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.13,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve addl insert","code_information":[{"code":"31651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.49,"maximum":121.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.49}]}]},{"description":"Bronch ebus samplng 1/2 node","code_information":[{"code":"31652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":354.52,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":354.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Bronch ebus samplng 3/> node","code_information":[{"code":"31653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":392.82,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":392.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Bronch ebus ivntj perph les","code_information":[{"code":"31654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.28,"maximum":107.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.28}]}]},{"description":"Bronch thermoplsty 1 lobe","code_information":[{"code":"31660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":302.91,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Bronch thermoplsty 2/> lobes","code_information":[{"code":"31661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.93,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial brush biopsy","code_information":[{"code":"31717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":170.26,"maximum":2040.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":654.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":170.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1816.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2040.22,"additional_payer_notes":"APC"}]}]},{"description":"Clearance of airways","code_information":[{"code":"31720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.93,"maximum":1142.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":366.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1016.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1142.26,"additional_payer_notes":"APC"}]}]},{"description":"Clearance of airways","code_information":[{"code":"31725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.6,"maximum":127.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.6}]}]},{"description":"Intro windpipe wire/tube","code_information":[{"code":"31730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":242.55,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Repair of windpipe","code_information":[{"code":"31750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2206.83,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2206.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair of windpipe","code_information":[{"code":"31755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2822.09,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2822.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair of windpipe","code_information":[{"code":"31760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2227.36,"maximum":2227.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2227.36}]}]},{"description":"Reconstruction of windpipe","code_information":[{"code":"31766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2863.1,"maximum":2863.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2863.1}]}]},{"description":"Repair/graft of bronchus","code_information":[{"code":"31770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2143.35,"maximum":2143.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2143.35}]}]},{"description":"Reconstruct bronchus","code_information":[{"code":"31775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2257.58,"maximum":2257.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2257.58}]}]},{"description":"Reconstruct windpipe","code_information":[{"code":"31780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1969.33,"maximum":1969.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1969.33}]}]},{"description":"Reconstruct windpipe","code_information":[{"code":"31781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2357.32,"maximum":2357.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2357.32}]}]},{"description":"Remove windpipe lesion","code_information":[{"code":"31785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1762.4,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1762.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove windpipe lesion","code_information":[{"code":"31786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2327.78,"maximum":2327.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2327.78}]}]},{"description":"Repair of windpipe injury","code_information":[{"code":"31800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.5,"maximum":1154.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1154.5}]}]},{"description":"Repair of windpipe injury","code_information":[{"code":"31805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1330.64,"maximum":1330.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.64}]}]},{"description":"Closure of windpipe lesion","code_information":[{"code":"31820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":546.65,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":546.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair of windpipe defect","code_information":[{"code":"31825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":801.27,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":801.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Revise windpipe scar","code_information":[{"code":"31830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":606.3,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":606.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Thoracostomy w/rib resection","code_information":[{"code":"32035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1198.1,"maximum":1198.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1198.1}]}]},{"description":"Thoracostomy w/flap drainage","code_information":[{"code":"32036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1279.82,"maximum":1279.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1279.82}]}]},{"description":"Open wedge/bx lung infiltr","code_information":[{"code":"32096","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1302.83,"maximum":1302.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1302.83}]}]},{"description":"Open wedge/bx lung nodule","code_information":[{"code":"32097","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.26,"maximum":1303.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.26}]}]},{"description":"Open biopsy of lung pleura","code_information":[{"code":"32098","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1227.14,"maximum":1227.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1227.14}]}]},{"description":"Exploration of chest","code_information":[{"code":"32100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1320.74,"maximum":1320.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1320.74}]}]},{"description":"Explore/repair chest","code_information":[{"code":"32110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2403.54,"maximum":2403.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2403.54}]}]},{"description":"Re-exploration of chest","code_information":[{"code":"32120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1422.75,"maximum":1422.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1422.75}]}]},{"description":"Explore chest free adhesions","code_information":[{"code":"32124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.87,"maximum":1500.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.87}]}]},{"description":"Removal of lung lesion(s)","code_information":[{"code":"32140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1608.87,"maximum":1608.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1608.87}]}]},{"description":"Remove/treat lung lesions","code_information":[{"code":"32141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2457.77,"maximum":2457.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2457.77}]}]},{"description":"Removal of lung lesion(s)","code_information":[{"code":"32150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1653.11,"maximum":1653.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1653.11}]}]},{"description":"Ablate inf turbinate submuc","code_information":[{"code":"30802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.79,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.24,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.6,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Repeat control of nosebleed","code_information":[{"code":"30906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.01,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Ligation nasal sinus artery","code_information":[{"code":"30915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":986.48,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligation upper jaw artery","code_information":[{"code":"30920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1424.11,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1424.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ther fx nasal inf turbinate","code_information":[{"code":"30930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.47,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Irrigation maxillary sinus","code_information":[{"code":"31000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.95,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Irrigation sphenoid sinus","code_information":[{"code":"31002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":305.56,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":564.95,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":564.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":847.71,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":847.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Explore sinus remove polyps","code_information":[{"code":"31032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":977.53,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":977.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Exploration behind upper jaw","code_information":[{"code":"31040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1315.72,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1315.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Exploration sphenoid sinus","code_information":[{"code":"31050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.94,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":846.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Sphenoid sinus surgery","code_information":[{"code":"31051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1131.15,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1131.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of frontal sinus","code_information":[{"code":"31070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":778.08,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":778.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of frontal sinus","code_information":[{"code":"31075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1353.18,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1353.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1779.17,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1779.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.43,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1973.54,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1973.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2034.69,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2034.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1922.71,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1922.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of frontal sinus","code_information":[{"code":"31087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.97,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1834.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of sinuses","code_information":[{"code":"31090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1802.65,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1802.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1018.82,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1018.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1273.46,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1273.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1533.01,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1533.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of upper jaw","code_information":[{"code":"31225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2948.02,"maximum":2948.02,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2948.02}]}]},{"description":"Removal of upper jaw","code_information":[{"code":"31230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3288.14,"maximum":3288.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3288.14}]}]},{"description":"Nasal endoscopy dx","code_information":[{"code":"31231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.3,"maximum":1041.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":333.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":926.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1041.22,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy dx","code_information":[{"code":"31233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":221.49,"maximum":2040.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":654.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":221.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1816.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2040.22,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy dx","code_information":[{"code":"31235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":263.45,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":263.42,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.4,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":997.38,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":997.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.26,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":261.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc w/artery lig","code_information":[{"code":"31241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":723.77,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":723.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sinus ndsc rf abltj pnn","code_information":[{"code":"31242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":258.11,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sinus ndsc cryoabltj pnn","code_information":[{"code":"31243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":258.11,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc total","code_information":[{"code":"31253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":814.4,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":814.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ethmoid sinus","code_information":[{"code":"31254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":397.32,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":397.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":527.27,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":527.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.22,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc tot w/sphendt","code_information":[{"code":"31257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":726.51,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":726.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc sphn tiss rmvl","code_information":[{"code":"31259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":769.04,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":769.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy maxillary sinus","code_information":[{"code":"31267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":432.82,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":432.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endoscopy surgical","code_information":[{"code":"31276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":616.75,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.09,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.53,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1878.41,"maximum":1878.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.41}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2009.4,"maximum":2009.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2009.4}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1621.41,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1621.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1754.87,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1754.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2005.97,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2005.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":258.64,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.17,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":295.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":235.69,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc w/sins dilat","code_information":[{"code":"31298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.98,"maximum":36814.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11805.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8027.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32773.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36814.25,"additional_payer_notes":"APC"}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2046.72,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2046.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of larynx","code_information":[{"code":"31360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3360.72,"maximum":3360.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3360.72}]}]},{"description":"Removal of larynx","code_information":[{"code":"31365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4150.18,"maximum":4150.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4150.18}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3553.23,"maximum":3553.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3553.23}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3925.19,"maximum":3925.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3925.19}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3332.34,"maximum":3332.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3332.34}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3169.32,"maximum":3169.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3169.32}]}]},{"description":"Partial removal of larynx","code_information":[{"code":"31380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3125.1,"maximum":3125.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3125.1}]}]},{"description":"Remv&replc pm gen dual lead","code_information":[{"code":"33228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":572.65,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":572.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"Remv&replc pm gen mult leads","code_information":[{"code":"33229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.45,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Insrt pulse gen w/dual leads","code_information":[{"code":"33230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":602.7,"maximum":116030.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24806.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37209.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":602.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25302.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103295.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116030.5,"additional_payer_notes":"APC"}]}]},{"description":"Insrt pulse gen w/mult leads","code_information":[{"code":"33231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":645.7,"maximum":163735.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52507.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":645.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35705.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145764.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163735.62,"additional_payer_notes":"APC"}]}]},{"description":"Removal of pm generator","code_information":[{"code":"33233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":377.6,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":377.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Removal of pacemaker system","code_information":[{"code":"33234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":780.68,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":780.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal pacemaker electrode","code_information":[{"code":"33235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1025.59,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1025.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove electrode/thoracotomy","code_information":[{"code":"33236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1272.89,"maximum":1272.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1272.89}]}]},{"description":"Remove electrode/thoracotomy","code_information":[{"code":"33237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1363.36,"maximum":1363.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1363.36}]}]},{"description":"Remove electrode/thoracotomy","code_information":[{"code":"33238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1534.15,"maximum":1534.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1534.15}]}]},{"description":"Insrt pulse gen w/singl lead","code_information":[{"code":"33240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.31,"maximum":116030.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24806.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37209.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25302.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103295.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116030.5,"additional_payer_notes":"APC"}]}]},{"description":"Remove pulse generator","code_information":[{"code":"33241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":348.26,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":348.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove eltrd/thoracotomy","code_information":[{"code":"33243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2219.05,"maximum":2219.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2219.05}]}]},{"description":"Remove elctrd transvenously","code_information":[{"code":"33244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1387.17,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1387.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt defib w/lead(s)","code_information":[{"code":"33249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1465.79,"maximum":163735.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52507.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1465.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35705.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145764.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163735.62,"additional_payer_notes":"APC"}]}]},{"description":"Ablate heart dysrhythm focus","code_information":[{"code":"33250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2342.51,"maximum":2342.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2342.51}]}]},{"description":"Ablate heart dysrhythm focus","code_information":[{"code":"33251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2623.57,"maximum":2623.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2623.57}]}]},{"description":"Ablate atria lmtd","code_information":[{"code":"33254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2193.62,"maximum":2193.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2193.62}]}]},{"description":"Ablate atria w/o bypass ext","code_information":[{"code":"33255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2614.31,"maximum":2614.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2614.31}]}]},{"description":"Ablate atria w/bypass exten","code_information":[{"code":"33256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3093.82,"maximum":3093.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3093.82}]}]},{"description":"Ablate atria lmtd add-on","code_information":[{"code":"33257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":945.01,"maximum":945.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":945.01}]}]},{"description":"Ablate atria x10sv add-on","code_information":[{"code":"33258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1049.32,"maximum":1049.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1049.32}]}]},{"description":"Ablate atria w/bypass add-on","code_information":[{"code":"33259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1371.91,"maximum":1371.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1371.91}]}]},{"description":"Ablate heart dysrhythm focus","code_information":[{"code":"33261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2590.39,"maximum":2590.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2590.39}]}]},{"description":"Rmvl& replc pulse gen 1 lead","code_information":[{"code":"33262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.94,"maximum":116030.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24806.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37209.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":599.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25302.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103295.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116030.5,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl & rplcmt dfb gen 2 lead","code_information":[{"code":"33263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":623.87,"maximum":116030.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24806.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37209.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":623.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25302.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103295.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116030.5,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl & rplcmt dfb gen mlt ld","code_information":[{"code":"33264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":649.98,"maximum":163735.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52507.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":649.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35705.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145764.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163735.62,"additional_payer_notes":"APC"}]}]},{"description":"Ablate atria lmtd endo","code_information":[{"code":"33265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2197.98,"maximum":2197.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2197.98}]}]},{"description":"Ablate atria x10sv endo","code_information":[{"code":"33266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2964.43,"maximum":2964.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2964.43}]}]},{"description":"Excl laa open any method","code_information":[{"code":"33267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.32,"maximum":1686.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.32}]}]},{"description":"Excl laa opn oth px any meth","code_information":[{"code":"33268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.51,"maximum":207.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.51}]}]},{"description":"Excl laa thrscp any method","code_information":[{"code":"33269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1343.58,"maximum":1343.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1343.58}]}]},{"description":"Ins/rep subq defibrillator","code_information":[{"code":"33270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":901.67,"maximum":163735.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52507.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":901.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35705.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145764.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163735.62,"additional_payer_notes":"APC"}]}]},{"description":"Insj subq impltbl dfb elctrd","code_information":[{"code":"33271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":733.91,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":733.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl of subq defibrillator","code_information":[{"code":"33272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":562.84,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":562.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Repos prev impltbl subq dfb","code_information":[{"code":"33273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":647.89,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":647.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcat insj/rpl perm ldls pm","code_information":[{"code":"33274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":768.3,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":768.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl perm ldls pm","code_information":[{"code":"33275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":812.45,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":812.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insj phrnc nrv stim sys","code_information":[{"code":"33276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":934.39,"maximum":229762.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49120.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73681.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":934.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50103.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":204543.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":229762.29,"additional_payer_notes":"APC"}]}]},{"description":"Insj phrnc nrv stim transvns","code_information":[{"code":"33277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":447.25,"maximum":447.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":447.25}]}]},{"description":"Rmvl phrnc nrv stim sys","code_information":[{"code":"33278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":927.3,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":927.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim transvns","code_information":[{"code":"33279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":556.86,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":556.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim pg only","code_information":[{"code":"33280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":337.81,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":337.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Reposg phrnc nrv stim trnsvn","code_information":[{"code":"33281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":594.16,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":594.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Insj subq car rhythm mntr","code_information":[{"code":"33285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.51,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl subq car rhythm mntr","code_information":[{"code":"33286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.79,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Rmv&rplcmt phrnc nrv stim pg","code_information":[{"code":"33287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":628.7,"maximum":160964.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34412.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51618.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143297.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160964.87,"additional_payer_notes":"APC"}]}]},{"description":"Rmv&rplcmt phrnc nrv stim ld","code_information":[{"code":"33288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":799.25,"maximum":58124.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18639.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51744.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58124.31,"additional_payer_notes":"APC"}]}]},{"description":"Tcat impl wrls p-art prs snr","code_information":[{"code":"33289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":535.44,"maximum":149622.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31987.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47981.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":535.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32627.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":133200.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149622.71,"additional_payer_notes":"APC"}]}]},{"description":"Repair of heart wound","code_information":[{"code":"33300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3930.27,"maximum":3930.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3930.27}]}]},{"description":"Repair of heart wound","code_information":[{"code":"33305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6548.7,"maximum":6548.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.7}]}]},{"description":"Exploratory heart surgery","code_information":[{"code":"33310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1887.0,"maximum":1887.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1887.0}]}]},{"description":"Exploratory heart surgery","code_information":[{"code":"33315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3070.63,"maximum":3070.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3070.63}]}]},{"description":"Repair major blood vessel(s)","code_information":[{"code":"33320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1728.36,"maximum":1728.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1728.36}]}]},{"description":"Repair major vessel","code_information":[{"code":"33321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1914.85,"maximum":1914.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1914.85}]}]},{"description":"Repair major blood vessel(s)","code_information":[{"code":"33322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2237.76,"maximum":2237.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2237.76}]}]},{"description":"Insert major vessel graft","code_information":[{"code":"33330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2291.86,"maximum":2291.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2291.86}]}]},{"description":"Insert major vessel graft","code_information":[{"code":"33335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2998.01,"maximum":2998.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2998.01}]}]},{"description":"Replace aortic valve perq","code_information":[{"code":"33361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1934.34,"maximum":1934.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1934.34}]}]},{"description":"Replace aortic valve open","code_information":[{"code":"33362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2110.72,"maximum":2110.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2110.72}]}]},{"description":"Replace aortic valve open","code_information":[{"code":"33363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2185.94,"maximum":2185.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2185.94}]}]},{"description":"Replace aortic valve open","code_information":[{"code":"33364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2180.94,"maximum":2180.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2180.94}]}]},{"description":"Replace aortic valve open","code_information":[{"code":"33365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2277.0,"maximum":2277.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2277.0}]}]},{"description":"Trcath replace aortic valve","code_information":[{"code":"33366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2511.84,"maximum":2511.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2511.84}]}]},{"description":"Replace aortic valve w/byp","code_information":[{"code":"33367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":973.69,"maximum":973.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":973.69}]}]},{"description":"Replace aortic valve w/byp","code_information":[{"code":"33368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1178.59,"maximum":1178.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1178.59}]}]},{"description":"Replace aortic valve w/byp","code_information":[{"code":"33369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1555.65,"maximum":1555.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1555.65}]}]},{"description":"Tcat plmt&rmvl cepd perq","code_information":[{"code":"33370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.08,"maximum":214.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.08}]}]},{"description":"Valvuloplasty aortic valve","code_information":[{"code":"33390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3095.15,"maximum":3095.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.15}]}]},{"description":"Valvuloplasty aortic valve","code_information":[{"code":"33391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3667.96,"maximum":3667.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3667.96}]}]},{"description":"Prepare heart-aorta conduit","code_information":[{"code":"33404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2809.4,"maximum":2809.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2809.4}]}]},{"description":"Replacement aortic valve opn","code_information":[{"code":"33405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3647.63,"maximum":3647.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3647.63}]}]},{"description":"Replacement aortic valve opn","code_information":[{"code":"33406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4629.7,"maximum":4629.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4629.7}]}]},{"description":"Replacement aortic valve opn","code_information":[{"code":"33410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4089.55,"maximum":4089.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.55}]}]},{"description":"Replacement of aortic valve","code_information":[{"code":"33411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5376.61,"maximum":5376.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5376.61}]}]},{"description":"Replacement of aortic valve","code_information":[{"code":"33412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5028.38,"maximum":5028.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.38}]}]},{"description":"Replacement of aortic valve","code_information":[{"code":"33413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5154.6,"maximum":5154.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5154.6}]}]},{"description":"Repair of aortic valve","code_information":[{"code":"33414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3449.33,"maximum":3449.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3449.33}]}]},{"description":"Revision subvalvular tissue","code_information":[{"code":"33415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3259.22,"maximum":3259.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3259.22}]}]},{"description":"Revise ventricle muscle","code_information":[{"code":"33416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3254.32,"maximum":3254.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3254.32}]}]},{"description":"Repair of aortic valve","code_information":[{"code":"33417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2693.63,"maximum":2693.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2693.63}]}]},{"description":"Repair tcat mitral valve","code_information":[{"code":"33418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2883.09,"maximum":2883.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2883.09}]}]},{"description":"Repair tcat mitral valve","code_information":[{"code":"33419","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.12,"maximum":676.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":676.12}]}]},{"description":"Revision of mitral valve","code_information":[{"code":"33420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2333.78,"maximum":2333.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2333.78}]}]},{"description":"Revision of mitral valve","code_information":[{"code":"33422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2675.89,"maximum":2675.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2675.89}]}]},{"description":"Repair of mitral valve","code_information":[{"code":"33425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4376.97,"maximum":4376.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4376.97}]}]},{"description":"Repair of mitral valve","code_information":[{"code":"33426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3830.48,"maximum":3830.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3830.48}]}]},{"description":"Repair of mitral valve","code_information":[{"code":"33427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3915.93,"maximum":3915.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3915.93}]}]},{"description":"Replacement of mitral valve","code_information":[{"code":"33430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4501.57,"maximum":4501.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4501.57}]}]},{"description":"Rplcmt a-valve tlcj autol pv","code_information":[{"code":"33440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5438.16,"maximum":5438.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5438.16}]}]},{"description":"Remove lung foreign body","code_information":[{"code":"32151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1631.26,"maximum":1631.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1631.26}]}]},{"description":"Open chest heart massage","code_information":[{"code":"32160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.52,"maximum":1305.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1305.52}]}]},{"description":"Drain open lung lesion","code_information":[{"code":"32200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1853.67,"maximum":1853.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1853.67}]}]},{"description":"Treat chest lining","code_information":[{"code":"32215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1306.69,"maximum":1306.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1306.69}]}]},{"description":"Release of lung","code_information":[{"code":"32220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2593.11,"maximum":2593.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2593.11}]}]},{"description":"Partial release of lung","code_information":[{"code":"32225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1615.65,"maximum":1615.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1615.65}]}]},{"description":"Removal of chest lining","code_information":[{"code":"32310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1492.9,"maximum":1492.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1492.9}]}]},{"description":"Free/remove chest lining","code_information":[{"code":"32320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2599.3,"maximum":2599.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2599.3}]}]},{"description":"Needle biopsy chest lining","code_information":[{"code":"32400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.18,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Core ndl bx lng/med perq","code_information":[{"code":"32408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.64,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove lung pneumonectomy","code_information":[{"code":"32440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2536.95,"maximum":2536.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2536.95}]}]},{"description":"Sleeve pneumonectomy","code_information":[{"code":"32442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4901.67,"maximum":4901.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4901.67}]}]},{"description":"Removal of lung extrapleural","code_information":[{"code":"32445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5677.07,"maximum":5677.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5677.07}]}]},{"description":"Partial removal of lung","code_information":[{"code":"32480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2391.07,"maximum":2391.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2391.07}]}]},{"description":"Bilobectomy","code_information":[{"code":"32482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2559.14,"maximum":2559.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2559.14}]}]},{"description":"Segmentectomy","code_information":[{"code":"32484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2316.59,"maximum":2316.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2316.59}]}]},{"description":"Sleeve lobectomy","code_information":[{"code":"32486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3761.82,"maximum":3761.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3761.82}]}]},{"description":"Completion pneumonectomy","code_information":[{"code":"32488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3849.72,"maximum":3849.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3849.72}]}]},{"description":"Lung volume reduction","code_information":[{"code":"32491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2384.71,"maximum":2384.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2384.71}]}]},{"description":"Repair bronchus add-on","code_information":[{"code":"32501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.84,"maximum":388.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":388.84}]}]},{"description":"Resect apical lung tumor","code_information":[{"code":"32503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2894.57,"maximum":2894.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2894.57}]}]},{"description":"Resect apical lung tum/chest","code_information":[{"code":"32504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3293.26,"maximum":3293.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3293.26}]}]},{"description":"Wedge resect of lung initial","code_information":[{"code":"32505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1510.59,"maximum":1510.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1510.59}]}]},{"description":"Wedge resect of lung add-on","code_information":[{"code":"32506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.93,"maximum":248.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.93}]}]},{"description":"Wedge resect of lung diag","code_information":[{"code":"32507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.93,"maximum":248.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.93}]}]},{"description":"Removal of lung lesion","code_information":[{"code":"32540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2787.86,"maximum":2787.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2787.86}]}]},{"description":"Insert pleural cath","code_information":[{"code":"32550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.88,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of chest tube","code_information":[{"code":"32551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.57,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Remove lung catheter","code_information":[{"code":"32552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.76,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Ins mark thor for rt perq","code_information":[{"code":"32553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":284.39,"maximum":7220.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1543.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2315.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1574.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6427.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7220.12,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate pleura w/o imaging","code_information":[{"code":"32554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.74,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate pleura w/ imaging","code_information":[{"code":"32555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.69,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Insert cath pleura w/o image","code_information":[{"code":"32556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.54,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Insert cath pleura w/ image","code_information":[{"code":"32557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":239.74,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":239.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Treat pleurodesis w/agent","code_information":[{"code":"32560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.35,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Lyse chest fibrin init day","code_information":[{"code":"32561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.83,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Lyse chest fibrin subq day","code_information":[{"code":"32562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.83,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy diagnostic","code_information":[{"code":"32601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":497.17,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":497.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy wbx sac","code_information":[{"code":"32604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":770.45,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":770.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx med space","code_information":[{"code":"32606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":744.31,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":744.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx infiltrate","code_information":[{"code":"32607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":496.59,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":496.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx nodule","code_information":[{"code":"32608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":610.34,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":610.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx pleura","code_information":[{"code":"32609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":411.45,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":411.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/pleurodesis","code_information":[{"code":"32650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1087.61,"maximum":1087.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1087.61}]}]},{"description":"Thoracoscopy remove cortex","code_information":[{"code":"32651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1773.6,"maximum":1773.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1773.6}]}]},{"description":"Thoracoscopy rem totl cortex","code_information":[{"code":"32652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2684.03,"maximum":2684.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2684.03}]}]},{"description":"Thoracoscopy remov fb/fibrin","code_information":[{"code":"32653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1717.93,"maximum":1717.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1717.93}]}]},{"description":"Thoracoscopy contrl bleeding","code_information":[{"code":"32654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1939.7,"maximum":1939.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1939.7}]}]},{"description":"Thoracoscopy resect bullae","code_information":[{"code":"32655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1550.81,"maximum":1550.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1550.81}]}]},{"description":"Thoracoscopy w/pleurectomy","code_information":[{"code":"32656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1306.81,"maximum":1306.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1306.81}]}]},{"description":"Thoracoscopy w/sac fb remove","code_information":[{"code":"32658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1162.49,"maximum":1162.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1162.49}]}]},{"description":"Thoracoscopy w/sac drainage","code_information":[{"code":"32659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1194.08,"maximum":1194.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1194.08}]}]},{"description":"Thoracoscopy w/pericard exc","code_information":[{"code":"32661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1295.93,"maximum":1295.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.93}]}]},{"description":"Thoracoscopy w/mediast exc","code_information":[{"code":"32662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1450.53,"maximum":1450.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1450.53}]}]},{"description":"Thoracoscopy w/lobectomy","code_information":[{"code":"32663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2256.04,"maximum":2256.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2256.04}]}]},{"description":"Thoracoscopy w/ th nrv exc","code_information":[{"code":"32664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1375.43,"maximum":1375.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1375.43}]}]},{"description":"Thoracoscop w/esoph musc exc","code_information":[{"code":"32665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1989.68,"maximum":1989.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1989.68}]}]},{"description":"Thoracoscopy w/wedge resect","code_information":[{"code":"32666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1411.92,"maximum":1411.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1411.92}]}]},{"description":"Thoracoscopy w/w resect addl","code_information":[{"code":"32667","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.47,"maximum":249.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.47}]}]},{"description":"Thoracoscopy w/w resect diag","code_information":[{"code":"32668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.0,"maximum":250.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":250.0}]}]},{"description":"Thoracoscopy remove segment","code_information":[{"code":"32669","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2166.7,"maximum":2166.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2166.7}]}]},{"description":"Thoracoscopy bilobectomy","code_information":[{"code":"32670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2579.7,"maximum":2579.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2579.7}]}]},{"description":"Thoracoscopy pneumonectomy","code_information":[{"code":"32671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2853.44,"maximum":2853.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2853.44}]}]},{"description":"Thoracoscopy for lvrs","code_information":[{"code":"32672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2446.01,"maximum":2446.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2446.01}]}]},{"description":"Thoracoscopy w/thymus resect","code_information":[{"code":"32673","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.03,"maximum":1963.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1963.03}]}]},{"description":"Thoracoscopy lymph node exc","code_information":[{"code":"32674","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":343.62,"maximum":343.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.62}]}]},{"description":"Thorax stereo rad targetw/tx","code_information":[{"code":"32701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":335.6,"maximum":335.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.6}]}]},{"description":"Repair lung hernia","code_information":[{"code":"32800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1541.62,"maximum":1541.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1541.62}]}]},{"description":"Close chest after drainage","code_information":[{"code":"32810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1464.6,"maximum":1464.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1464.6}]}]},{"description":"Close bronchial fistula","code_information":[{"code":"32815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4511.12,"maximum":4511.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4511.12}]}]},{"description":"Reconstruct injured chest","code_information":[{"code":"32820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2266.89,"maximum":2266.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2266.89}]}]},{"description":"Lung transplant single","code_information":[{"code":"32851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5270.18,"maximum":5270.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5270.18}]}]},{"description":"Lung transplant with bypass","code_information":[{"code":"32852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5676.26,"maximum":5676.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5676.26}]}]},{"description":"Lung transplant double","code_information":[{"code":"32853","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7373.51,"maximum":7373.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7373.51}]}]},{"description":"Lung transplant with bypass","code_information":[{"code":"32854","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7793.69,"maximum":7793.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7793.69}]}]},{"description":"Removal of rib(s)","code_information":[{"code":"32900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2376.77,"maximum":2376.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2376.77}]}]},{"description":"Revise & repair chest wall","code_information":[{"code":"32905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2156.81,"maximum":2156.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2156.81}]}]},{"description":"Revise & repair chest wall","code_information":[{"code":"32906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2656.21,"maximum":2656.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2656.21}]}]},{"description":"Revision of lung","code_information":[{"code":"32940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.57,"maximum":1995.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.57}]}]},{"description":"Therapeutic pneumothorax","code_information":[{"code":"32960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":147.22,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Ablate pulm tumor perq crybl","code_information":[{"code":"32994","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":705.18,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Total lung lavage","code_information":[{"code":"32997","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":541.75,"maximum":541.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":541.75}]}]},{"description":"Perq rf ablate tx pul tumor","code_information":[{"code":"32998","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":704.65,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":704.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Pericardiocentesis w/imaging","code_information":[{"code":"33016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.44,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Prcrd drg 6yr+ w/o cgen car","code_information":[{"code":"33017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.05,"maximum":395.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":395.05}]}]},{"description":"Prcrd drg 0-5yr or w/anomly","code_information":[{"code":"33018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":463.56,"maximum":463.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":463.56}]}]},{"description":"Perq prcrd drg insj cath ct","code_information":[{"code":"33019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":336.31,"maximum":336.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.31}]}]},{"description":"Incision of heart sac","code_information":[{"code":"33020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1340.97,"maximum":1340.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1340.97}]}]},{"description":"Incision of heart sac","code_information":[{"code":"33025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1248.35,"maximum":1248.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1248.35}]}]},{"description":"Partial removal of heart sac","code_information":[{"code":"33030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3220.81,"maximum":3220.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3220.81}]}]},{"description":"Partial removal of heart sac","code_information":[{"code":"33031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3974.18,"maximum":3974.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3974.18}]}]},{"description":"Resect heart sac lesion","code_information":[{"code":"33050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1632.88,"maximum":1632.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1632.88}]}]},{"description":"Removal of heart lesion","code_information":[{"code":"33120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3359.67,"maximum":3359.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3359.67}]}]},{"description":"Removal of heart lesion","code_information":[{"code":"33130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2200.29,"maximum":2200.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2200.29}]}]},{"description":"Heart revascularize (tmr)","code_information":[{"code":"33140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2498.54,"maximum":2498.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2498.54}]}]},{"description":"Heart Tmr W/Other Procedure","code_information":[{"code":"33141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.29,"maximum":211.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.29}]}]},{"description":"Insert epicard eltrd open","code_information":[{"code":"33202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1246.24,"maximum":1246.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1246.24}]}]},{"description":"Insert epicard eltrd endo","code_information":[{"code":"33203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1310.22,"maximum":1310.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1310.22}]}]},{"description":"Insert heart pm atrial","code_information":[{"code":"33206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":733.33,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":733.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"Insert heart pm ventricular","code_information":[{"code":"33207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.51,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"Insrt heart pm atrial & vent","code_information":[{"code":"33208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":833.12,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":833.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"Insert electrd/pm cath sngl","code_information":[{"code":"33210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":258.4,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insert card electrodes dual","code_information":[{"code":"33211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.19,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insert pulse gen sngl lead","code_information":[{"code":"33212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":523.63,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":523.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insert pulse gen dual leads","code_information":[{"code":"33213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":544.96,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":544.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"Upgrade of pacemaker system","code_information":[{"code":"33214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":772.52,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":772.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"Reposition pacing-defib lead","code_information":[{"code":"33215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":501.4,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insert 1 electrode pm-defib","code_information":[{"code":"33216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.85,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":599.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insert 2 electrode pm-defib","code_information":[{"code":"33217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":596.56,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":596.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Repair lead pace-defib one","code_information":[{"code":"33218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":628.7,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Repair lead pace-defib dual","code_information":[{"code":"33220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":615.59,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":615.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Insert pulse gen mult leads","code_information":[{"code":"33221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":575.93,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":575.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Relocation pocket pacemaker","code_information":[{"code":"33222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":556.12,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":556.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Relocate pocket for defib","code_information":[{"code":"33223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":659.74,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":659.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Insert pacing lead & connect","code_information":[{"code":"33224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":819.24,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":819.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"L ventric pacing lead add-on","code_information":[{"code":"33225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":738.64,"maximum":738.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":738.64}]}]},{"description":"Reposition l ventric lead","code_information":[{"code":"33226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":784.3,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":784.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Remove&replace pm gen singl","code_information":[{"code":"33227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":547.11,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":547.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Repair great vessels defect","code_information":[{"code":"33774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2906.51,"maximum":2906.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2906.51}]}]},{"description":"Repair great vessels defect","code_information":[{"code":"33775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2989.96,"maximum":2989.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2989.96}]}]},{"description":"Repair great vessels defect","code_information":[{"code":"33776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3162.47,"maximum":3162.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3162.47}]}]},{"description":"Repair great vessels defect","code_information":[{"code":"33777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3042.4,"maximum":3042.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3042.4}]}]},{"description":"Repair great vessels defect","code_information":[{"code":"33778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3777.55,"maximum":3777.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.55}]}]},{"description":"Repair great vessels defect","code_information":[{"code":"33779","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3722.4,"maximum":3722.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3722.4}]}]},{"description":"Repair great vessels defect","code_information":[{"code":"33780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3795.3,"maximum":3795.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3795.3}]}]},{"description":"Repair great vessels defect","code_information":[{"code":"33781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3699.6,"maximum":3699.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3699.6}]}]},{"description":"Nikaidoh proc","code_information":[{"code":"33782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5168.19,"maximum":5168.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5168.19}]}]},{"description":"Nikaidoh proc w/ostia implt","code_information":[{"code":"33783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5584.21,"maximum":5584.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5584.21}]}]},{"description":"Repair arterial trunk","code_information":[{"code":"33786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3652.51,"maximum":3652.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3652.51}]}]},{"description":"Revision of pulmonary artery","code_information":[{"code":"33788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2468.97,"maximum":2468.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2468.97}]}]},{"description":"Aortic suspension","code_information":[{"code":"33800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1593.9,"maximum":1593.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1593.9}]}]},{"description":"Repair vessel defect","code_information":[{"code":"33802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1762.4,"maximum":1762.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1762.4}]}]},{"description":"Repair vessel defect","code_information":[{"code":"33803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1856.94,"maximum":1856.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1856.94}]}]},{"description":"Repair septal defect","code_information":[{"code":"33814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2465.41,"maximum":2465.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2465.41}]}]},{"description":"Revise major vessel","code_information":[{"code":"33820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1567.12,"maximum":1567.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1567.12}]}]},{"description":"Revise major vessel","code_information":[{"code":"33822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1651.55,"maximum":1651.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1651.55}]}]},{"description":"Revise major vessel","code_information":[{"code":"33824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1914.4,"maximum":1914.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1914.4}]}]},{"description":"Remove aorta constriction","code_information":[{"code":"33840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2008.59,"maximum":2008.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2008.59}]}]},{"description":"Remove aorta constriction","code_information":[{"code":"33845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2163.68,"maximum":2163.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2163.68}]}]},{"description":"Remove aorta constriction","code_information":[{"code":"33851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2062.47,"maximum":2062.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2062.47}]}]},{"description":"Repair septal defect","code_information":[{"code":"33852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2263.48,"maximum":2263.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2263.48}]}]},{"description":"Repair septal defect","code_information":[{"code":"33853","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2957.24,"maximum":2957.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2957.24}]}]},{"description":"As-aort grf f/aortic dsj","code_information":[{"code":"33858","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5434.92,"maximum":5434.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5434.92}]}]},{"description":"As-aort grf f/ds oth/thn dsj","code_information":[{"code":"33859","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3907.7,"maximum":3907.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3907.7}]}]},{"description":"Ascending aortic graft","code_information":[{"code":"33863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5036.45,"maximum":5036.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5036.45}]}]},{"description":"Ascending aortic graft","code_information":[{"code":"33864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5147.91,"maximum":5147.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5147.91}]}]},{"description":"Aortic hemiarch graft","code_information":[{"code":"33866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1469.62,"maximum":1469.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1469.62}]}]},{"description":"Transvrs a-arch grf hypthrm","code_information":[{"code":"33871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5209.04,"maximum":5209.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5209.04}]}]},{"description":"Thoracic aortic graft","code_information":[{"code":"33875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4391.78,"maximum":4391.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4391.78}]}]},{"description":"Thoracoabdominal graft","code_information":[{"code":"33877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5766.14,"maximum":5766.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5766.14}]}]},{"description":"Endovasc taa repr incl subcl","code_information":[{"code":"33880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2847.77,"maximum":2847.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2847.77}]}]},{"description":"Endovasc taa repr w/o subcl","code_information":[{"code":"33881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2446.22,"maximum":2446.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2446.22}]}]},{"description":"Insert endovasc prosth taa","code_information":[{"code":"33883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1771.25,"maximum":1771.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.25}]}]},{"description":"Endovasc prosth taa add-on","code_information":[{"code":"33884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":628.67,"maximum":628.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.67}]}]},{"description":"Endovasc prosth delayed","code_information":[{"code":"33886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1531.46,"maximum":1531.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1531.46}]}]},{"description":"Artery transpose/endovas taa","code_information":[{"code":"33889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1271.3,"maximum":1271.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1271.3}]}]},{"description":"Car-car bp grft/endovas taa","code_information":[{"code":"33891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1533.01,"maximum":1533.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1533.01}]}]},{"description":"Evasc st rpr thrc/aa acrs br","code_information":[{"code":"33894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1565.71,"maximum":1565.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1565.71}]}]},{"description":"Evasc st rpr thrc/aa x crsg","code_information":[{"code":"33895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1245.4,"maximum":1245.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1245.4}]}]},{"description":"Perq trluml angp nt/recr coa","code_information":[{"code":"33897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":926.14,"maximum":926.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":926.14}]}]},{"description":"Perq p-art revsc 1 nm nt uni","code_information":[{"code":"33900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":945.22,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":945.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 nm nt bi","code_information":[{"code":"33901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1242.64,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1242.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 abnor uni","code_information":[{"code":"33902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1199.6,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1199.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 abnor bi","code_information":[{"code":"33903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1413.73,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1413.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc each addl","code_information":[{"code":"33904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":473.94,"maximum":473.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":473.94}]}]},{"description":"Remove lung artery emboli","code_information":[{"code":"33910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4185.79,"maximum":4185.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4185.79}]}]},{"description":"Remove lung artery emboli","code_information":[{"code":"33915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2208.71,"maximum":2208.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2208.71}]}]},{"description":"Surgery of great vessel","code_information":[{"code":"33916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6686.97,"maximum":6686.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6686.97}]}]},{"description":"Repair pulmonary artery","code_information":[{"code":"33917","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2358.74,"maximum":2358.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2358.74}]}]},{"description":"Repair pulmonary atresia","code_information":[{"code":"33920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2911.18,"maximum":2911.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2911.18}]}]},{"description":"Transect pulmonary artery","code_information":[{"code":"33922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2247.16,"maximum":2247.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2247.16}]}]},{"description":"Remove pulmonary shunt","code_information":[{"code":"33924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":456.34,"maximum":456.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":456.34}]}]},{"description":"Rpr pul art unifocal w/o cpb","code_information":[{"code":"33925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2757.75,"maximum":2757.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2757.75}]}]},{"description":"Repr pul art unifocal w/cpb","code_information":[{"code":"33926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.62,"maximum":3873.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.62}]}]},{"description":"Impltj tot rplcmt hrt sys","code_information":[{"code":"33927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4066.65,"maximum":4066.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4066.65}]}]},{"description":"Transplantation heart/lung","code_information":[{"code":"33935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7882.31,"maximum":7882.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7882.31}]}]},{"description":"Transplantation of heart","code_information":[{"code":"33945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7799.21,"maximum":7799.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7799.21}]}]},{"description":"Ecmo/ecls initiation venous","code_information":[{"code":"33946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":496.07,"maximum":496.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":496.07}]}]},{"description":"Ecmo/ecls initiation artery","code_information":[{"code":"33947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":549.91,"maximum":549.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":549.91}]}]},{"description":"Ecmo/ecls daily mgmt-venous","code_information":[{"code":"33948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":384.2,"maximum":384.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":384.2}]}]},{"description":"Ecmo/ecls daily mgmt artery","code_information":[{"code":"33949","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.92,"maximum":374.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.92}]}]},{"description":"Ecmo/ecls insj prph cannula","code_information":[{"code":"33951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":675.02,"maximum":675.02,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":675.02}]}]},{"description":"Ecmo/ecls insj prph cannula","code_information":[{"code":"33952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":681.75,"maximum":681.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":681.75}]}]},{"description":"Ecmo/ecls insj prph cannula","code_information":[{"code":"33953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":752.97,"maximum":752.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":752.97}]}]},{"description":"Ecmo/ecls insj prph cannula","code_information":[{"code":"33954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":761.57,"maximum":761.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":761.57}]}]},{"description":"Ecmo/ecls insj ctr cannula","code_information":[{"code":"33955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1315.91,"maximum":1315.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1315.91}]}]},{"description":"Ecmo/ecls insj ctr cannula","code_information":[{"code":"33956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1332.45,"maximum":1332.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1332.45}]}]},{"description":"Ecmo/ecls repos perph cnula","code_information":[{"code":"33957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":294.2,"maximum":294.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294.2}]}]},{"description":"Ecmo/ecls repos perph cnula","code_information":[{"code":"33958","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":294.2,"maximum":294.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294.2}]}]},{"description":"Ecmo/ecls repos perph cnula","code_information":[{"code":"33959","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":373.2,"maximum":373.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":373.2}]}]},{"description":"Ecmo/ecls repos perph cnula","code_information":[{"code":"33962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":373.2,"maximum":373.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":373.2}]}]},{"description":"Ecmo/ecls repos perph cnula","code_information":[{"code":"33963","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":743.19,"maximum":743.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":743.19}]}]},{"description":"Ecmo/ecls repos perph cnula","code_information":[{"code":"33964","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":783.56,"maximum":783.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":783.56}]}]},{"description":"Ecmo/ecls rmvl perph cannula","code_information":[{"code":"33965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":294.2,"maximum":294.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294.2}]}]},{"description":"Ecmo/ecls rmvl prph cannula","code_information":[{"code":"33966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.7,"maximum":378.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.7}]}]},{"description":"Insert i-aort percut device","code_information":[{"code":"33967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":413.52,"maximum":413.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":413.52}]}]},{"description":"Remove aortic assist device","code_information":[{"code":"33968","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.48,"maximum":54.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.48}]}]},{"description":"Ecmo/ecls rmvl perph cannula","code_information":[{"code":"33969","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":432.66,"maximum":432.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":432.66}]}]},{"description":"Aortic circulation assist","code_information":[{"code":"33970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":563.86,"maximum":563.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":563.86}]}]},{"description":"Aortic circulation assist","code_information":[{"code":"33971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1141.74,"maximum":1141.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1141.74}]}]},{"description":"Insert balloon device","code_information":[{"code":"33973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.79,"maximum":798.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":798.79}]}]},{"description":"Remove intra-aortic balloon","code_information":[{"code":"33974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1441.85,"maximum":1441.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1441.85}]}]},{"description":"Implant ventricular device","code_information":[{"code":"33975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2087.73,"maximum":2087.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2087.73}]}]},{"description":"Implant ventricular device","code_information":[{"code":"33976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2516.89,"maximum":2516.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2516.89}]}]},{"description":"Remove ventricular device","code_information":[{"code":"33977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1802.79,"maximum":1802.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1802.79}]}]},{"description":"Remove ventricular device","code_information":[{"code":"33978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2124.69,"maximum":2124.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2124.69}]}]},{"description":"Insert intracorporeal device","code_information":[{"code":"33979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3101.24,"maximum":3101.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3101.24}]}]},{"description":"Remove intracorporeal device","code_information":[{"code":"33980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2847.25,"maximum":2847.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2847.25}]}]},{"description":"Revision of tricuspid valve","code_information":[{"code":"33460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3837.41,"maximum":3837.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3837.41}]}]},{"description":"Valvuloplasty tricuspid","code_information":[{"code":"33463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4932.12,"maximum":4932.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4932.12}]}]},{"description":"Valvuloplasty tricuspid","code_information":[{"code":"33464","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3914.27,"maximum":3914.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3914.27}]}]},{"description":"Replace tricuspid valve","code_information":[{"code":"33465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4418.27,"maximum":4418.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4418.27}]}]},{"description":"Revision of tricuspid valve","code_information":[{"code":"33468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.86,"maximum":3931.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.86}]}]},{"description":"Revision of pulmonary valve","code_information":[{"code":"33474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.82,"maximum":3506.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.82}]}]},{"description":"Replacement pulmonary valve","code_information":[{"code":"33475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3721.76,"maximum":3721.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.76}]}]},{"description":"Revision of heart chamber","code_information":[{"code":"33476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2463.79,"maximum":2463.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2463.79}]}]},{"description":"Implant tcat pulm vlv perq","code_information":[{"code":"33477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2083.18,"maximum":2083.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2083.18}]}]},{"description":"Revision of heart chamber","code_information":[{"code":"33478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2544.4,"maximum":2544.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2544.4}]}]},{"description":"Repair prosth valve clot","code_information":[{"code":"33496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2675.94,"maximum":2675.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2675.94}]}]},{"description":"Repair heart vessel fistula","code_information":[{"code":"33500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2509.23,"maximum":2509.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2509.23}]}]},{"description":"Repair heart vessel fistula","code_information":[{"code":"33501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1799.34,"maximum":1799.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1799.34}]}]},{"description":"Coronary artery correction","code_information":[{"code":"33502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2072.21,"maximum":2072.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2072.21}]}]},{"description":"Coronary artery graft","code_information":[{"code":"33503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2155.38,"maximum":2155.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2155.38}]}]},{"description":"Coronary artery graft","code_information":[{"code":"33504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2373.91,"maximum":2373.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2373.91}]}]},{"description":"Repair artery w/tunnel","code_information":[{"code":"33505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3299.87,"maximum":3299.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3299.87}]}]},{"description":"Repair artery translocation","code_information":[{"code":"33506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3293.16,"maximum":3293.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3293.16}]}]},{"description":"Repair art intramural","code_information":[{"code":"33507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2766.46,"maximum":2766.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2766.46}]}]},{"description":"Endoscopic vein harvest","code_information":[{"code":"33508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.61,"maximum":25.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.61}]}]},{"description":"Ndsc hrv uxtr art 1 sgm cab","code_information":[{"code":"33509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":277.25,"maximum":277.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277.25}]}]},{"description":"Cabg vein single","code_information":[{"code":"33510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3108.98,"maximum":3108.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3108.98}]}]},{"description":"Cabg vein two","code_information":[{"code":"33511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3414.99,"maximum":3414.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3414.99}]}]},{"description":"Cabg vein three","code_information":[{"code":"33512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3885.59,"maximum":3885.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.59}]}]},{"description":"Cabg vein four","code_information":[{"code":"33513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3970.4,"maximum":3970.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3970.4}]}]},{"description":"Replace vad pump ext","code_information":[{"code":"33981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1318.64,"maximum":1318.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1318.64}]}]},{"description":"Replace vad intra w/o bp","code_information":[{"code":"33982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3100.41,"maximum":3100.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.41}]}]},{"description":"Replace vad intra w/bp","code_information":[{"code":"33983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3646.96,"maximum":3646.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3646.96}]}]},{"description":"Ecmo/ecls rmvl prph cannula","code_information":[{"code":"33984","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.75,"maximum":453.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.75}]}]},{"description":"Ecmo/ecls rmvl ctr cannula","code_information":[{"code":"33985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":815.71,"maximum":815.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":815.71}]}]},{"description":"Ecmo/ecls rmvl ctr cannula","code_information":[{"code":"33986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":839.42,"maximum":839.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":839.42}]}]},{"description":"Artery expos/graft artery","code_information":[{"code":"33987","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":330.24,"maximum":330.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":330.24}]}]},{"description":"Insertion of left heart vent","code_information":[{"code":"33988","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1235.21,"maximum":1235.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1235.21}]}]},{"description":"Removal of left heart vent","code_information":[{"code":"33989","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":783.56,"maximum":783.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":783.56}]}]},{"description":"Insert vad artery access","code_information":[{"code":"33990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":575.33,"maximum":575.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":575.33}]}]},{"description":"Insert vad art&vein access","code_information":[{"code":"33991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":723.63,"maximum":723.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":723.63}]}]},{"description":"Remove vad different session","code_information":[{"code":"33992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.2,"maximum":300.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.2}]}]},{"description":"Reposition vad diff session","code_information":[{"code":"33993","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.93,"maximum":264.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.93}]}]},{"description":"Insj perq vad r hrt venous","code_information":[{"code":"33995","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":565.62,"maximum":565.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":565.62}]}]},{"description":"Rmvl perq right heart vad","code_information":[{"code":"33997","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.66,"maximum":257.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.66}]}]},{"description":"Removal of artery clot","code_information":[{"code":"34001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1465.57,"maximum":1465.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1465.57}]}]},{"description":"Removal of artery clot","code_information":[{"code":"34051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1604.25,"maximum":1604.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1604.25}]}]},{"description":"Removal of artery clot","code_information":[{"code":"34101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":956.68,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":956.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm artery clot","code_information":[{"code":"34111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":954.49,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":954.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Removal of artery clot","code_information":[{"code":"34151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2224.52,"maximum":2224.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2224.52}]}]},{"description":"Removal of artery clot","code_information":[{"code":"34201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1631.03,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1631.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Removal of leg artery clot","code_information":[{"code":"34203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1517.63,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1517.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2143.73,"maximum":2143.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2143.73}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1115.29,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1115.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2296.83,"maximum":2296.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2296.83}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.57,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1728.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.57,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Repair valve femoral vein","code_information":[{"code":"34501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1439.16,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1439.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct vena cava","code_information":[{"code":"34502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2487.95,"maximum":2487.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2487.95}]}]},{"description":"Transposition of vein valve","code_information":[{"code":"34510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1637.62,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1637.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Cross-over vein graft","code_information":[{"code":"34520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1587.44,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1587.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Leg vein fusion","code_information":[{"code":"34530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1510.61,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1510.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Evasc rpr a-ao ndgft","code_information":[{"code":"34701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1974.36,"maximum":1974.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1974.36}]}]},{"description":"Evasc rpr a-ao ndgft rpt","code_information":[{"code":"34702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2862.86,"maximum":2862.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2862.86}]}]},{"description":"Evasc rpr a-unilac ndgft","code_information":[{"code":"34703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2187.89,"maximum":2187.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2187.89}]}]},{"description":"Evasc rpr a-unilac ndgft rpt","code_information":[{"code":"34704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3635.73,"maximum":3635.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3635.73}]}]},{"description":"Evac rpr a-biiliac ndgft","code_information":[{"code":"34705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2431.56,"maximum":2431.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2431.56}]}]},{"description":"Evasc rpr a-biiliac rpt","code_information":[{"code":"34706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3630.57,"maximum":3630.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3630.57}]}]},{"description":"Evasc rpr ilio-iliac ndgft","code_information":[{"code":"34707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1855.22,"maximum":1855.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1855.22}]}]},{"description":"Evasc rpr ilio-iliac rpt","code_information":[{"code":"34708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2901.01,"maximum":2901.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2901.01}]}]},{"description":"Plmt xtn prosth evasc rpr","code_information":[{"code":"34709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":512.12,"maximum":512.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":512.12}]}]},{"description":"Dlyd plmt xtn prosth 1st vsl","code_information":[{"code":"34710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1271.18,"maximum":1271.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1271.18}]}]},{"description":"Dlyd plmt xtn prosth ea addl","code_information":[{"code":"34711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":469.05,"maximum":469.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":469.05}]}]},{"description":"Tcat dlvr enhncd fixj dev","code_information":[{"code":"34712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1047.22,"maximum":1047.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.22}]}]},{"description":"Perq access & clsr fem art","code_information":[{"code":"34713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.14,"maximum":196.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196.14}]}]},{"description":"Opn fem art expos cndt crtj","code_information":[{"code":"34714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":429.78,"maximum":429.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":429.78}]}]},{"description":"Opn ax/subcla art expos","code_information":[{"code":"34715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":474.46,"maximum":474.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":474.46}]}]},{"description":"Opn ax/subcla art expos cndt","code_information":[{"code":"34716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":594.81,"maximum":594.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":594.81}]}]},{"description":"Evasc rpr a-iliac ndgft","code_information":[{"code":"34717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.84,"maximum":702.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":702.84}]}]},{"description":"Evasc rpr n/a a-iliac ndgft","code_information":[{"code":"34718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1970.57,"maximum":1970.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1970.57}]}]},{"description":"Endovas iliac a device addon","code_information":[{"code":"34808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":321.95,"maximum":321.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":321.95}]}]},{"description":"Xpose for endoprosth femorl","code_information":[{"code":"34812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.36,"maximum":327.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":327.36}]}]},{"description":"Cabg vein five","code_information":[{"code":"33514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4178.15,"maximum":4178.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4178.15}]}]},{"description":"Cabg vein six or more","code_information":[{"code":"33516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4324.65,"maximum":4324.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4324.65}]}]},{"description":"Cabg artery-vein single","code_information":[{"code":"33517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":298.53,"maximum":298.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.53}]}]},{"description":"Cabg artery-vein two","code_information":[{"code":"33518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":656.91,"maximum":656.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":656.91}]}]},{"description":"Cabg artery-vein three","code_information":[{"code":"33519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":866.68,"maximum":866.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":866.68}]}]},{"description":"Cabg artery-vein four","code_information":[{"code":"33521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1040.44,"maximum":1040.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1040.44}]}]},{"description":"Cabg artery-vein five","code_information":[{"code":"33522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1168.43,"maximum":1168.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1168.43}]}]},{"description":"Cabg art-vein six or more","code_information":[{"code":"33523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1315.95,"maximum":1315.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1315.95}]}]},{"description":"Coronary artery bypass/reop","code_information":[{"code":"33530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":836.74,"maximum":836.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":836.74}]}]},{"description":"Cabg arterial single","code_information":[{"code":"33533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3011.91,"maximum":3011.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3011.91}]}]},{"description":"Cabg arterial two","code_information":[{"code":"33534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3538.04,"maximum":3538.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3538.04}]}]},{"description":"Cabg arterial three","code_information":[{"code":"33535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3930.55,"maximum":3930.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3930.55}]}]},{"description":"Cabg arterial four or more","code_information":[{"code":"33536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4233.91,"maximum":4233.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.91}]}]},{"description":"Removal of heart lesion","code_information":[{"code":"33542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4223.8,"maximum":4223.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4223.8}]}]},{"description":"Repair of heart damage","code_information":[{"code":"33545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4905.08,"maximum":4905.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4905.08}]}]},{"description":"Restore/remodel ventricle","code_information":[{"code":"33548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4724.46,"maximum":4724.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4724.46}]}]},{"description":"Open coronary endarterectomy","code_information":[{"code":"33572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":366.65,"maximum":366.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":366.65}]}]},{"description":"Closure of valve","code_information":[{"code":"33600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2774.29,"maximum":2774.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2774.29}]}]},{"description":"Closure of valve","code_information":[{"code":"33602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2694.72,"maximum":2694.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2694.72}]}]},{"description":"Anastomosis/artery-aorta","code_information":[{"code":"33606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2868.5,"maximum":2868.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2868.5}]}]},{"description":"Repair anomaly w/conduit","code_information":[{"code":"33608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2906.01,"maximum":2906.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2906.01}]}]},{"description":"Repair by enlargement","code_information":[{"code":"33610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2866.24,"maximum":2866.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2866.24}]}]},{"description":"Repair double ventricle","code_information":[{"code":"33611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.93,"maximum":3132.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3132.93}]}]},{"description":"Repair double ventricle","code_information":[{"code":"33612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.26,"maximum":3216.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3216.26}]}]},{"description":"Repair modified fontan","code_information":[{"code":"33615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.54,"maximum":3216.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3216.54}]}]},{"description":"Repair single ventricle","code_information":[{"code":"33617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3481.28,"maximum":3481.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3481.28}]}]},{"description":"Repair single ventricle","code_information":[{"code":"33619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4420.65,"maximum":4420.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4420.65}]}]},{"description":"Apply r&l pulm art bands","code_information":[{"code":"33620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2649.94,"maximum":2649.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2649.94}]}]},{"description":"Transthor cath for stent","code_information":[{"code":"33621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1501.92,"maximum":1501.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1501.92}]}]},{"description":"Redo compl cardiac anomaly","code_information":[{"code":"33622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5495.43,"maximum":5495.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5495.43}]}]},{"description":"Repair heart septum defect","code_information":[{"code":"33641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2637.28,"maximum":2637.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2637.28}]}]},{"description":"Revision of heart veins","code_information":[{"code":"33645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2784.86,"maximum":2784.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2784.86}]}]},{"description":"Repair heart septum defects","code_information":[{"code":"33647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.99,"maximum":2919.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.99}]}]},{"description":"Repair of heart defects","code_information":[{"code":"33660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2823.58,"maximum":2823.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2823.58}]}]},{"description":"Repair of heart defects","code_information":[{"code":"33665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3074.08,"maximum":3074.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3074.08}]}]},{"description":"Repair of heart chambers","code_information":[{"code":"33670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3158.28,"maximum":3158.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3158.28}]}]},{"description":"Close Mult Vsd","code_information":[{"code":"33675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3165.08,"maximum":3165.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3165.08}]}]},{"description":"Close mult vsd w/resection","code_information":[{"code":"33676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3248.91,"maximum":3248.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3248.91}]}]},{"description":"Cl mult vsd w/rem pul band","code_information":[{"code":"33677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3374.16,"maximum":3374.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3374.16}]}]},{"description":"Repair heart septum defect","code_information":[{"code":"33681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2977.25,"maximum":2977.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.25}]}]},{"description":"Repair heart septum defect","code_information":[{"code":"33684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.81,"maximum":3033.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.81}]}]},{"description":"Repair heart septum defect","code_information":[{"code":"33688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3018.22,"maximum":3018.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3018.22}]}]},{"description":"Reinforce pulmonary artery","code_information":[{"code":"33690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1949.15,"maximum":1949.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1949.15}]}]},{"description":"Repair of heart defects","code_information":[{"code":"33692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3135.3,"maximum":3135.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3135.3}]}]},{"description":"Repair of heart defects","code_information":[{"code":"33694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.93,"maximum":3132.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3132.93}]}]},{"description":"Repair of heart defects","code_information":[{"code":"33697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3300.09,"maximum":3300.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3300.09}]}]},{"description":"Repair of heart defects","code_information":[{"code":"33702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2499.25,"maximum":2499.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2499.25}]}]},{"description":"Repair of heart defects","code_information":[{"code":"33710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3294.12,"maximum":3294.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3294.12}]}]},{"description":"Repair of heart defect","code_information":[{"code":"33720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2500.89,"maximum":2500.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2500.89}]}]},{"description":"Repair Venous Anomaly","code_information":[{"code":"33724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2475.55,"maximum":2475.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2475.55}]}]},{"description":"Repair Pul Venous Stenosis","code_information":[{"code":"33726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3262.55,"maximum":3262.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3262.55}]}]},{"description":"Repair heart-vein defect(s)","code_information":[{"code":"33730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3229.64,"maximum":3229.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3229.64}]}]},{"description":"Repair heart-vein defect","code_information":[{"code":"33732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2662.09,"maximum":2662.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2662.09}]}]},{"description":"Femoral endovas graft add-on","code_information":[{"code":"34813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":373.18,"maximum":373.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":373.18}]}]},{"description":"Xpose for endoprosth iliac","code_information":[{"code":"34820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":536.61,"maximum":536.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":536.61}]}]},{"description":"Open Aortic Tube Prosth Repr","code_information":[{"code":"34830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2815.99,"maximum":2815.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2815.99}]}]},{"description":"Open Aortoiliac Prosth Repr","code_information":[{"code":"34831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3089.67,"maximum":3089.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3089.67}]}]},{"description":"Open Aortofemor Prosth Repr","code_information":[{"code":"34832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3027.84,"maximum":3027.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3027.84}]}]},{"description":"Xpose for endoprosth iliac","code_information":[{"code":"34833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":625.42,"maximum":625.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.42}]}]},{"description":"Xpose endoprosth brachial","code_information":[{"code":"34834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":205.41,"maximum":205.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.41}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1774.73,"maximum":1774.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1774.73}]}]},{"description":"Repair artery rupture neck","code_information":[{"code":"35002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1822.81,"maximum":1822.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1822.81}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1597.28,"maximum":1597.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.28}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1614.39,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1614.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair artery rupture arm","code_information":[{"code":"35013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1896.9,"maximum":1896.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1896.9}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2029.25,"maximum":2029.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2029.25}]}]},{"description":"Repair artery rupture chest","code_information":[{"code":"35022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2318.57,"maximum":2318.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2318.57}]}]},{"description":"Repair defect of arm artery","code_information":[{"code":"35045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1551.52,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1551.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2759.67,"maximum":2759.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2759.67}]}]},{"description":"Repair artery rupture aorta","code_information":[{"code":"35082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3457.85,"maximum":3457.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3457.85}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2841.58,"maximum":2841.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2841.58}]}]},{"description":"Repair artery rupture aorta","code_information":[{"code":"35092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4141.16,"maximum":4141.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4141.16}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2998.13,"maximum":2998.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2998.13}]}]},{"description":"Repair artery rupture aorta","code_information":[{"code":"35103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3459.35,"maximum":3459.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3459.35}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2126.26,"maximum":2126.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2126.26}]}]},{"description":"Repair artery rupture spleen","code_information":[{"code":"35112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2612.22,"maximum":2612.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2612.22}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2527.24,"maximum":2527.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2527.24}]}]},{"description":"Repair artery rupture belly","code_information":[{"code":"35122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3019.74,"maximum":3019.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3019.74}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2214.88,"maximum":2214.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2214.88}]}]},{"description":"Revision of heart chamber","code_information":[{"code":"33735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2101.13,"maximum":2101.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2101.13}]}]},{"description":"Revision of heart chamber","code_information":[{"code":"33736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2278.1,"maximum":2278.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2278.1}]}]},{"description":"Tas congenital car anomal","code_information":[{"code":"33741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1199.6,"maximum":1199.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1199.6}]}]},{"description":"Tis cgen car anomal 1st shnt","code_information":[{"code":"33745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1713.91,"maximum":1713.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1713.91}]}]},{"description":"Tis cgen car anomal ea addl","code_information":[{"code":"33746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.83,"maximum":684.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.83}]}]},{"description":"Major vessel shunt","code_information":[{"code":"33750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2036.6,"maximum":2036.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2036.6}]}]},{"description":"Major vessel shunt","code_information":[{"code":"33755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2135.4,"maximum":2135.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2135.4}]}]},{"description":"Major vessel shunt","code_information":[{"code":"33762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2069.23,"maximum":2069.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2069.23}]}]},{"description":"Major vessel shunt & graft","code_information":[{"code":"33764","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2135.4,"maximum":2135.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2135.4}]}]},{"description":"Major vessel shunt","code_information":[{"code":"33766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2148.24,"maximum":2148.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2148.24}]}]},{"description":"Major vessel shunt","code_information":[{"code":"33767","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2291.48,"maximum":2291.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2291.48}]}]},{"description":"Cavopulmonary shunting","code_information":[{"code":"33768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":663.86,"maximum":663.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":663.86}]}]},{"description":"Repair great vessels defect","code_information":[{"code":"33770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3393.4,"maximum":3393.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3393.4}]}]},{"description":"Repair great vessels defect","code_information":[{"code":"33771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3486.08,"maximum":3486.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3486.08}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2055.76,"maximum":2055.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.76}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1641.95,"maximum":1641.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1641.95}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2433.55,"maximum":2433.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2433.55}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2596.36,"maximum":2596.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2596.36}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1300.89,"maximum":1300.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1300.89}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1557.0,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1557.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Reoperation carotid add-on","code_information":[{"code":"35390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":253.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81}]}]},{"description":"Angioscopy","code_information":[{"code":"35400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.38,"maximum":229.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.38}]}]},{"description":"Harvest vein for bypass","code_information":[{"code":"35500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":506.07,"maximum":506.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":506.07}]}]},{"description":"Art byp grft ipsilat carotid","code_information":[{"code":"35501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2330.64,"maximum":2330.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2330.64}]}]},{"description":"Art byp grft subclav-carotid","code_information":[{"code":"35506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2038.05,"maximum":2038.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2038.05}]}]},{"description":"Art byp grft carotid-vertbrl","code_information":[{"code":"35508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2128.36,"maximum":2128.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2128.36}]}]},{"description":"Art byp grft contral carotid","code_information":[{"code":"35509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2255.99,"maximum":2255.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2255.99}]}]},{"description":"Art byp grft carotid-brchial","code_information":[{"code":"35510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1965.67,"maximum":1965.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1965.67}]}]},{"description":"Art byp grft subclav-subclav","code_information":[{"code":"35511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1791.89,"maximum":1791.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1791.89}]}]},{"description":"Art byp grft subclav-brchial","code_information":[{"code":"35512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1928.04,"maximum":1928.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1928.04}]}]},{"description":"Art byp grft subclav-vertbrl","code_information":[{"code":"35515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2128.36,"maximum":2128.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2128.36}]}]},{"description":"Art byp grft subclav-axilary","code_information":[{"code":"35516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1951.48,"maximum":1951.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1951.48}]}]},{"description":"Art byp grft axillary-axilry","code_information":[{"code":"35518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1828.31,"maximum":1828.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1828.31}]}]},{"description":"Art byp grft axill-femoral","code_information":[{"code":"35521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1965.57,"maximum":1965.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1965.57}]}]},{"description":"Art byp grft axill-brachial","code_information":[{"code":"35522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1870.88,"maximum":1870.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1870.88}]}]},{"description":"Art byp grft brchl-ulnr-rdl","code_information":[{"code":"35523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1968.29,"maximum":1968.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1968.29}]}]},{"description":"Art byp grft brachial-brchl","code_information":[{"code":"35525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1760.23,"maximum":1760.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1760.23}]}]},{"description":"Art byp grft aor/carot/innom","code_information":[{"code":"35526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.72,"maximum":2773.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2773.72}]}]},{"description":"Art byp grft aorcel/aormesen","code_information":[{"code":"35531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3113.93,"maximum":3113.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3113.93}]}]},{"description":"Art byp grft axill/fem/fem","code_information":[{"code":"35533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2408.52,"maximum":2408.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2408.52}]}]},{"description":"Art byp grft hepatorenal","code_information":[{"code":"35535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3039.31,"maximum":3039.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3039.31}]}]},{"description":"Art byp grft splenorenal","code_information":[{"code":"35536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2701.03,"maximum":2701.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2701.03}]}]},{"description":"Art byp grft aortoiliac","code_information":[{"code":"35537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3327.51,"maximum":3327.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3327.51}]}]},{"description":"Art byp grft aortobi-iliac","code_information":[{"code":"35538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3728.42,"maximum":3728.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3728.42}]}]},{"description":"Art byp grft aortofemoral","code_information":[{"code":"35539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3498.58,"maximum":3498.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3498.58}]}]},{"description":"Art byp grft aortbifemoral","code_information":[{"code":"35540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.44,"maximum":3898.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.44}]}]},{"description":"Art byp grft fem-popliteal","code_information":[{"code":"35556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2223.57,"maximum":2223.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2223.57}]}]},{"description":"Art byp grft fem-femoral","code_information":[{"code":"35558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1952.82,"maximum":1952.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1952.82}]}]},{"description":"Art byp grft aortorenal","code_information":[{"code":"35560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2724.45,"maximum":2724.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2724.45}]}]},{"description":"Art byp grft ilioiliac","code_information":[{"code":"35563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2118.63,"maximum":2118.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2118.63}]}]},{"description":"Art byp grft iliofemoral","code_information":[{"code":"35565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2091.23,"maximum":2091.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2091.23}]}]},{"description":"Art byp fem-ant-post tib/prl","code_information":[{"code":"35566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2647.45,"maximum":2647.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2647.45}]}]},{"description":"Art byp tibial-tib/peroneal","code_information":[{"code":"35570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2356.17,"maximum":2356.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2356.17}]}]},{"description":"Art byp pop-tibl-prl-other","code_information":[{"code":"35571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2111.94,"maximum":2111.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2111.94}]}]},{"description":"Harvest femoropopliteal vein","code_information":[{"code":"35572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":546.36,"maximum":546.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":546.36}]}]},{"description":"Vein byp grft fem-popliteal","code_information":[{"code":"35583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2299.83,"maximum":2299.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2299.83}]}]},{"description":"Vein byp fem-tibial peroneal","code_information":[{"code":"35585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2662.54,"maximum":2662.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2662.54}]}]},{"description":"Vein byp pop-tibl peroneal","code_information":[{"code":"35587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2131.67,"maximum":2131.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2131.67}]}]},{"description":"Harvest art for cabg add-on","code_information":[{"code":"35600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.89,"maximum":296.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.89}]}]},{"description":"Art byp common ipsi carotid","code_information":[{"code":"35601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2247.52,"maximum":2247.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2247.52}]}]},{"description":"Art byp carotid-subclavian","code_information":[{"code":"35606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1875.57,"maximum":1875.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1875.57}]}]},{"description":"Art byp subclav-subclavian","code_information":[{"code":"35612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1675.2,"maximum":1675.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1675.2}]}]},{"description":"Art byp subclav-axillary","code_information":[{"code":"35616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1763.53,"maximum":1763.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1763.53}]}]},{"description":"Art byp axillary-femoral","code_information":[{"code":"35621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1748.11,"maximum":1748.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1748.11}]}]},{"description":"Art byp axillary-pop-tibial","code_information":[{"code":"35623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2103.89,"maximum":2103.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2103.89}]}]},{"description":"Art byp aorsubcl/carot/innom","code_information":[{"code":"35626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2557.23,"maximum":2557.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2557.23}]}]},{"description":"Art byp aor-celiac-msn-renal","code_information":[{"code":"35631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2946.53,"maximum":2946.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2946.53}]}]},{"description":"Art byp ilio-celiac","code_information":[{"code":"35632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2885.71,"maximum":2885.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2885.71}]}]},{"description":"Art byp ilio-mesenteric","code_information":[{"code":"35633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3154.25,"maximum":3154.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3154.25}]}]},{"description":"Art byp iliorenal","code_information":[{"code":"35634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2824.16,"maximum":2824.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2824.16}]}]},{"description":"Art byp spenorenal","code_information":[{"code":"35636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2549.57,"maximum":2549.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2549.57}]}]},{"description":"Art byp aortoiliac","code_information":[{"code":"35637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2650.88,"maximum":2650.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2650.88}]}]},{"description":"Art byp aortobi-iliac","code_information":[{"code":"35638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2787.74,"maximum":2787.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2787.74}]}]},{"description":"Art byp carotid-vertebral","code_information":[{"code":"35642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1586.87,"maximum":1586.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1586.87}]}]},{"description":"Art byp subclav-vertebrl","code_information":[{"code":"35645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1517.84,"maximum":1517.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1517.84}]}]},{"description":"Art byp aortobifemoral","code_information":[{"code":"35646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2715.05,"maximum":2715.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2715.05}]}]},{"description":"Art byp aortofemoral","code_information":[{"code":"35647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2450.31,"maximum":2450.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2450.31}]}]},{"description":"Art byp axillary-axillary","code_information":[{"code":"35650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1635.02,"maximum":1635.02,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1635.02}]}]},{"description":"Art byp axill-fem-femoral","code_information":[{"code":"35654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2181.11,"maximum":2181.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2181.11}]}]},{"description":"Art byp femoral-popliteal","code_information":[{"code":"35656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1709.96,"maximum":1709.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1709.96}]}]},{"description":"Art byp femoral-femoral","code_information":[{"code":"35661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1729.45,"maximum":1729.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1729.45}]}]},{"description":"Art byp ilioiliac","code_information":[{"code":"35663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.82,"maximum":1950.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1950.82}]}]},{"description":"Art byp iliofemoral","code_information":[{"code":"35665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1871.76,"maximum":1871.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1871.76}]}]},{"description":"Art byp fem-ant-post tib/prl","code_information":[{"code":"35666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2050.55,"maximum":2050.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2050.55}]}]},{"description":"Art byp pop-tibl-prl-other","code_information":[{"code":"35671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1799.05,"maximum":1799.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1799.05}]}]},{"description":"Composite byp grft pros&vein","code_information":[{"code":"35681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.37,"maximum":126.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.37}]}]},{"description":"Composite byp grft 2 veins","code_information":[{"code":"35682","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":559.39,"maximum":559.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":559.39}]}]},{"description":"Composite byp grft 3/> segmt","code_information":[{"code":"35683","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":652.03,"maximum":652.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":652.03}]}]},{"description":"Bypass graft patency/patch","code_information":[{"code":"35685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.39,"maximum":315.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":315.39}]}]},{"description":"Bypass graft/av fist patency","code_information":[{"code":"35686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.05,"maximum":256.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.05}]}]},{"description":"Art trnsposj vertbrl carotid","code_information":[{"code":"35691","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1515.66,"maximum":1515.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1515.66}]}]},{"description":"Art trnsposj subclavian","code_information":[{"code":"35693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1344.99,"maximum":1344.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1344.99}]}]},{"description":"Art trnsposj subclav carotid","code_information":[{"code":"35694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1583.73,"maximum":1583.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1583.73}]}]},{"description":"Art trnsposj carotid subclav","code_information":[{"code":"35695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.12,"maximum":1643.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.12}]}]},{"description":"Reimplant artery each","code_information":[{"code":"35697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":233.17,"maximum":233.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.17}]}]},{"description":"Reoperation bypass graft","code_information":[{"code":"35700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.31,"maximum":241.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.31}]}]},{"description":"Exploration carotid artery","code_information":[{"code":"35701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":714.75,"maximum":714.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":714.75}]}]},{"description":"Expl n/flwd surg uxtr art","code_information":[{"code":"35702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":663.19,"maximum":663.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":663.19}]}]},{"description":"Expl n/flwd surg lxtr art","code_information":[{"code":"35703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":673.06,"maximum":673.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":673.06}]}]},{"description":"Explore neck vessels","code_information":[{"code":"35800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1200.27,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1200.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Explore chest vessels","code_information":[{"code":"35820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3239.94,"maximum":3239.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.94}]}]},{"description":"Explore abdominal vessels","code_information":[{"code":"35840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1986.85,"maximum":1986.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1986.85}]}]},{"description":"Explore limb vessels","code_information":[{"code":"35860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1358.54,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1358.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Repair vessel graft defect","code_information":[{"code":"35870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1997.14,"maximum":1997.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1997.14}]}]},{"description":"Removal of clot in graft","code_information":[{"code":"35875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":945.2,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":945.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Removal of clot in graft","code_information":[{"code":"35876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1505.83,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1505.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Revise graft w/vein","code_information":[{"code":"35879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1474.55,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1474.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Revise graft w/vein","code_information":[{"code":"35881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1635.84,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1635.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Revise Graft w/Nonauto Graft","code_information":[{"code":"35883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1904.99,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1904.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Revise graft w/vein","code_information":[{"code":"35884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1980.42,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1980.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Excision graft neck","code_information":[{"code":"35901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":769.18,"maximum":769.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":769.18}]}]},{"description":"Excision graft extremity","code_information":[{"code":"35903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":903.59,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":903.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Excision graft thorax","code_information":[{"code":"35905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2684.68,"maximum":2684.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2684.68}]}]},{"description":"Excision graft abdomen","code_information":[{"code":"35907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3053.04,"maximum":3053.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3053.04}]}]},{"description":"Place needle in vein","code_information":[{"code":"36000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.76,"maximum":14.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.76}]}]},{"description":"Pseudoaneurysm injection trt","code_information":[{"code":"36002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.62,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Injection ext venography","code_information":[{"code":"36005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.43,"maximum":76.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.43}]}]},{"description":"Place catheter in vein","code_information":[{"code":"36010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":172.47,"maximum":172.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":172.47}]}]},{"description":"Place catheter in vein","code_information":[{"code":"36011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.07,"maximum":250.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":250.07}]}]},{"description":"Place catheter in vein","code_information":[{"code":"36012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":280.59,"maximum":280.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.16,"maximum":202.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.16}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.5,"maximum":243.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.5}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":277.08,"maximum":277.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277.08}]}]},{"description":"Establish access to artery","code_information":[{"code":"36100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.12,"maximum":244.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.12}]}]},{"description":"Establish access to artery","code_information":[{"code":"36140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":141.79,"maximum":141.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141.79}]}]},{"description":"Establish access to aorta","code_information":[{"code":"36160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.3,"maximum":197.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.3}]}]},{"description":"Place catheter in aorta","code_information":[{"code":"36200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.44,"maximum":223.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.44}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.95,"maximum":342.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.95}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":437.28,"maximum":437.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":437.28}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.98,"maximum":542.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":542.98}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":84.5,"maximum":84.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84.5}]}]},{"description":"Place cath thoracic aorta","code_information":[{"code":"36221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":319.91,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Place cath carotid/inom art","code_information":[{"code":"36222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.1,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Place cath carotid/inom art","code_information":[{"code":"36223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":534.53,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":534.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Place cath carotd art","code_information":[{"code":"36224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.95,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":599.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Place cath subclavian art","code_information":[{"code":"36225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":531.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":531.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Place cath vertebral art","code_information":[{"code":"36226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":595.69,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Place cath xtrnl carotid","code_information":[{"code":"36227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.23,"maximum":196.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196.23}]}]},{"description":"Place cath intracranial art","code_information":[{"code":"36228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":406.31,"maximum":406.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":406.31}]}]},{"description":"Ins cath abd/l-ext art 1st","code_information":[{"code":"36245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.17,"maximum":378.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.17}]}]},{"description":"Ins cath abd/l-ext art 2nd","code_information":[{"code":"36246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":402.48,"maximum":402.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":402.48}]}]},{"description":"Ins cath abd/l-ext art 3rd","code_information":[{"code":"36247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":475.62,"maximum":475.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":475.62}]}]},{"description":"Ins cath abd/l-ext art addl","code_information":[{"code":"36248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.64,"maximum":77.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.64}]}]},{"description":"Ins cath ren art 1st unilat","code_information":[{"code":"36251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.17,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 1st bilat","code_information":[{"code":"36252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":569.5,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":569.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 2nd+ unilat","code_information":[{"code":"36253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":566.05,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":566.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 2nd+ bilat","code_information":[{"code":"36254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":665.97,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":665.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of infusion pump","code_information":[{"code":"36260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1082.45,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1082.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Revision of infusion pump","code_information":[{"code":"36261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":683.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":683.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of infusion pump","code_information":[{"code":"36262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":521.97,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Bl draw < 3 yrs fem/jugular","code_information":[{"code":"36400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.11,"maximum":30.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.11}]}]},{"description":"Bl draw <3 yrs scalp vein","code_information":[{"code":"36405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.09,"maximum":24.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.09}]}]},{"description":"Bl draw <3 yrs other vein","code_information":[{"code":"36406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.24,"maximum":14.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.24}]}]},{"description":"Non-routine bl draw 3/> yrs","code_information":[{"code":"36410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.76,"maximum":14.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.76}]}]},{"description":"Vein access cutdown < 1 yr","code_information":[{"code":"36420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Vein access cutdown > 1 yr","code_information":[{"code":"36425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.86,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Repair artery rupture groin","code_information":[{"code":"35132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2612.22,"maximum":2612.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2612.22}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1744.85,"maximum":1744.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1744.85}]}]},{"description":"Repair artery rupture thigh","code_information":[{"code":"35142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2107.53,"maximum":2107.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2107.53}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1977.38,"maximum":1977.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1977.38}]}]},{"description":"Repair ruptd popliteal art","code_information":[{"code":"35152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2236.31,"maximum":2236.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2236.31}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1259.59,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1259.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2890.23,"maximum":2890.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2890.23}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1545.62,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2130.02,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2130.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2412.9,"maximum":2412.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2412.9}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1211.82,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1211.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.43,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1287.41,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1287.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1252.12,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1252.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2242.95,"maximum":2242.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2242.95}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3356.36,"maximum":3356.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3356.36}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2368.01,"maximum":2368.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2368.01}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1328.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2034.27,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2034.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1626.38,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2308.24,"maximum":2308.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2308.24}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.98,"maximum":2510.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2510.98}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2779.89,"maximum":2779.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2779.89}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1634.93,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1634.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1573.33,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1573.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1390.83,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1390.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2223.76,"maximum":2223.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2223.76}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2346.27,"maximum":2346.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2346.27}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2622.52,"maximum":2622.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2622.52}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1484.29,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1484.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1803.26,"maximum":1803.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1803.26}]}]},{"description":"Rechanneling of Artery","code_information":[{"code":"35302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1781.37,"maximum":1781.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1781.37}]}]},{"description":"Rechanneling of Artery","code_information":[{"code":"35303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1957.32,"maximum":1957.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1957.32}]}]},{"description":"Rechanneling of Artery","code_information":[{"code":"35304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2034.06,"maximum":2034.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2034.06}]}]},{"description":"Rechanneling of Artery","code_information":[{"code":"35305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1951.82,"maximum":1951.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1951.82}]}]},{"description":"Rechanneling of Artery","code_information":[{"code":"35306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.75,"maximum":708.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.75}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2490.54,"maximum":2490.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2490.54}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1453.06,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1453.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2311.86,"maximum":2311.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2311.86}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2197.77,"maximum":2197.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2197.77}]}]},{"description":"Stent placemt ante carotid","code_information":[{"code":"37218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1330.19,"maximum":1330.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.19}]}]},{"description":"Iliac revasc","code_information":[{"code":"37220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":636.12,"maximum":636.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":636.12}]}]},{"description":"Iliac revasc w/stent","code_information":[{"code":"37221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":783.13,"maximum":783.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":783.13}]}]},{"description":"Iliac revasc add-on","code_information":[{"code":"37222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.46,"maximum":295.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":295.46}]}]},{"description":"Iliac revasc w/stent add-on","code_information":[{"code":"37223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":336.78,"maximum":336.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.78}]}]},{"description":"Fem/popl revas w/tla","code_information":[{"code":"37224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.27,"maximum":706.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":706.27}]}]},{"description":"Fem/popl revas w/ather","code_information":[{"code":"37225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":948.13,"maximum":948.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":948.13}]}]},{"description":"Fem/popl revasc w/stent","code_information":[{"code":"37226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":824.52,"maximum":824.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.52}]}]},{"description":"Fem/popl revasc stnt & ather","code_information":[{"code":"37227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1137.31,"maximum":1137.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1137.31}]}]},{"description":"Tib/per revasc w/tla","code_information":[{"code":"37228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":860.09,"maximum":860.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":860.09}]}]},{"description":"Tib/per revasc w/ather","code_information":[{"code":"37229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1101.23,"maximum":1101.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1101.23}]}]},{"description":"Tib/per revasc w/stent","code_information":[{"code":"37230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1104.78,"maximum":1104.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1104.78}]}]},{"description":"Tib/per revasc stent & ather","code_information":[{"code":"37231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1178.51,"maximum":1178.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1178.51}]}]},{"description":"Tib/per revasc add-on","code_information":[{"code":"37232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":316.33,"maximum":316.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":316.33}]}]},{"description":"Tibper revasc w/ather add-on","code_information":[{"code":"37233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":512.33,"maximum":512.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":512.33}]}]},{"description":"Revsc opn/prq tib/pero stent","code_information":[{"code":"37234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":447.59,"maximum":447.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":447.59}]}]},{"description":"Tib/per revasc stnt & ather","code_information":[{"code":"37235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":595.09,"maximum":595.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.09}]}]},{"description":"Open/perq place stent 1st","code_information":[{"code":"37236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.08,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":702.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Open/perq place stent ea add","code_information":[{"code":"37237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":336.31,"maximum":336.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.31}]}]},{"description":"Open/perq place stent same","code_information":[{"code":"37238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":489.81,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":489.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Open/perq place stent ea add","code_information":[{"code":"37239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.05,"maximum":241.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.05}]}]},{"description":"Vasc embolize/occlude venous","code_information":[{"code":"37241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":681.94,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":681.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude artery","code_information":[{"code":"37242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.81,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude organ","code_information":[{"code":"37243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.34,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":897.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude bleed","code_information":[{"code":"37244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1055.39,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1055.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Trluml balo angiop 1st art","code_information":[{"code":"37246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":556.48,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":556.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Trluml balo angiop addl art","code_information":[{"code":"37247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":277.78,"maximum":277.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277.78}]}]},{"description":"Trluml balo angiop 1st vein","code_information":[{"code":"37248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":474.17,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":474.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Trluml balo angiop addl vein","code_information":[{"code":"37249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.14,"maximum":234.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.14}]}]},{"description":"Intrvasc us noncoronary 1st","code_information":[{"code":"37252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.37,"maximum":142.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.37}]}]},{"description":"Intrvasc us noncoronary addl","code_information":[{"code":"37253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.47,"maximum":113.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.47}]}]},{"description":"Endoscopy ligate perf veins","code_information":[{"code":"37500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1014.39,"maximum":1014.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1014.39}]}]},{"description":"Ligation of neck vein","code_information":[{"code":"37565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1185.16,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1185.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1228.45,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1228.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1185.04,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1185.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1221.43,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1221.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of a-v fistula","code_information":[{"code":"37607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":604.3,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":604.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Temporal artery procedure","code_information":[{"code":"37609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":332.12,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.44,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":846.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of chest artery","code_information":[{"code":"37616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.65,"maximum":1858.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.65}]}]},{"description":"Ligation of abdomen artery","code_information":[{"code":"37617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2145.31,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2145.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of extremity artery","code_information":[{"code":"37618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":637.84,"maximum":637.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":637.84}]}]},{"description":"Ligation of inf vena cava","code_information":[{"code":"37619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2816.78,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2816.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Revision of major vein","code_information":[{"code":"37650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.07,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":742.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Revision of major vein","code_information":[{"code":"37660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2150.52,"maximum":2150.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2150.52}]}]},{"description":"Revise leg vein","code_information":[{"code":"37700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":397.2,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":397.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/strip short leg vein","code_information":[{"code":"37718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":635.86,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":635.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/strip long leg vein","code_information":[{"code":"37722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.31,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Removal of leg veins/lesion","code_information":[{"code":"37735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":937.13,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":937.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligate leg veins radical","code_information":[{"code":"37760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":928.38,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":928.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligate leg veins open","code_information":[{"code":"37761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":858.99,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":858.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Stab phleb veins xtr 10-20","code_information":[{"code":"37765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":433.61,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":433.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Phleb veins - extrem 20+","code_information":[{"code":"37766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":534.89,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":534.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Revision of leg vein","code_information":[{"code":"37780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":383.15,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":383.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/divide/excise vein","code_information":[{"code":"37785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":408.14,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":408.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Revascularization penis","code_information":[{"code":"37788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2060.59,"maximum":2060.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2060.59}]}]},{"description":"Penile venous occlusion","code_information":[{"code":"37790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.79,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":798.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of spleen total","code_information":[{"code":"38100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1885.69,"maximum":1885.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1885.69}]}]},{"description":"Removal of spleen partial","code_information":[{"code":"38101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1910.38,"maximum":1910.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1910.38}]}]},{"description":"Removal of spleen total","code_information":[{"code":"38102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":425.99,"maximum":425.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.99}]}]},{"description":"Repair of ruptured spleen","code_information":[{"code":"38115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2116.69,"maximum":2116.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2116.69}]}]},{"description":"Laparoscopy splenectomy","code_information":[{"code":"38120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1742.83,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1742.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Injection for spleen x-ray","code_information":[{"code":"38200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":210.15,"maximum":210.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210.15}]}]},{"description":"Harvest auto stem cells","code_information":[{"code":"38206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.48,"maximum":8124.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1736.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2605.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7232.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8124.1,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow aspiration","code_information":[{"code":"38220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.89,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow biopsy","code_information":[{"code":"38221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.21,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Dx bone marrow bx & aspir","code_information":[{"code":"38222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.42,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Car-t hrv bld-drv t lymphcyt","code_information":[{"code":"38225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.59,"maximum":158.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158.59}]}]},{"description":"Car-t prep t lymphcyt f/trns","code_information":[{"code":"38226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.01,"maximum":64.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.01}]}]},{"description":"Car-t receipt&prepj admn","code_information":[{"code":"38227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.58,"maximum":64.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.58}]}]},{"description":"Car-t admn autologous","code_information":[{"code":"38228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":288.09,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow harvest allogen","code_information":[{"code":"38230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":330.21,"maximum":8124.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1736.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2605.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":330.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7232.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8124.1,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow harvest autolog","code_information":[{"code":"38232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.27,"maximum":22719.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4857.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7285.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":304.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20226.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22719.87,"additional_payer_notes":"APC"}]}]},{"description":"Transplt allo hct/donor","code_information":[{"code":"38240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.08,"maximum":328114.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70147.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105221.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":394.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71550.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":292101.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":328114.87,"additional_payer_notes":"APC"}]}]},{"description":"Transplt autol hct/donor","code_information":[{"code":"38241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":290.82,"maximum":8124.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1736.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2605.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":290.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7232.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8124.1,"additional_payer_notes":"APC"}]}]},{"description":"Transplt allo lymphocytes","code_information":[{"code":"38242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":205.51,"maximum":8124.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1736.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2605.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7232.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8124.1,"additional_payer_notes":"APC"}]}]},{"description":"Transplj hematopoietic boost","code_information":[{"code":"38243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.28,"maximum":8124.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1736.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2605.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7232.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8124.1,"additional_payer_notes":"APC"}]}]},{"description":"Drainage lymph node lesion","code_information":[{"code":"38300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":348.94,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":348.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Drainage lymph node lesion","code_information":[{"code":"38305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":822.12,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":822.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Incision of lymph channels","code_information":[{"code":"38308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":780.27,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":780.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Thoracic duct procedure","code_information":[{"code":"38380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":958.93,"maximum":958.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":958.93}]}]},{"description":"Thoracic duct procedure","code_information":[{"code":"38381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1319.95,"maximum":1319.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1319.95}]}]},{"description":"Thoracic duct procedure","code_information":[{"code":"38382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1116.54,"maximum":1116.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1116.54}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":420.64,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":420.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy lymph nodes","code_information":[{"code":"38505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.39,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":689.25,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":689.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":775.84,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":730.52,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":730.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":942.35,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":942.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Open bx/exc inguinofem nodes","code_information":[{"code":"38531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.47,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Blood transfusion service","code_information":[{"code":"36430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.88,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Bl push transfuse 2 yr/<","code_information":[{"code":"36440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.98,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Bl exchange/transfuse nb","code_information":[{"code":"36450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":273.32,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Bl exchange/transfuse non-nb","code_information":[{"code":"36455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.04,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Prtl exchange transfuse nb","code_information":[{"code":"36456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.14,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Transfusion service fetal","code_information":[{"code":"36460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":558.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Njx noncmpnd sclrsnt 1 vein","code_information":[{"code":"36465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.01,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Njx noncmpnd sclrsnt mlt vn","code_information":[{"code":"36466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.79,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Injection therapy of vein","code_information":[{"code":"36470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.13,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Injection therapy of veins","code_information":[{"code":"36471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.65,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous mchnchem 1st vein","code_information":[{"code":"36473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":290.08,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":290.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous mchnchem add-on","code_information":[{"code":"36474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.94,"maximum":143.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.94}]}]},{"description":"Endovenous rf 1st vein","code_information":[{"code":"36475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":444.73,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous rf vein add-on","code_information":[{"code":"36476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.22,"maximum":214.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.22}]}]},{"description":"Endovenous laser 1st vein","code_information":[{"code":"36478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.99,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous laser vein addon","code_information":[{"code":"36479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.58,"maximum":217.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.58}]}]},{"description":"Insertion of catheter vein","code_information":[{"code":"36481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":520.85,"maximum":520.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":520.85}]}]},{"description":"Endoven ther chem adhes 1st","code_information":[{"code":"36482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":287.91,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":287.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Endoven ther chem adhes sbsq","code_information":[{"code":"36483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.25,"maximum":142.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.25}]}]},{"description":"Insertion of catheter vein","code_information":[{"code":"36500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.46,"maximum":293.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":293.46}]}]},{"description":"Insertion of catheter vein","code_information":[{"code":"36510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":84.91,"maximum":84.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84.91}]}]},{"description":"Apheresis wbc","code_information":[{"code":"36511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":181.06,"maximum":8124.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1736.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2605.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7232.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8124.1,"additional_payer_notes":"APC"}]}]},{"description":"Apheresis rbc","code_information":[{"code":"36512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":171.83,"maximum":8124.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1736.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2605.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7232.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8124.1,"additional_payer_notes":"APC"}]}]},{"description":"Apheresis platelets","code_information":[{"code":"36513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.45,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Apheresis plasma","code_information":[{"code":"36514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":151.53,"maximum":8124.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1736.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2605.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7232.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8124.1,"additional_payer_notes":"APC"}]}]},{"description":"Apheresis selective","code_information":[{"code":"36516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":22719.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4857.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7285.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20226.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22719.87,"additional_payer_notes":"APC"}]}]},{"description":"Photopheresis","code_information":[{"code":"36522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.36,"maximum":22719.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4857.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7285.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20226.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22719.87,"additional_payer_notes":"APC"}]}]},{"description":"Insert non-tunnel cv cath","code_information":[{"code":"36555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":136.46,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insert non-tunnel cv cath","code_information":[{"code":"36556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":136.13,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":526.52,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":526.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.26,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":628.3,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":536.84,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":536.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":588.74,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":588.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":546.36,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":546.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.52,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Insert picc cath","code_information":[{"code":"36568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.96,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Insert picc cath","code_information":[{"code":"36569","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.46,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Insert picvad cath","code_information":[{"code":"36570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":545.06,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":545.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insert picvad cath","code_information":[{"code":"36571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":507.69,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":507.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insj picc rs&i <5 yr","code_information":[{"code":"36572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.34,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Insj picc rs&i 5 yr+","code_information":[{"code":"36573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.58,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Repair tunneled cv cath","code_information":[{"code":"36575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.15,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Repair tunneled cv cath","code_information":[{"code":"36576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.49,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.41,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Replace cvad cath","code_information":[{"code":"36580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":104.42,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.91,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":295.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":464.74,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":464.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":539.6,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":539.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Replace picc cath","code_information":[{"code":"36584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.16,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Replace picvad cath","code_information":[{"code":"36585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.83,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Removal tunneled cv cath","code_information":[{"code":"36589","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":221.49,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":221.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Removal tunneled cv cath","code_information":[{"code":"36590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.01,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":308.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Draw blood off venous device","code_information":[{"code":"36591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.99,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Collect blood from picc","code_information":[{"code":"36592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.23,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Declot vascular device","code_information":[{"code":"36593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.34,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Mech remov tunneled cv cath","code_information":[{"code":"36595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":290.85,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":290.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Mech remov tunneled cv cath","code_information":[{"code":"36596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.15,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Reposition venous catheter","code_information":[{"code":"36597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.28,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Inj w/fluor eval cv device","code_information":[{"code":"36598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.94,"maximum":1109.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":355.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":987.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.54,"additional_payer_notes":"APC"}]}]},{"description":"Withdrawal of arterial blood","code_information":[{"code":"36600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.11,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Insertion catheter artery","code_information":[{"code":"36620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.69,"maximum":70.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.69}]}]},{"description":"Insertion catheter artery","code_information":[{"code":"36625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.36,"maximum":169.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.36}]}]},{"description":"Insertion catheter artery","code_information":[{"code":"36640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.83,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insertion catheter artery","code_information":[{"code":"36660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.07,"maximum":110.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.07}]}]},{"description":"Insert needle bone cavity","code_information":[{"code":"36680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.14,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula","code_information":[{"code":"36800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.66,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula","code_information":[{"code":"36810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":312.65,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":312.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula","code_information":[{"code":"36815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.3,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Av fuse uppr arm cephalic","code_information":[{"code":"36818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1103.65,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1103.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Av fuse uppr arm basilic","code_information":[{"code":"36819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1166.83,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1166.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Av fusion/forearm vein","code_information":[{"code":"36820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1168.92,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1168.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Av fusion direct any site","code_information":[{"code":"36821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1056.81,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1056.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula(s)","code_information":[{"code":"36823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2302.0,"maximum":2302.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2302.0}]}]},{"description":"Artery-vein autograft","code_information":[{"code":"36825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1269.03,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1269.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Artery-vein nonautograft","code_information":[{"code":"36830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.71,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Open thrombect av fistula","code_information":[{"code":"36831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":991.31,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":991.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Av fistula revision open","code_information":[{"code":"36832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1211.39,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1211.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Av fistula revision","code_information":[{"code":"36833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1292.53,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1292.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Artery to vein shunt","code_information":[{"code":"36835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":787.89,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Prq av fstl crtj uxtr 1 acs","code_information":[{"code":"36836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":571.55,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":571.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Prq av fstl crt uxtr sep acs","code_information":[{"code":"36837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":736.41,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Dist revas ligation hemo","code_information":[{"code":"36838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1824.31,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1824.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"External cannula declotting","code_information":[{"code":"36860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":178.54,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Cannula declotting","code_information":[{"code":"36861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.2,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":269.8,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.96,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.52,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":503.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Thrmbc/nfs dialysis circuit","code_information":[{"code":"36904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":587.88,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":587.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Thrmbc/nfs dialysis circuit","code_information":[{"code":"36905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":707.67,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":707.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Thrmbc/nfs dialysis circuit","code_information":[{"code":"36906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":814.71,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":814.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Balo angiop ctr dialysis seg","code_information":[{"code":"36907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.84,"maximum":234.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.84}]}]},{"description":"Stent plmt ctr dialysis seg","code_information":[{"code":"36908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.45,"maximum":331.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.45}]}]},{"description":"Dialysis circuit embolj","code_information":[{"code":"36909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.05,"maximum":320.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.05}]}]},{"description":"Revision of circulation","code_information":[{"code":"37140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3788.07,"maximum":3788.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3788.07}]}]},{"description":"Revision of circulation","code_information":[{"code":"37145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3515.93,"maximum":3515.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3515.93}]}]},{"description":"Revision of circulation","code_information":[{"code":"37160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3610.12,"maximum":3610.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.12}]}]},{"description":"Revision of circulation","code_information":[{"code":"37180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3470.76,"maximum":3470.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3470.76}]}]},{"description":"Splice spleen/kidney veins","code_information":[{"code":"37181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3788.07,"maximum":3788.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3788.07}]}]},{"description":"Insert hepatic shunt (tips)","code_information":[{"code":"37182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.39,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Remove hepatic shunt (tips)","code_information":[{"code":"37183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.47,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Prim art m-thrmbc 1st vsl","code_information":[{"code":"37184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":688.61,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":688.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Prim art m-thrmbc sbsq vsl","code_information":[{"code":"37185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":259.78,"maximum":259.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":259.78}]}]},{"description":"Sec art thrombectomy add-on","code_information":[{"code":"37186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.44,"maximum":390.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.44}]}]},{"description":"Venous mech thrombectomy","code_information":[{"code":"37187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":629.49,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":629.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Venous m-thrombectomy add-on","code_information":[{"code":"37188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":451.78,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":451.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ins endovas vena cava filtr","code_information":[{"code":"37191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":352.97,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":352.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Redo endovas vena cava filtr","code_information":[{"code":"37192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":549.67,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":549.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Rem endovas vena cava filter","code_information":[{"code":"37193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":554.05,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":554.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Remove intrvas foreign body","code_information":[{"code":"37197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":480.5,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":480.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Transcatheter biopsy","code_information":[{"code":"37200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":345.78,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":345.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Thrombolytic art therapy","code_information":[{"code":"37211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":617.61,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Thrombolytic venous therapy","code_information":[{"code":"37212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":539.91,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":539.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Thromblytic art/ven therapy","code_information":[{"code":"37213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":369.04,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":369.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Cessj therapy cath removal","code_information":[{"code":"37214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.87,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Transcath stent cca w/eps","code_information":[{"code":"37215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1578.99,"maximum":1578.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1578.99}]}]},{"description":"Transcath stent cca w/o eps","code_information":[{"code":"37216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1600.27,"maximum":1600.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1600.27}]}]},{"description":"Stent placemt retro carotid","code_information":[{"code":"37217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1731.81,"maximum":1731.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1731.81}]}]},{"description":"Partial removal of tongue","code_information":[{"code":"41120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.98,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of tongue","code_information":[{"code":"41130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2134.41,"maximum":2134.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.41}]}]},{"description":"Tongue and neck surgery","code_information":[{"code":"41135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3519.93,"maximum":3519.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3519.93}]}]},{"description":"Removal of tongue","code_information":[{"code":"41140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3540.45,"maximum":3540.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3540.45}]}]},{"description":"Tongue removal neck surgery","code_information":[{"code":"41145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4458.26,"maximum":4458.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4458.26}]}]},{"description":"Tongue mouth jaw surgery","code_information":[{"code":"41150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3569.47,"maximum":3569.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3569.47}]}]},{"description":"Tongue mouth neck surgery","code_information":[{"code":"41153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3888.94,"maximum":3888.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3888.94}]}]},{"description":"Tongue jaw & neck surgery","code_information":[{"code":"41155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4841.55,"maximum":4841.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4841.55}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.71,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":303.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":344.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Tongue to lip surgery","code_information":[{"code":"41510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":743.91,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":743.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Tongue suspension","code_information":[{"code":"41512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1089.68,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction tongue fold","code_information":[{"code":"41520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":415.95,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":415.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Tongue base vol reduction","code_information":[{"code":"41530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":618.13,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":618.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of gum lesion","code_information":[{"code":"41800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":261.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Removal foreign body gum","code_information":[{"code":"41805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":317.05,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Removal foreign body jawbone","code_information":[{"code":"41806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":449.32,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":449.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":336.79,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":611.96,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":611.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.58,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":323.77,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":323.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":482.46,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":368.68,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Removal of gum tissue","code_information":[{"code":"41830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":516.88,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":516.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair gum","code_information":[{"code":"41872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":508.0,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair tooth socket","code_information":[{"code":"41874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":413.12,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":413.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Drainage mouth roof lesion","code_information":[{"code":"42000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.8,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy roof of mouth","code_information":[{"code":"42100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.56,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision lesion mouth roof","code_information":[{"code":"42104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.39,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision lesion mouth roof","code_information":[{"code":"42106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.61,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision lesion mouth roof","code_information":[{"code":"42107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":539.37,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":539.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove palate/lesion","code_information":[{"code":"42120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1641.9,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1641.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excision of uvula","code_information":[{"code":"42140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":271.07,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair palate pharynx/uvula","code_information":[{"code":"42145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1133.17,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Treatment mouth roof lesion","code_information":[{"code":"42160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.12,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair palate","code_information":[{"code":"42180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.57,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Repair palate","code_information":[{"code":"42182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":426.35,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1526.8,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1526.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1587.09,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1587.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1772.61,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1159.57,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1159.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":955.3,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":955.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1624.12,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1624.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of palate","code_information":[{"code":"42226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1490.88,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1490.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of palate","code_information":[{"code":"42227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1388.67,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1388.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair palate","code_information":[{"code":"42235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1221.6,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1221.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair nose to lip fistula","code_information":[{"code":"42260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1106.89,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1106.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Insertion palate prosthesis","code_information":[{"code":"42281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.07,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":258.78,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":717.39,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":717.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":224.0,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":224.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.96,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":273.63,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":438.54,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":438.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":571.65,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":571.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of salivary gland","code_information":[{"code":"42400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.78,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of salivary gland","code_information":[{"code":"42405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.6,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision of salivary cyst","code_information":[{"code":"42408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.09,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":579.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary cyst","code_information":[{"code":"42409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":387.81,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":387.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excise parotid gland/lesion","code_information":[{"code":"42410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1039.58,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1039.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excise parotid gland/lesion","code_information":[{"code":"42415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1744.76,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1744.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excise parotid gland/lesion","code_information":[{"code":"42420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1952.79,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1952.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excise parotid gland/lesion","code_information":[{"code":"42425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1385.76,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1385.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excise parotid gland/lesion","code_information":[{"code":"42426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2219.9,"maximum":2219.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2219.9}]}]},{"description":"Excise submaxillary gland","code_information":[{"code":"42440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":688.54,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":688.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Excise sublingual gland","code_information":[{"code":"42450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":604.71,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":604.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair salivary duct","code_information":[{"code":"42500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":572.6,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":572.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair salivary duct","code_information":[{"code":"42505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":757.57,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":757.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Parotid duct diversion","code_information":[{"code":"42507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":812.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":812.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Parotid duct diversion","code_information":[{"code":"42509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1342.02,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1342.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Parotid duct diversion","code_information":[{"code":"42510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":999.97,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":999.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Injection for salivary x-ray","code_information":[{"code":"42550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.12,"maximum":100.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.12}]}]},{"description":"Closure of salivary fistula","code_information":[{"code":"42600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":591.3,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":591.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of salivary duct","code_information":[{"code":"42650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.59,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of salivary duct","code_information":[{"code":"42660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.29,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of salivary duct","code_information":[{"code":"42665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":362.7,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":362.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of tonsil abscess","code_information":[{"code":"42700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.98,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of throat abscess","code_information":[{"code":"42720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":635.51,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":635.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of throat abscess","code_information":[{"code":"42725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1319.38,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1319.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of throat","code_information":[{"code":"42800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.97,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of upper nose/throat","code_information":[{"code":"42804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.06,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":203.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of upper nose/throat","code_information":[{"code":"42806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.15,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excise pharynx lesion","code_information":[{"code":"42808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":276.3,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":276.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Remove pharynx foreign body","code_information":[{"code":"42809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":208.2,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":208.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Excision of neck cyst","code_information":[{"code":"42810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":469.96,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":469.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision of neck cyst","code_information":[{"code":"42815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":887.55,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":887.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove tonsils and adenoids","code_information":[{"code":"42820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":484.58,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":484.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove tonsils and adenoids","code_information":[{"code":"42821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":505.26,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":505.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tonsils","code_information":[{"code":"42825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":448.35,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":448.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal neck/armpit lesion","code_information":[{"code":"38550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":867.87,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":867.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal neck/armpit lesion","code_information":[{"code":"38555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1692.18,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1692.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Removal pelvic lymph nodes","code_information":[{"code":"38562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1168.81,"maximum":42635.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13672.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1168.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9297.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37955.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42635.34,"additional_payer_notes":"APC"}]}]},{"description":"Removal abdomen lymph nodes","code_information":[{"code":"38564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1157.73,"maximum":1157.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1157.73}]}]},{"description":"Laparoscopy lymph node biop","code_information":[{"code":"38570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":849.85,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":849.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lymphadenectomy","code_information":[{"code":"38571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1086.09,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1086.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lymphadenectomy","code_information":[{"code":"38572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1472.43,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laps pelvic lymphadec","code_information":[{"code":"38573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1935.1,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1935.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of lymph nodes neck","code_information":[{"code":"38700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1330.59,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Removal of lymph nodes neck","code_information":[{"code":"38720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.57,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Removal of lymph nodes neck","code_information":[{"code":"38724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2386.09,"maximum":2386.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2386.09}]}]},{"description":"Remove armpit lymph nodes","code_information":[{"code":"38740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.42,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1160.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove armpit lymph nodes","code_information":[{"code":"38745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1457.58,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1457.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove thoracic lymph nodes","code_information":[{"code":"38746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":343.12,"maximum":343.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.12}]}]},{"description":"Remove abdominal lymph nodes","code_information":[{"code":"38747","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":431.85,"maximum":431.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":431.85}]}]},{"description":"Remove groin lymph nodes","code_information":[{"code":"38760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1378.46,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1378.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Remove groin lymph nodes","code_information":[{"code":"38765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.23,"maximum":2154.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.23}]}]},{"description":"Remove pelvis lymph nodes","code_information":[{"code":"38770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1323.26,"maximum":1323.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1323.26}]}]},{"description":"Remove abdomen lymph nodes","code_information":[{"code":"38780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1736.07,"maximum":1736.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1736.07}]}]},{"description":"Inject for lymphatic x-ray","code_information":[{"code":"38790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.68,"maximum":134.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.68}]}]},{"description":"Ra tracer id of sentinl node","code_information":[{"code":"38792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.96,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Access thoracic lymph duct","code_information":[{"code":"38794","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":462.98,"maximum":462.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.98}]}]},{"description":"Io map of sent lymph node","code_information":[{"code":"38900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.81,"maximum":223.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.81}]}]},{"description":"Exploration of chest","code_information":[{"code":"39000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":827.9,"maximum":827.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":827.9}]}]},{"description":"Exploration of chest","code_information":[{"code":"39010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.68,"maximum":1284.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1284.68}]}]},{"description":"Resect mediastinal cyst","code_information":[{"code":"39200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1409.9,"maximum":1409.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1409.9}]}]},{"description":"Resect mediastinal tumor","code_information":[{"code":"39220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1848.89,"maximum":1848.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1848.89}]}]},{"description":"Mediastinoscpy w/medstnl bx","code_information":[{"code":"39401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":499.83,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":499.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Mediastinoscpy w/lmph nod bx","code_information":[{"code":"39402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":651.69,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":651.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair diaphragm laceration","code_information":[{"code":"39501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1394.6,"maximum":1394.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1394.6}]}]},{"description":"Repair of diaphragm hernia","code_information":[{"code":"39503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9326.87,"maximum":9326.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9326.87}]}]},{"description":"Repair of diaphragm hernia","code_information":[{"code":"39540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1410.87,"maximum":1410.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1410.87}]}]},{"description":"Repair of diaphragm hernia","code_information":[{"code":"39541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1532.1,"maximum":1532.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1532.1}]}]},{"description":"Revision of diaphragm","code_information":[{"code":"39545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1461.36,"maximum":1461.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1461.36}]}]},{"description":"Resect diaphragm simple","code_information":[{"code":"39560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1318.19,"maximum":1318.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1318.19}]}]},{"description":"Resect diaphragm complex","code_information":[{"code":"39561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2058.76,"maximum":2058.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2058.76}]}]},{"description":"Biopsy of lip","code_information":[{"code":"40490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.63,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.9,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.38,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":579.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":594.95,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":594.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct lip with flap","code_information":[{"code":"40525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":910.02,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":910.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct lip with flap","code_information":[{"code":"40527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1039.06,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1039.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of lip","code_information":[{"code":"40530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":671.74,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":671.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair lip","code_information":[{"code":"40650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":529.4,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":529.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Repair lip","code_information":[{"code":"40652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":601.46,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":603.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Repair lip","code_information":[{"code":"40654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":709.68,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":709.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1665.92,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1665.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1962.5,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1962.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1651.31,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1651.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1693.89,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1693.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1779.01,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1779.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"40800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.78,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"40801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.66,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal foreign body mouth","code_information":[{"code":"40804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.49,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Removal foreign body mouth","code_information":[{"code":"40805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.12,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Incision of lip fold","code_information":[{"code":"40806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.53,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of mouth lesion","code_information":[{"code":"40808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.72,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Excision of mouth lesion","code_information":[{"code":"40810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.08,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excise/repair mouth lesion","code_information":[{"code":"40812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.41,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excise/repair mouth lesion","code_information":[{"code":"40814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":470.34,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":470.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision of mouth lesion","code_information":[{"code":"40816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":502.88,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":502.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excise oral mucosa for graft","code_information":[{"code":"40818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.66,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Excise lip or cheek fold","code_information":[{"code":"40819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":334.21,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":334.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of mouth lesion","code_information":[{"code":"40820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.4,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair mouth laceration","code_information":[{"code":"40830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":242.52,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair mouth laceration","code_information":[{"code":"40831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":335.21,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of mouth","code_information":[{"code":"40840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1039.41,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1039.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of mouth","code_information":[{"code":"40842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1014.11,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1014.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of mouth","code_information":[{"code":"40843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1438.04,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1438.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of mouth","code_information":[{"code":"40844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1947.05,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1947.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of mouth","code_information":[{"code":"40845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1988.16,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1988.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.11,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.01,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":387.87,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":387.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.04,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":371.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.38,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":475.82,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":475.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tongue fold","code_information":[{"code":"41010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.69,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":499.05,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":499.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.52,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":566.21,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":566.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":662.86,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":662.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Place needles h&n for rt","code_information":[{"code":"41019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":810.2,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":810.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of tongue","code_information":[{"code":"41100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.69,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of tongue","code_information":[{"code":"41105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.61,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of floor of mouth","code_information":[{"code":"41108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":151.95,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.53,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":402.02,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":402.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":436.51,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1021.97,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1021.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue fold","code_information":[{"code":"41115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.76,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision of mouth lesion","code_information":[{"code":"41116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":358.37,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":358.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tonsils","code_information":[{"code":"42826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":426.11,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.66,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":355.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":386.15,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":386.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.66,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":410.22,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":410.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Extensive surgery of throat","code_information":[{"code":"42842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1650.26,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1650.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Extensive surgery of throat","code_information":[{"code":"42844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2246.33,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2246.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Extensive surgery of throat","code_information":[{"code":"42845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3587.46,"maximum":3587.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3587.46}]}]},{"description":"Excision of tonsil tags","code_information":[{"code":"42860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":324.53,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":324.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision of lingual tonsil","code_information":[{"code":"42870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":963.1,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":963.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of pharynx","code_information":[{"code":"42890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2310.49,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2310.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision of pharyngeal walls","code_information":[{"code":"42892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3035.34,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3035.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revision of pharyngeal walls","code_information":[{"code":"42894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3851.15,"maximum":3851.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3851.15}]}]},{"description":"Repair throat wound","code_information":[{"code":"42900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":547.03,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":547.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of throat","code_information":[{"code":"42950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1301.95,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1301.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair throat esophagus","code_information":[{"code":"42953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1566.57,"maximum":1566.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1566.57}]}]},{"description":"Surgical opening of throat","code_information":[{"code":"42955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1238.42,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1238.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Control throat bleeding","code_information":[{"code":"42960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.11,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Control throat bleeding","code_information":[{"code":"42961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.75,"maximum":693.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":693.75}]}]},{"description":"Control throat bleeding","code_information":[{"code":"42962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":855.28,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":855.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Control nose/throat bleeding","code_information":[{"code":"42970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":680.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Control nose/throat bleeding","code_information":[{"code":"42971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.0,"maximum":749.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":749.0}]}]},{"description":"Control nose/throat bleeding","code_information":[{"code":"42972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":837.4,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":837.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Dise eval slp do brth flx dx","code_information":[{"code":"42975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.29,"maximum":9284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1984.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2977.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2024.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8265.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9284.59,"additional_payer_notes":"APC"}]}]},{"description":"Incision of esophagus","code_information":[{"code":"43020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":937.58,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":937.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Throat muscle surgery","code_information":[{"code":"43030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":867.29,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":867.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Incision of esophagus","code_information":[{"code":"43045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2120.48,"maximum":2120.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2120.48}]}]},{"description":"Excision of esophagus lesion","code_information":[{"code":"43100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1051.24,"maximum":1051.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1051.24}]}]},{"description":"Excision of esophagus lesion","code_information":[{"code":"43101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1635.08,"maximum":1635.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1635.08}]}]},{"description":"Removal of esophagus","code_information":[{"code":"43107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4808.13,"maximum":4808.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4808.13}]}]},{"description":"Removal of esophagus","code_information":[{"code":"43108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7132.77,"maximum":7132.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7132.77}]}]},{"description":"Removal of esophagus","code_information":[{"code":"43112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5507.73,"maximum":5507.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5507.73}]}]},{"description":"Removal of esophagus","code_information":[{"code":"43113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6983.22,"maximum":6983.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.22}]}]},{"description":"Partial removal of esophagus","code_information":[{"code":"43116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7972.05,"maximum":7972.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.05}]}]},{"description":"Partial removal of esophagus","code_information":[{"code":"43117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5261.62,"maximum":5261.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5261.62}]}]},{"description":"Partial removal of esophagus","code_information":[{"code":"43118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5821.88,"maximum":5821.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5821.88}]}]},{"description":"Partial removal of esophagus","code_information":[{"code":"43121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4605.98,"maximum":4605.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4605.98}]}]},{"description":"Partial removal of esophagus","code_information":[{"code":"43122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4187.1,"maximum":4187.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4187.1}]}]},{"description":"Partial removal of esophagus","code_information":[{"code":"43123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7237.54,"maximum":7237.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7237.54}]}]},{"description":"Removal of esophagus","code_information":[{"code":"43124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6129.03,"maximum":6129.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6129.03}]}]},{"description":"Removal of esophagus pouch","code_information":[{"code":"43130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.12,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1305.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of esophagus pouch","code_information":[{"code":"43135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2375.77,"maximum":2375.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2375.77}]}]},{"description":"Esophagoscopy rigid trnso","code_information":[{"code":"43180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":902.72,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":902.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy rigid trnso dx","code_information":[{"code":"43191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.28,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso inject","code_information":[{"code":"43192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.77,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso biopsy","code_information":[{"code":"43193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":279.27,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":279.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso rem fb","code_information":[{"code":"43194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.51,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":315.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy rigid balloon","code_information":[{"code":"43195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.87,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":304.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp guide wire dilat","code_information":[{"code":"43196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.45,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Excision of rectal stricture","code_information":[{"code":"45150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":703.63,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":703.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Excision of rectal lesion","code_information":[{"code":"45160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1691.91,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1691.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc rect tum transanal part","code_information":[{"code":"45171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1018.56,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1018.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc rect tum transanal full","code_information":[{"code":"45172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1354.94,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1354.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction rectal tumor","code_information":[{"code":"45190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1148.74,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1148.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy dx","code_information":[{"code":"45300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.62,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy dilate","code_information":[{"code":"45303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.62,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy w/bx","code_information":[{"code":"45305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.9,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy fb","code_information":[{"code":"45307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":165.4,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.24,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":147.96,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.61,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy bleed","code_information":[{"code":"45317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":181.12,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy ablate","code_information":[{"code":"45320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.52,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy volvul","code_information":[{"code":"45321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":170.79,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":170.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy W/Stent","code_information":[{"code":"45327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.09,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex dx brush","code_information":[{"code":"43197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.73,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Esophagosc flex trnsn biopsy","code_information":[{"code":"43198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.0,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flexible brush","code_information":[{"code":"43200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.91,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Esoph scope w/submucous inj","code_information":[{"code":"43201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.62,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":168.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex biopsy","code_information":[{"code":"43202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.02,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esoph scope w/sclerosis inj","code_information":[{"code":"43204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.49,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus endoscopy/ligation","code_information":[{"code":"43205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":227.74,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esoph optical endomicroscopy","code_information":[{"code":"43206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.24,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd esophagogastrc fndoplsty","code_information":[{"code":"43210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":696.73,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":696.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscop mucosal resect","code_information":[{"code":"43211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":379.06,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":379.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscop stent placement","code_information":[{"code":"43212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":307.12,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy retro balloon","code_information":[{"code":"43213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.69,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagosc dilate balloon 30","code_information":[{"code":"43214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":317.5,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex remove fb","code_information":[{"code":"43215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":230.2,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy lesion removal","code_information":[{"code":"43216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.3,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy snare les remv","code_information":[{"code":"43217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":259.38,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":259.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy balloon <30mm","code_information":[{"code":"43220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.63,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esoph endoscopy dilation","code_information":[{"code":"43226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.23,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy control bleed","code_information":[{"code":"43227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.02,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy lesion ablate","code_information":[{"code":"43229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":317.83,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscop ultrasound exam","code_information":[{"code":"43231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.91,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy w/us needle bx","code_information":[{"code":"43232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.21,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd balloon dil esoph30 mm/>","code_information":[{"code":"43233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.49,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":370.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd diagnostic brush wash","code_information":[{"code":"43235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":199.23,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Uppr gi scope w/submuc inj","code_information":[{"code":"43236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.87,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopic us exam esoph","code_information":[{"code":"43237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.72,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":315.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd us fine needle bx/aspir","code_information":[{"code":"43238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.79,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd biopsy single/multiple","code_information":[{"code":"43239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.87,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Egd w/transmural drain cyst","code_information":[{"code":"43240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":630.49,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":630.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Esphg thrsc moblj","code_information":[{"code":"43288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6051.72,"maximum":6051.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6051.72}]}]},{"description":"Egd flx trnsorl dplmnt balo","code_information":[{"code":"43290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":289.61,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":289.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx trnsorl rmvl balo","code_information":[{"code":"43291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.45,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":261.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Repair of esophagus","code_information":[{"code":"43300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1036.91,"maximum":1036.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1036.91}]}]},{"description":"Repair esophagus and fistula","code_information":[{"code":"43305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1802.38,"maximum":1802.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1802.38}]}]},{"description":"Repair of esophagus","code_information":[{"code":"43310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2396.97,"maximum":2396.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2396.97}]}]},{"description":"Repair esophagus and fistula","code_information":[{"code":"43312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2556.42,"maximum":2556.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2556.42}]}]},{"description":"Esophagoplasty congenital","code_information":[{"code":"43313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4757.22,"maximum":4757.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4757.22}]}]},{"description":"Tracheo-esophagoplasty cong","code_information":[{"code":"43314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5084.79,"maximum":5084.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.79}]}]},{"description":"Fuse esophagus & stomach","code_information":[{"code":"43320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2293.96,"maximum":2293.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2293.96}]}]},{"description":"Revise esophagus & stomach","code_information":[{"code":"43325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2230.86,"maximum":2230.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2230.86}]}]},{"description":"Esoph fundoplasty lap","code_information":[{"code":"43327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1372.03,"maximum":1372.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1372.03}]}]},{"description":"Esoph fundoplasty thor","code_information":[{"code":"43328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1814.5,"maximum":1814.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1814.5}]}]},{"description":"Esophagomyotomy abdominal","code_information":[{"code":"43330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2194.37,"maximum":2194.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2194.37}]}]},{"description":"Esophagomyotomy thoracic","code_information":[{"code":"43331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2174.04,"maximum":2174.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2174.04}]}]},{"description":"Transab esoph hiat hern rpr","code_information":[{"code":"43332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1875.62,"maximum":1875.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1875.62}]}]},{"description":"Transab esoph hiat hern rpr","code_information":[{"code":"43333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2061.69,"maximum":2061.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2061.69}]}]},{"description":"Transthor diaphrag hern rpr","code_information":[{"code":"43334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2005.15,"maximum":2005.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2005.15}]}]},{"description":"Transthor diaphrag hern rpr","code_information":[{"code":"43335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2151.62,"maximum":2151.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2151.62}]}]},{"description":"Thorabd diaphr hern repair","code_information":[{"code":"43336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2338.27,"maximum":2338.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2338.27}]}]},{"description":"Thorabd diaphr hern repair","code_information":[{"code":"43337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2491.28,"maximum":2491.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2491.28}]}]},{"description":"Esoph lengthening","code_information":[{"code":"43338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.54,"maximum":183.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.54}]}]},{"description":"Fuse esophagus & intestine","code_information":[{"code":"43340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2265.67,"maximum":2265.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2265.67}]}]},{"description":"Fuse esophagus & intestine","code_information":[{"code":"43341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2270.99,"maximum":2270.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2270.99}]}]},{"description":"Surgical opening esophagus","code_information":[{"code":"43351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2146.57,"maximum":2146.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2146.57}]}]},{"description":"Surgical opening esophagus","code_information":[{"code":"43352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1738.36,"maximum":1738.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1738.36}]}]},{"description":"Gastrointestinal repair","code_information":[{"code":"43360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3632.94,"maximum":3632.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3632.94}]}]},{"description":"Gastrointestinal repair","code_information":[{"code":"43361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4418.44,"maximum":4418.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4418.44}]}]},{"description":"Ligate esophagus veins","code_information":[{"code":"43400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2497.01,"maximum":2497.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2497.01}]}]},{"description":"Ligate/staple esophagus","code_information":[{"code":"43405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2368.79,"maximum":2368.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2368.79}]}]},{"description":"Repair esophagus wound","code_information":[{"code":"43410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1707.03,"maximum":1707.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1707.03}]}]},{"description":"Repair esophagus wound","code_information":[{"code":"43415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4163.39,"maximum":4163.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4163.39}]}]},{"description":"Repair esophagus opening","code_information":[{"code":"43420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1675.27,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1675.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair esophagus opening","code_information":[{"code":"43425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2337.99,"maximum":2337.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2337.99}]}]},{"description":"Dilate esophagus 1/mult pass","code_information":[{"code":"43450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.87,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Dilate esophagus","code_information":[{"code":"43453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":141.34,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Pressure treatment esophagus","code_information":[{"code":"43460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":344.05,"maximum":344.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":344.05}]}]},{"description":"Transorl lwr esophgl myotomy","code_information":[{"code":"43497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1286.08,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1286.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Surgical opening of stomach","code_information":[{"code":"43500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1298.36,"maximum":1298.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1298.36}]}]},{"description":"Surgical repair of stomach","code_information":[{"code":"43501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2209.15,"maximum":2209.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2209.15}]}]},{"description":"Surgical repair of stomach","code_information":[{"code":"43502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2503.03,"maximum":2503.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2503.03}]}]},{"description":"Surgical opening of stomach","code_information":[{"code":"43510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1567.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Incision of pyloric muscle","code_information":[{"code":"43520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1176.68,"maximum":1176.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1176.68}]}]},{"description":"Biopsy of stomach","code_information":[{"code":"43605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1391.71,"maximum":1391.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1391.71}]}]},{"description":"Excision of stomach lesion","code_information":[{"code":"43610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1602.89,"maximum":1602.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1602.89}]}]},{"description":"Excision of stomach lesion","code_information":[{"code":"43611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2016.99,"maximum":2016.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2016.99}]}]},{"description":"Removal of stomach","code_information":[{"code":"43620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3244.37,"maximum":3244.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3244.37}]}]},{"description":"Removal of stomach","code_information":[{"code":"43621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3721.63,"maximum":3721.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.63}]}]},{"description":"Removal of stomach","code_information":[{"code":"43622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3776.14,"maximum":3776.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3776.14}]}]},{"description":"Removal of stomach partial","code_information":[{"code":"43631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2382.17,"maximum":2382.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2382.17}]}]},{"description":"Removal of stomach partial","code_information":[{"code":"43632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3333.13,"maximum":3333.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3333.13}]}]},{"description":"Removal of stomach partial","code_information":[{"code":"43633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3152.51,"maximum":3152.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3152.51}]}]},{"description":"Removal of stomach partial","code_information":[{"code":"43634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3475.14,"maximum":3475.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3475.14}]}]},{"description":"Removal of stomach partial","code_information":[{"code":"43635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.9,"maximum":182.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.9}]}]},{"description":"Vagotomy & pylorus repair","code_information":[{"code":"43640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1960.27,"maximum":1960.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1960.27}]}]},{"description":"Vagotomy & pylorus repair","code_information":[{"code":"43641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1982.09,"maximum":1982.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1982.09}]}]},{"description":"Lap gastric bypass/roux-en-y","code_information":[{"code":"43644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2848.7,"maximum":2848.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2848.7}]}]},{"description":"Lap gastr bypass incl smll i","code_information":[{"code":"43645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3037.03,"maximum":3037.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3037.03}]}]},{"description":"Laparoscopy vagus nerve","code_information":[{"code":"43651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1087.9,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1087.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy vagus nerve","code_information":[{"code":"43652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1264.82,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1264.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy gastrostomy","code_information":[{"code":"43653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.29,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/orogastric w/tube plmt","code_information":[{"code":"43752","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.05,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Tx gastro intub w/asp","code_information":[{"code":"43753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.97,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Dx gastr intub w/asp spec","code_information":[{"code":"43754","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.08,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Dx gastr intub w/asp specs","code_information":[{"code":"43755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.21,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Dx duod intub w/asp spec","code_information":[{"code":"43756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":82.4,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Dx duod intub w/asp specs","code_information":[{"code":"43757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.51,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Reposition gastrostomy tube","code_information":[{"code":"43761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.09,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":168.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Rplc gtube no revj trc","code_information":[{"code":"43762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.08,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Rplc gtube  revj gstrst trc","code_information":[{"code":"43763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.27,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Lap place gastr adj device","code_information":[{"code":"43770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1853.53,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1853.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Lap revise gastr adj device","code_information":[{"code":"43771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2101.72,"maximum":2101.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2101.72}]}]},{"description":"Lap rmvl gastr adj device","code_information":[{"code":"43772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1565.02,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1565.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Lap replace gastr adj device","code_information":[{"code":"43773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2101.72,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2101.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Lap rmvl gastr adj all parts","code_information":[{"code":"43774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1583.32,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1583.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Lap sleeve gastrectomy","code_information":[{"code":"43775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1805.59,"maximum":1805.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1805.59}]}]},{"description":"Reconstruction of pylorus","code_information":[{"code":"43800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1528.61,"maximum":1528.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1528.61}]}]},{"description":"Fusion of stomach and bowel","code_information":[{"code":"43810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1673.09,"maximum":1673.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1673.09}]}]},{"description":"Fusion of stomach and bowel","code_information":[{"code":"43820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2209.62,"maximum":2209.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2209.62}]}]},{"description":"Fusion of stomach and bowel","code_information":[{"code":"43825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2155.69,"maximum":2155.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2155.69}]}]},{"description":"Place gastrostomy tube","code_information":[{"code":"43830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1158.4,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1158.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube","code_information":[{"code":"43831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1008.23,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1008.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube","code_information":[{"code":"43832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1721.34,"maximum":1721.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.34}]}]},{"description":"Repair of stomach lesion","code_information":[{"code":"43840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2233.57,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2233.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"V-band gastroplasty","code_information":[{"code":"43842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1890.31,"maximum":1890.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1890.31}]}]},{"description":"Gastroplasty w/o v-band","code_information":[{"code":"43843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2111.1,"maximum":2111.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2111.1}]}]},{"description":"Gastroplasty duodenal switch","code_information":[{"code":"43845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3219.99,"maximum":3219.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3219.99}]}]},{"description":"Gastric bypass for obesity","code_information":[{"code":"43846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2712.36,"maximum":2712.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2712.36}]}]},{"description":"Gastric bypass incl small i","code_information":[{"code":"43847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2966.55,"maximum":2966.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2966.55}]}]},{"description":"Revision gastroplasty","code_information":[{"code":"43848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3171.46,"maximum":3171.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3171.46}]}]},{"description":"Revise stomach-bowel fusion","code_information":[{"code":"43860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2683.25,"maximum":2683.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2683.25}]}]},{"description":"Revise stomach-bowel fusion","code_information":[{"code":"43865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2800.78,"maximum":2800.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2800.78}]}]},{"description":"Repair stomach opening","code_information":[{"code":"43870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1166.99,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1166.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Repair stomach-bowel fistula","code_information":[{"code":"43880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2635.28,"maximum":2635.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2635.28}]}]},{"description":"Revise gastric port open","code_information":[{"code":"43886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":611.63,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":611.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove gastric port open","code_information":[{"code":"43887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":554.0,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":554.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Change gastric port open","code_information":[{"code":"43888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":772.18,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":772.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Freeing of bowel adhesion","code_information":[{"code":"44005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1790.34,"maximum":1790.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.34}]}]},{"description":"Incision of small bowel","code_information":[{"code":"44010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1386.74,"maximum":1386.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1386.74}]}]},{"description":"Insert needle cath bowel","code_information":[{"code":"44015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.7,"maximum":228.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.7}]}]},{"description":"Explore small intestine","code_information":[{"code":"44020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1602.22,"maximum":1602.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1602.22}]}]},{"description":"Decompress small bowel","code_information":[{"code":"44021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1600.66,"maximum":1600.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1600.66}]}]},{"description":"Incision of large bowel","code_information":[{"code":"44025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1614.15,"maximum":1614.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1614.15}]}]},{"description":"Reduce bowel obstruction","code_information":[{"code":"44050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1539.13,"maximum":1539.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1539.13}]}]},{"description":"Correct malrotation of bowel","code_information":[{"code":"44055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2446.58,"maximum":2446.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2446.58}]}]},{"description":"Biopsy of bowel","code_information":[{"code":"44100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":171.6,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Excise intestine lesion(s)","code_information":[{"code":"44110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1395.22,"maximum":1395.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1395.22}]}]},{"description":"Excision of bowel lesion(s)","code_information":[{"code":"44111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1605.94,"maximum":1605.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1605.94}]}]},{"description":"Removal of small intestine","code_information":[{"code":"44120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.18,"maximum":2003.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.18}]}]},{"description":"Removal of small intestine","code_information":[{"code":"44121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.5,"maximum":390.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.5}]}]},{"description":"Removal of small intestine","code_information":[{"code":"44125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1927.65,"maximum":1927.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1927.65}]}]},{"description":"Enterectomy w/o taper cong","code_information":[{"code":"44126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4040.4,"maximum":4040.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4040.4}]}]},{"description":"Enterectomy w/taper cong","code_information":[{"code":"44127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4660.43,"maximum":4660.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4660.43}]}]},{"description":"Enterectomy cong add-on","code_information":[{"code":"44128","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.58,"maximum":394.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":394.58}]}]},{"description":"Bowel to bowel fusion","code_information":[{"code":"44130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2160.07,"maximum":2160.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2160.07}]}]},{"description":"Mobilization of colon","code_information":[{"code":"44139","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.02,"maximum":195.02,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.02}]}]},{"description":"Partial removal of colon","code_information":[{"code":"44140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2198.34,"maximum":2198.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2198.34}]}]},{"description":"Partial removal of colon","code_information":[{"code":"44141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2954.5,"maximum":2954.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2954.5}]}]},{"description":"Partial removal of colon","code_information":[{"code":"44143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2694.91,"maximum":2694.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2694.91}]}]},{"description":"Partial removal of colon","code_information":[{"code":"44144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2878.76,"maximum":2878.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2878.76}]}]},{"description":"Partial removal of colon","code_information":[{"code":"44145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2691.34,"maximum":2691.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2691.34}]}]},{"description":"Partial removal of colon","code_information":[{"code":"44146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3419.74,"maximum":3419.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3419.74}]}]},{"description":"Partial removal of colon","code_information":[{"code":"44147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.04,"maximum":3159.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3159.04}]}]},{"description":"Removal of colon","code_information":[{"code":"44150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3023.58,"maximum":3023.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3023.58}]}]},{"description":"Removal of colon/ileostomy","code_information":[{"code":"44151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3508.75,"maximum":3508.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3508.75}]}]},{"description":"Removal of colon/ileostomy","code_information":[{"code":"44155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3365.72,"maximum":3365.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3365.72}]}]},{"description":"Removal of colon/ileostomy","code_information":[{"code":"44156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3750.32,"maximum":3750.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3750.32}]}]},{"description":"Colectomy w/Ileoanal Anast","code_information":[{"code":"44157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3568.65,"maximum":3568.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3568.65}]}]},{"description":"Colectomy w/Neo-Rectum Pouch","code_information":[{"code":"44158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3656.85,"maximum":3656.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3656.85}]}]},{"description":"Removal of colon","code_information":[{"code":"44160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2034.67,"maximum":2034.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2034.67}]}]},{"description":"Lap enterolysis","code_information":[{"code":"44180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1513.02,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1513.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Lap jejunostomy","code_information":[{"code":"44186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1072.48,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1072.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Lap ileo/jejuno-stomy","code_information":[{"code":"44187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1780.53,"maximum":1780.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1780.53}]}]},{"description":"Lap colostomy","code_information":[{"code":"44188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1981.61,"maximum":1981.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1981.61}]}]},{"description":"Lap enterectomy","code_information":[{"code":"44202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2270.74,"maximum":2270.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2270.74}]}]},{"description":"Lap resect s/intestine addl","code_information":[{"code":"44203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.44,"maximum":389.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.44}]}]},{"description":"Laparo partial colectomy","code_information":[{"code":"44204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2505.8,"maximum":2505.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2505.8}]}]},{"description":"Lap colectomy part w/ileum","code_information":[{"code":"44205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2176.61,"maximum":2176.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2176.61}]}]},{"description":"Lap part colectomy w/stoma","code_information":[{"code":"44206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2831.99,"maximum":2831.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2831.99}]}]},{"description":"L colectomy/coloproctostomy","code_information":[{"code":"44207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2944.93,"maximum":2944.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2944.93}]}]},{"description":"L colectomy/coloproctostomy","code_information":[{"code":"44208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3200.84,"maximum":3200.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3200.84}]}]},{"description":"Laparo total proctocolectomy","code_information":[{"code":"44210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2877.97,"maximum":2877.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2877.97}]}]},{"description":"Colonoscopy w/resection","code_information":[{"code":"44403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":489.5,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":489.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/injection","code_information":[{"code":"44404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.39,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/dilation","code_information":[{"code":"44405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.55,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ultrasound","code_information":[{"code":"44406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.84,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":370.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ndl aspir/bx","code_information":[{"code":"44407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":444.09,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/decompression","code_information":[{"code":"44408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.13,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Suture small intestine","code_information":[{"code":"44602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2295.52,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2295.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Suture small intestine","code_information":[{"code":"44603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2642.07,"maximum":2642.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2642.07}]}]},{"description":"Suture large intestine","code_information":[{"code":"44604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.52,"maximum":1724.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.52}]}]},{"description":"Repair of bowel lesion","code_information":[{"code":"44605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2107.65,"maximum":2107.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2107.65}]}]},{"description":"Intestinal stricturoplasty","code_information":[{"code":"44615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.39,"maximum":1755.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.39}]}]},{"description":"Repair bowel opening","code_information":[{"code":"44620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1415.16,"maximum":1415.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1415.16}]}]},{"description":"Repair bowel opening","code_information":[{"code":"44625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1650.64,"maximum":1650.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1650.64}]}]},{"description":"Repair bowel opening","code_information":[{"code":"44626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2591.77,"maximum":2591.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2591.77}]}]},{"description":"Repair bowel-skin fistula","code_information":[{"code":"44640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2278.27,"maximum":2278.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2278.27}]}]},{"description":"Repair bowel fistula","code_information":[{"code":"44650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2344.84,"maximum":2344.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2344.84}]}]},{"description":"Repair bowel-bladder fistula","code_information":[{"code":"44660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2188.6,"maximum":2188.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2188.6}]}]},{"description":"Repair bowel-bladder fistula","code_information":[{"code":"44661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2519.74,"maximum":2519.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2519.74}]}]},{"description":"Surgical revision intestine","code_information":[{"code":"44680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1768.91,"maximum":1768.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1768.91}]}]},{"description":"Suspend bowel w/prosthesis","code_information":[{"code":"44700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1632.33,"maximum":1632.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1632.33}]}]},{"description":"Intraop colon lavage add-on","code_information":[{"code":"44701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.94,"maximum":275.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.94}]}]},{"description":"Excision of bowel pouch","code_information":[{"code":"44800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1277.77,"maximum":1277.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1277.77}]}]},{"description":"Excision of mesentery lesion","code_information":[{"code":"44820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1403.12,"maximum":1403.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1403.12}]}]},{"description":"Repair of mesentery","code_information":[{"code":"44850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1233.0,"maximum":1233.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1233.0}]}]},{"description":"Drain appendix abscess open","code_information":[{"code":"44900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1291.55,"maximum":1291.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1291.55}]}]},{"description":"Appendectomy","code_information":[{"code":"44950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1056.93,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1056.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Appendectomy add-on","code_information":[{"code":"44955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.65,"maximum":135.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.65}]}]},{"description":"Appendectomy","code_information":[{"code":"44960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1442.06,"maximum":1442.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1442.06}]}]},{"description":"Laparoscopy appendectomy","code_information":[{"code":"44970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":995.19,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":995.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic abscess","code_information":[{"code":"45000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.7,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of rectal abscess","code_information":[{"code":"45005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.33,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of rectal abscess","code_information":[{"code":"45020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":949.29,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":949.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of rectum","code_information":[{"code":"45100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.09,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":503.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anorectal lesion","code_information":[{"code":"45108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.61,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":622.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rectum","code_information":[{"code":"45110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2954.57,"maximum":2954.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2954.57}]}]},{"description":"Partial removal of rectum","code_information":[{"code":"45111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1775.75,"maximum":1775.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1775.75}]}]},{"description":"Removal of rectum","code_information":[{"code":"45112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2951.38,"maximum":2951.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2951.38}]}]},{"description":"Partial proctectomy","code_information":[{"code":"45113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3030.03,"maximum":3030.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3030.03}]}]},{"description":"Partial removal of rectum","code_information":[{"code":"45114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2975.92,"maximum":2975.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2975.92}]}]},{"description":"Partial removal of rectum","code_information":[{"code":"45116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2516.92,"maximum":2516.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2516.92}]}]},{"description":"Remove rectum w/reservoir","code_information":[{"code":"45119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3050.83,"maximum":3050.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3050.83}]}]},{"description":"Removal of rectum","code_information":[{"code":"45120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2626.34,"maximum":2626.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2626.34}]}]},{"description":"Removal of rectum and colon","code_information":[{"code":"45121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2863.17,"maximum":2863.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2863.17}]}]},{"description":"Partial proctectomy","code_information":[{"code":"45123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1819.71,"maximum":1819.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1819.71}]}]},{"description":"Pelvic exenteration","code_information":[{"code":"45126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4442.31,"maximum":4442.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4442.31}]}]},{"description":"Excision of rectal prolapse","code_information":[{"code":"45130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1772.79,"maximum":1772.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1772.79}]}]},{"description":"Excision of rectal prolapse","code_information":[{"code":"45135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2118.88,"maximum":2118.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2118.88}]}]},{"description":"Excise ileoanal reservior","code_information":[{"code":"45136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2900.59,"maximum":2900.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2900.59}]}]},{"description":"Egd tube/cath insertion","code_information":[{"code":"43241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":230.93,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd us fine needle bx/aspir","code_information":[{"code":"43242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":423.38,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd injection varices","code_information":[{"code":"43243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":384.36,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":384.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd varices ligation","code_information":[{"code":"43244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.96,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":394.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd dilate stricture","code_information":[{"code":"43245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.92,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":285.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd place gastrostomy tube","code_information":[{"code":"43246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":324.12,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":324.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd remove foreign body","code_information":[{"code":"43247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.56,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":285.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Egd guide wire insertion","code_information":[{"code":"43248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.66,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Esoph egd dilation <30 mm","code_information":[{"code":"43249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.41,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd cautery tumor polyp","code_information":[{"code":"43250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":276.13,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":276.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd remove lesion snare","code_information":[{"code":"43251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":316.74,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":316.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd optical endomicroscopy","code_information":[{"code":"43252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":271.95,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd us transmural injxn/mark","code_information":[{"code":"43253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":423.88,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd endo mucosal resection","code_information":[{"code":"43254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.9,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd control bleeding any","code_information":[{"code":"43255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":323.9,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":323.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd w/thrml txmnt gerd","code_information":[{"code":"43257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.23,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Egd us exam duodenum/jejunum","code_information":[{"code":"43259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":365.42,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":365.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Ercp w/specimen collection","code_information":[{"code":"43260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.52,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":519.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Endo cholangiopancreatograph","code_information":[{"code":"43261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":544.68,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":544.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Endo cholangiopancreatograph","code_information":[{"code":"43262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":574.74,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":574.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Ercp sphincter pressure meas","code_information":[{"code":"43263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":575.81,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":575.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Ercp remove duct calculi","code_information":[{"code":"43264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":586.73,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":586.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Ercp lithotripsy calculi","code_information":[{"code":"43265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":695.56,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":695.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Egd endoscopic stent place","code_information":[{"code":"43266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":351.66,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":351.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Egd lesion ablation","code_information":[{"code":"43270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":363.16,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":363.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopic pancreatoscopy","code_information":[{"code":"43273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.78,"maximum":191.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":191.78}]}]},{"description":"Lap colectomy w/proctectomy","code_information":[{"code":"44211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3433.13,"maximum":3433.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3433.13}]}]},{"description":"Laparo total proctocolectomy","code_information":[{"code":"44212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3300.04,"maximum":3300.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3300.04}]}]},{"description":"Lap mobil splenic fl add-on","code_information":[{"code":"44213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":302.01,"maximum":302.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.01}]}]},{"description":"Lap close enterostomy","code_information":[{"code":"44227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2699.7,"maximum":2699.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2699.7}]}]},{"description":"Open bowel to skin","code_information":[{"code":"44300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1383.38,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1383.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Ileostomy/jejunostomy","code_information":[{"code":"44310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1702.7,"maximum":1702.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1702.7}]}]},{"description":"Revision of ileostomy","code_information":[{"code":"44312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":983.05,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":983.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ileostomy","code_information":[{"code":"44314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1644.02,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1644.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Devise bowel pouch","code_information":[{"code":"44316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2322.3,"maximum":2322.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2322.3}]}]},{"description":"Colostomy","code_information":[{"code":"44320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1967.45,"maximum":1967.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1967.45}]}]},{"description":"Colostomy with biopsies","code_information":[{"code":"44322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1646.41,"maximum":1646.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1646.41}]}]},{"description":"Revision of colostomy","code_information":[{"code":"44340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1034.82,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1034.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of colostomy","code_information":[{"code":"44345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.78,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of colostomy","code_information":[{"code":"44346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1939.29,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1939.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.1,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy/biopsy","code_information":[{"code":"44361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.67,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.13,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":309.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.91,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":294.37,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":386.75,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":386.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.05,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small Bowel Endoscopy/Stent","code_information":[{"code":"44370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":430.4,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":430.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":387.65,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":387.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.15,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":458.35,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":458.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy/biopsy","code_information":[{"code":"44377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":480.77,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":480.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Ercp duct stent placement","code_information":[{"code":"43274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":744.12,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":744.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Ercp remove forgn body duct","code_information":[{"code":"43275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":605.87,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Ercp stent exchange w/dilate","code_information":[{"code":"43276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":774.21,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Ercp ea duct/ampulla dilate","code_information":[{"code":"43277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.16,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Ercp lesion ablate w/dilate","code_information":[{"code":"43278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":696.58,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":696.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Lap myotomy heller","code_information":[{"code":"43279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2097.66,"maximum":2097.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2097.66}]}]},{"description":"Laparoscopy fundoplasty","code_information":[{"code":"43280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1768.13,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1768.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Lap paraesophag hern repair","code_information":[{"code":"43281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2509.06,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2509.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Lap paraesoph her rpr w/mesh","code_information":[{"code":"43282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2827.99,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2827.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Lap esoph lengthening","code_information":[{"code":"43283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.29,"maximum":254.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.29}]}]},{"description":"Laps esophgl sphnctr agmntj","code_information":[{"code":"43284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1078.14,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl esophgl sphnctr dev","code_information":[{"code":"43285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1107.03,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1107.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Esphg tot w/laps moblj","code_information":[{"code":"43286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5157.65,"maximum":5157.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5157.65}]}]},{"description":"Esphg dstl 2/3 w/laps moblj","code_information":[{"code":"43287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5731.94,"maximum":5731.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.94}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":618.99,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":618.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"S Bowel Endoscope W/Stent","code_information":[{"code":"44379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":658.81,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":658.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy br/wa","code_information":[{"code":"44380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.33,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.58,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy of bowel pouch","code_information":[{"code":"44385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.42,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy bowel pouch/biop","code_information":[{"code":"44386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.69,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy thru stoma spx","code_information":[{"code":"44388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.71,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy with biopsy","code_information":[{"code":"44389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.39,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy for foreign body","code_information":[{"code":"44390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.76,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy for bleeding","code_information":[{"code":"44391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.39,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":371.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy & polypectomy","code_information":[{"code":"44392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":324.0,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":324.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/snare","code_information":[{"code":"44394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.18,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy with ablation","code_information":[{"code":"44401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.56,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/stent plcmt","code_information":[{"code":"44402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.19,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Lap remove rectum w/pouch","code_information":[{"code":"45397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3446.93,"maximum":3446.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3446.93}]}]},{"description":"Colonoscopy w/band ligation","code_information":[{"code":"45398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.39,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":380.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopic proc","code_information":[{"code":"45400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1848.28,"maximum":1848.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1848.28}]}]},{"description":"Lap proctopexy w/sig resect","code_information":[{"code":"45402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2469.36,"maximum":2469.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2469.36}]}]},{"description":"Repair of rectum","code_information":[{"code":"45500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":945.06,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":945.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Repair of rectum","code_information":[{"code":"45505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":995.17,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":995.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rectal prolapse","code_information":[{"code":"45520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.53,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Correct rectal prolapse","code_information":[{"code":"45540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1717.48,"maximum":1717.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1717.48}]}]},{"description":"Correct rectal prolapse","code_information":[{"code":"45541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1543.41,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1543.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Repair rectum/remove sigmoid","code_information":[{"code":"45550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2374.5,"maximum":2374.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2374.5}]}]},{"description":"Repair of rectocele","code_information":[{"code":"45560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1137.01,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1137.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Exploration/repair of rectum","code_information":[{"code":"45562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1924.54,"maximum":1924.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1924.54}]}]},{"description":"Exploration/repair of rectum","code_information":[{"code":"45563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2717.97,"maximum":2717.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2717.97}]}]},{"description":"Repair rect/bladder fistula","code_information":[{"code":"45800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2090.18,"maximum":2090.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2090.18}]}]},{"description":"Repair fistula w/colostomy","code_information":[{"code":"45805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2406.78,"maximum":2406.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2406.78}]}]},{"description":"Repair rectourethral fistula","code_information":[{"code":"45820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2095.1,"maximum":2095.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2095.1}]}]},{"description":"Repair fistula w/colostomy","code_information":[{"code":"45825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2520.96,"maximum":2520.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2520.96}]}]},{"description":"Reduction of rectal prolapse","code_information":[{"code":"45900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":351.85,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":351.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of anal sphincter","code_information":[{"code":"45905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.08,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of rectal narrowing","code_information":[{"code":"45910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":319.81,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Remove rectal obstruction","code_information":[{"code":"45915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":379.53,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":379.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Surg dx exam anorectal","code_information":[{"code":"45990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.43,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Placement of seton","code_information":[{"code":"46020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.33,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rectal marker","code_information":[{"code":"46030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.89,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":710.51,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":710.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":729.39,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":729.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal abscess","code_information":[{"code":"46050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.69,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":168.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":809.6,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":809.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal septum","code_information":[{"code":"46070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.2,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal sphincter","code_information":[{"code":"46080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.47,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":261.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Incise external hemorrhoid","code_information":[{"code":"46083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.9,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anal fissure","code_information":[{"code":"46200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":563.74,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":563.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Excise anal ext tag/papilla","code_information":[{"code":"46220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.47,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of hemorrhoid(s)","code_information":[{"code":"46221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.74,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anal tags","code_information":[{"code":"46230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":288.15,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove ext hem groups 2+","code_information":[{"code":"46250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":531.28,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":531.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove int/ext hem 1 group","code_information":[{"code":"46255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":587.68,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":587.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grp & fiss","code_information":[{"code":"46257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":692.2,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":692.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grp w/fistu","code_information":[{"code":"46258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":801.44,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":801.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem groups 2+","code_information":[{"code":"46260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":799.27,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grps & fiss","code_information":[{"code":"46261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":882.31,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":882.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grps w/fist","code_information":[{"code":"46262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":974.38,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":974.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist subq","code_information":[{"code":"46270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":669.31,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":669.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist inter","code_information":[{"code":"46275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.92,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":702.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist complex","code_information":[{"code":"46280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.82,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":798.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist 2 stage","code_information":[{"code":"46285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":707.13,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":707.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Repair anal fistula","code_information":[{"code":"46288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":927.0,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":927.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hemorrhoid clot","code_information":[{"code":"46320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":187.4,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Injection into hemorrhoid(s)","code_information":[{"code":"46500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.12,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":304.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenervation anal musc","code_information":[{"code":"46505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":410.57,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":410.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic anoscopy spx","code_information":[{"code":"46600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.1,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic anoscopy","code_information":[{"code":"46601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.38,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy and dilation","code_information":[{"code":"46604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.95,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy and biopsy","code_information":[{"code":"46606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.27,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic anoscopy & biopsy","code_information":[{"code":"46607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.54,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove for body","code_information":[{"code":"46608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.24,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove lesion","code_information":[{"code":"46610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.89,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy","code_information":[{"code":"46611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.96,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove lesions","code_information":[{"code":"46612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.21,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy control bleeding","code_information":[{"code":"46614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.3,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy","code_information":[{"code":"46615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.39,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal stricture","code_information":[{"code":"46700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1082.97,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1082.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal stricture","code_information":[{"code":"46705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.91,"maximum":950.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":950.91}]}]},{"description":"Repr of anal fistula w/glue","code_information":[{"code":"46706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.13,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Repair anorectal fist w/plug","code_information":[{"code":"46707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":839.38,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":839.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Repr per/vag pouch sngl proc","code_information":[{"code":"46710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1829.37,"maximum":1829.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.37}]}]},{"description":"Repr per/vag pouch dbl proc","code_information":[{"code":"46712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3624.21,"maximum":3624.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3624.21}]}]},{"description":"Rep perf anoper fistu","code_information":[{"code":"46715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":921.66,"maximum":921.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":921.66}]}]},{"description":"Rep perf anoper/vestib fistu","code_information":[{"code":"46716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2045.84,"maximum":2045.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2045.84}]}]},{"description":"Construction of absent anus","code_information":[{"code":"46730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3275.79,"maximum":3275.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3275.79}]}]},{"description":"Construction of absent anus","code_information":[{"code":"46735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3764.53,"maximum":3764.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3764.53}]}]},{"description":"Construction of absent anus","code_information":[{"code":"46740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3571.3,"maximum":3571.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3571.3}]}]},{"description":"Repair of imperforated anus","code_information":[{"code":"46742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4117.31,"maximum":4117.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4117.31}]}]},{"description":"Repair of cloacal anomaly","code_information":[{"code":"46744","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5794.25,"maximum":5794.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5794.25}]}]},{"description":"Repair of cloacal anomaly","code_information":[{"code":"46746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6377.75,"maximum":6377.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6377.75}]}]},{"description":"Repair of cloacal anomaly","code_information":[{"code":"46748","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6907.93,"maximum":6907.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.93}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1229.47,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1229.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46751","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1109.89,"maximum":1109.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1109.89}]}]},{"description":"Reconstruction of anus","code_information":[{"code":"46753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1026.82,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1026.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Removal of suture from anus","code_information":[{"code":"46754","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":402.07,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":402.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1813.28,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1813.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1496.25,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1496.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.89,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.89,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Cryosurgery anal lesion(s)","code_information":[{"code":"46916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery anal lesions","code_information":[{"code":"46917","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.67,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Excision of anal lesion(s)","code_information":[{"code":"46922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.69,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":302.03,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Destroy internal hemorrhoids","code_information":[{"code":"46930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.21,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of anal fissure","code_information":[{"code":"46940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.89,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of anal fissure","code_information":[{"code":"46942","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.37,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Remove by ligat int hem grp","code_information":[{"code":"46945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":565.93,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":565.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Remove by ligat int hem grps","code_information":[{"code":"46946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":629.94,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":629.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Hemorrhoidopexy by stapling","code_information":[{"code":"46947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":643.41,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":643.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Int hrhc tranal dartlzj 2+","code_information":[{"code":"46948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":732.65,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":732.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy of liver","code_information":[{"code":"47000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":141.6,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy liver add-on","code_information":[{"code":"47001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.28,"maximum":169.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.28}]}]},{"description":"Open drainage liver lesion","code_information":[{"code":"47010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1993.64,"maximum":1993.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1993.64}]}]},{"description":"Inject/aspirate liver cyst","code_information":[{"code":"47015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1914.9,"maximum":1914.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1914.9}]}]},{"description":"Wedge biopsy of liver","code_information":[{"code":"47100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1397.72,"maximum":1397.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1397.72}]}]},{"description":"Partial removal of liver","code_information":[{"code":"47120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3820.66,"maximum":3820.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3820.66}]}]},{"description":"Extensive removal of liver","code_information":[{"code":"47122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5601.97,"maximum":5601.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5601.97}]}]},{"description":"Partial removal of liver","code_information":[{"code":"47125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5026.71,"maximum":5026.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5026.71}]}]},{"description":"Partial removal of liver","code_information":[{"code":"47130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5389.34,"maximum":5389.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5389.34}]}]},{"description":"Transplantation of liver","code_information":[{"code":"47135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8848.48,"maximum":8848.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8848.48}]}]},{"description":"Surgery for liver lesion","code_information":[{"code":"47300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1863.06,"maximum":1863.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1863.06}]}]},{"description":"Repair liver wound","code_information":[{"code":"47350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2232.47,"maximum":2232.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2232.47}]}]},{"description":"Repair liver wound","code_information":[{"code":"47360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3066.07,"maximum":3066.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3066.07}]}]},{"description":"Repair liver wound","code_information":[{"code":"47361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4912.36,"maximum":4912.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4912.36}]}]},{"description":"Repair liver wound","code_information":[{"code":"47362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2326.9,"maximum":2326.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2326.9}]}]},{"description":"Laparo ablate liver tumor rf","code_information":[{"code":"47370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2062.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2062.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ablate liver cryosurg","code_information":[{"code":"47371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2069.18,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2069.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Open ablate liver tumor rf","code_information":[{"code":"47380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2372.29,"maximum":2372.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2372.29}]}]},{"description":"Open ablate liver tumor cryo","code_information":[{"code":"47381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2432.2,"maximum":2432.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2432.2}]}]},{"description":"Percut ablate liver rf","code_information":[{"code":"47382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1188.59,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1188.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Perq abltj lvr cryoablation","code_information":[{"code":"47383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":732.05,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":732.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Incision of liver duct","code_information":[{"code":"47400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3513.0,"maximum":3513.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3513.0}]}]},{"description":"Incision of bile duct","code_information":[{"code":"47420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2188.84,"maximum":2188.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2188.84}]}]},{"description":"Incision of bile duct","code_information":[{"code":"47425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2240.54,"maximum":2240.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.54}]}]},{"description":"Incise bile duct sphincter","code_information":[{"code":"47460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2083.2,"maximum":2083.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2083.2}]}]},{"description":"Incision of gallbladder","code_information":[{"code":"47480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1447.8,"maximum":1447.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1447.8}]}]},{"description":"Incision of gallbladder","code_information":[{"code":"47490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.51,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":538.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Injection for cholangiogram","code_information":[{"code":"47531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.7,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Injection for cholangiogram","code_information":[{"code":"47532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.55,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Plmt biliary drainage cath","code_information":[{"code":"47533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.81,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Plmt biliary drainage cath","code_information":[{"code":"47534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":590.88,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":590.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Conversion ext bil drg cath","code_information":[{"code":"47535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":313.95,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":313.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Exchange biliary drg cath","code_information":[{"code":"47536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":212.18,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":212.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal biliary drg cath","code_information":[{"code":"47537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":154.76,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":154.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.79,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.78,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":676.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.84,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Plmt access bil tree sm bwl","code_information":[{"code":"47541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":537.04,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":537.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Dilate biliary duct/ampulla","code_information":[{"code":"47542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.72,"maximum":216.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.72}]}]},{"description":"Endoluminal bx biliary tree","code_information":[{"code":"47543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.24,"maximum":228.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.24}]}]},{"description":"Removal duct glbldr calculi","code_information":[{"code":"47544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.05,"maximum":250.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":250.05}]}]},{"description":"Bile duct endoscopy add-on","code_information":[{"code":"47550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":264.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14}]}]},{"description":"Biliary endo perq dx w/speci","code_information":[{"code":"47552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.73,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":451.96,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":451.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":724.01,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":724.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":536.32,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":536.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":607.44,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":607.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopic cholecystectomy","code_information":[{"code":"47562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1091.38,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1091.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo cholecystectomy/graph","code_information":[{"code":"47563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1186.59,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1186.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo cholecystectomy/explr","code_information":[{"code":"47564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1842.82,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1842.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparo cholecystoenterostomy","code_information":[{"code":"47570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1279.06,"maximum":1279.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1279.06}]}]},{"description":"Removal of gallbladder","code_information":[{"code":"47600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1763.11,"maximum":1763.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1763.11}]}]},{"description":"Removal of gallbladder","code_information":[{"code":"47605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1853.92,"maximum":1853.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1853.92}]}]},{"description":"Removal of gallbladder","code_information":[{"code":"47610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2060.26,"maximum":2060.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2060.26}]}]},{"description":"Removal of gallbladder","code_information":[{"code":"47612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2087.77,"maximum":2087.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2087.77}]}]},{"description":"Removal of gallbladder","code_information":[{"code":"47620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2253.21,"maximum":2253.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2253.21}]}]},{"description":"Exploration of bile ducts","code_information":[{"code":"47700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1741.31,"maximum":1741.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1741.31}]}]},{"description":"Bile duct revision","code_information":[{"code":"47701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2841.32,"maximum":2841.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2841.32}]}]},{"description":"Excision of bile duct tumor","code_information":[{"code":"47711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2543.9,"maximum":2543.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2543.9}]}]},{"description":"Excision of bile duct tumor","code_information":[{"code":"47712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3264.29,"maximum":3264.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3264.29}]}]},{"description":"Excision of bile duct cyst","code_information":[{"code":"47715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2184.37,"maximum":2184.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2184.37}]}]},{"description":"Fuse gallbladder & bowel","code_information":[{"code":"47720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1898.67,"maximum":1898.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1898.67}]}]},{"description":"Fuse upper gi structures","code_information":[{"code":"47721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2223.55,"maximum":2223.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2223.55}]}]},{"description":"Fuse gallbladder & bowel","code_information":[{"code":"47740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2155.04,"maximum":2155.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2155.04}]}]},{"description":"Fuse gallbladder & bowel","code_information":[{"code":"47741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2420.08,"maximum":2420.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2420.08}]}]},{"description":"Fuse bile ducts and bowel","code_information":[{"code":"47760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3677.22,"maximum":3677.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3677.22}]}]},{"description":"Fuse liver ducts & bowel","code_information":[{"code":"47765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4945.56,"maximum":4945.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4945.56}]}]},{"description":"Fuse bile ducts and bowel","code_information":[{"code":"47780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4043.8,"maximum":4043.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4043.8}]}]},{"description":"Fuse bile ducts and bowel","code_information":[{"code":"47785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5270.21,"maximum":5270.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5270.21}]}]},{"description":"Reconstruction of bile ducts","code_information":[{"code":"47800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2554.81,"maximum":2554.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2554.81}]}]},{"description":"Placement bile duct support","code_information":[{"code":"47801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1818.57,"maximum":1818.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1818.57}]}]},{"description":"Suture bile duct injury","code_information":[{"code":"47900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2263.3,"maximum":2263.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2263.3}]}]},{"description":"Drainage of abdomen","code_information":[{"code":"48000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3080.97,"maximum":3080.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3080.97}]}]},{"description":"Placement of drain pancreas","code_information":[{"code":"48001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3768.39,"maximum":3768.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3768.39}]}]},{"description":"Removal of pancreatic stone","code_information":[{"code":"48020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1940.08,"maximum":1940.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1940.08}]}]},{"description":"Biopsy of pancreas open","code_information":[{"code":"48100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1460.7,"maximum":1460.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1460.7}]}]},{"description":"Needle biopsy pancreas","code_information":[{"code":"48102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":381.18,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":381.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect/Debride Pancreas","code_information":[{"code":"48105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4616.62,"maximum":4616.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4616.62}]}]},{"description":"Removal of pancreas lesion","code_information":[{"code":"48120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1829.26,"maximum":1829.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.26}]}]},{"description":"Partial removal of pancreas","code_information":[{"code":"48140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2569.4,"maximum":2569.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2569.4}]}]},{"description":"Partial removal of pancreas","code_information":[{"code":"48145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2676.56,"maximum":2676.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2676.56}]}]},{"description":"Pancreatectomy","code_information":[{"code":"48146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3084.32,"maximum":3084.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3084.32}]}]},{"description":"Removal of pancreatic duct","code_information":[{"code":"48148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2054.45,"maximum":2054.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2054.45}]}]},{"description":"Partial removal of pancreas","code_information":[{"code":"48150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5092.57,"maximum":5092.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5092.57}]}]},{"description":"Pancreatectomy","code_information":[{"code":"48152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4709.02,"maximum":4709.02,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4709.02}]}]},{"description":"Pancreatectomy","code_information":[{"code":"48153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5062.42,"maximum":5062.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5062.42}]}]},{"description":"Pancreatectomy","code_information":[{"code":"48154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4729.72,"maximum":4729.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4729.72}]}]},{"description":"Removal of pancreas","code_information":[{"code":"48155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2980.38,"maximum":2980.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2980.38}]}]},{"description":"Surgery of pancreatic cyst","code_information":[{"code":"48500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1888.81,"maximum":1888.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1888.81}]}]},{"description":"Drain pancreatic pseudocyst","code_information":[{"code":"48510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1803.33,"maximum":1803.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1803.33}]}]},{"description":"Fuse pancreas cyst and bowel","code_information":[{"code":"48520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1805.88,"maximum":1805.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1805.88}]}]},{"description":"Fuse pancreas cyst and bowel","code_information":[{"code":"48540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2144.35,"maximum":2144.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2144.35}]}]},{"description":"Pancreatorrhaphy","code_information":[{"code":"48545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.76,"maximum":2211.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.76}]}]},{"description":"Duodenal exclusion","code_information":[{"code":"48547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2934.58,"maximum":2934.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2934.58}]}]},{"description":"Fuse Pancreas and Bowel","code_information":[{"code":"48548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2738.09,"maximum":2738.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2738.09}]}]},{"description":"Diagnostic sigmoidoscopy","code_information":[{"code":"45330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.21,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy and biopsy","code_information":[{"code":"45331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.35,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/fb removal","code_information":[{"code":"45332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":170.83,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":170.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy & polypectomy","code_information":[{"code":"45333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.29,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy for bleeding","code_information":[{"code":"45334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.56,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/submuc inj","code_information":[{"code":"45335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.14,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy & decompress","code_information":[{"code":"45337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.16,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/tumr remove","code_information":[{"code":"45338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.42,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Sig w/tndsc balloon dilation","code_information":[{"code":"45340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.6,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy W/Ultrasound","code_information":[{"code":"45341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.94,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy W/Us Guide Bx","code_information":[{"code":"45342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.16,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/ablation","code_information":[{"code":"45346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":259.38,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":259.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/plcmt stent","code_information":[{"code":"45347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.04,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/resection","code_information":[{"code":"45349","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.07,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Sgmdsc w/band ligation","code_information":[{"code":"45350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.72,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic colonoscopy","code_information":[{"code":"45378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.2,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/fb removal","code_information":[{"code":"45379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":385.06,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":385.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy and biopsy","code_information":[{"code":"45380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.41,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":325.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy submucous njx","code_information":[{"code":"45381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.41,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":325.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/control bleed","code_information":[{"code":"45382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.86,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":369.44,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":369.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":410.19,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":410.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/balloon dilat","code_information":[{"code":"45386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":343.43,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ablation","code_information":[{"code":"45388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":436.35,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/stent plcmt","code_information":[{"code":"45389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.49,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/resection","code_information":[{"code":"45390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":535.37,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":535.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/endoscope us","code_information":[{"code":"45391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":415.73,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":415.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/endoscopic fnb","code_information":[{"code":"45392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":490.03,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":490.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/decompression","code_information":[{"code":"45393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":405.31,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":405.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Lap removal of rectum","code_information":[{"code":"45395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3178.43,"maximum":3178.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3178.43}]}]},{"description":"Transpl allograft pancreas","code_information":[{"code":"48554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4345.1,"maximum":4345.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4345.1}]}]},{"description":"Removal allograft pancreas","code_information":[{"code":"48556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2132.21,"maximum":2132.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2132.21}]}]},{"description":"Exploration of abdomen","code_information":[{"code":"49000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1266.11,"maximum":1266.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1266.11}]}]},{"description":"Reopening of abdomen","code_information":[{"code":"49002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1710.38,"maximum":1710.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1710.38}]}]},{"description":"Exploration behind abdomen","code_information":[{"code":"49010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1516.9,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1516.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Prpertl pel pack hemrrg trma","code_information":[{"code":"49013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":741.35,"maximum":741.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":741.35}]}]},{"description":"Reexploration pelvic wound","code_information":[{"code":"49014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":618.8,"maximum":618.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":618.8}]}]},{"description":"Drainage abdom abscess open","code_information":[{"code":"49020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2613.72,"maximum":2613.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2613.72}]}]},{"description":"Drain open abdom abscess","code_information":[{"code":"49040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1653.09,"maximum":1653.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1653.09}]}]},{"description":"Drain open retroperi abscess","code_information":[{"code":"49060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1813.21,"maximum":1813.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1813.21}]}]},{"description":"Drain to peritoneal cavity","code_information":[{"code":"49062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1268.66,"maximum":1268.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1268.66}]}]},{"description":"Abd paracentesis","code_information":[{"code":"49082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.94,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Abd paracentesis w/imaging","code_information":[{"code":"49083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":172.21,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":172.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Peritoneal lavage","code_information":[{"code":"49084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.35,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st 3-10 ncr/strn","code_information":[{"code":"49594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1221.5,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1221.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st > 10 rdc","code_information":[{"code":"49595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1266.27,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1266.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st > 10 ncr/strn","code_information":[{"code":"49596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1681.09,"maximum":1681.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1681.09}]}]},{"description":"Repair umbilical lesion","code_information":[{"code":"49600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1214.74,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1214.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Repair umbilical lesion","code_information":[{"code":"49605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8017.74,"maximum":8017.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8017.74}]}]},{"description":"Repair umbilical lesion","code_information":[{"code":"49606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1867.37,"maximum":1867.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1867.37}]}]},{"description":"Repair umbilical lesion","code_information":[{"code":"49610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1148.91,"maximum":1148.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1148.91}]}]},{"description":"Repair umbilical lesion","code_information":[{"code":"49611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1012.82,"maximum":1012.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1012.82}]}]},{"description":"Rpr aa hrn rcr < 3 rdc","code_information":[{"code":"49613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":690.28,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr < 3 ncr/strn","code_information":[{"code":"49614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":936.32,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":936.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr 3-10 rdc","code_information":[{"code":"49615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1046.84,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1046.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr 3-10 ncr/strn","code_information":[{"code":"49616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1405.57,"maximum":1405.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1405.57}]}]},{"description":"Rpr aa hrn rcr > 10 rdc","code_information":[{"code":"49617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1454.74,"maximum":1454.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1454.74}]}]},{"description":"Rpr aa hrn rcr > 10 ncr/strn","code_information":[{"code":"49618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2037.67,"maximum":2037.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2037.67}]}]},{"description":"Rpr parastomal hernia rdc","code_information":[{"code":"49621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1233.03,"maximum":1233.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1233.03}]}]},{"description":"Rpr parastomal hrna ncr/strn","code_information":[{"code":"49622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1533.3,"maximum":1533.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1533.3}]}]},{"description":"Rmvl ninfct mesh hernia rpr","code_information":[{"code":"49623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.05,"maximum":331.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.05}]}]},{"description":"Lap ing hernia repair init","code_information":[{"code":"49650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":719.08,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":719.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Lap ing hernia repair recur","code_information":[{"code":"49651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":937.7,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":937.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Repair of abdominal wall","code_information":[{"code":"49900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1363.63,"maximum":1363.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1363.63}]}]},{"description":"Omental flap extra-abdom","code_information":[{"code":"49904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2270.27,"maximum":2270.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2270.27}]}]},{"description":"Omental flap intra-abdom","code_information":[{"code":"49905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":571.48,"maximum":571.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":571.48}]}]},{"description":"Exploration of kidney","code_information":[{"code":"50010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1159.23,"maximum":1159.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1159.23}]}]},{"description":"Renal abscess open drain","code_information":[{"code":"50020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1664.06,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1664.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of kidney","code_information":[{"code":"50040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1517.22,"maximum":1517.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1517.22}]}]},{"description":"Exploration of kidney","code_information":[{"code":"50045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1528.7,"maximum":1528.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1528.7}]}]},{"description":"Removal of kidney stone","code_information":[{"code":"50060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1861.13,"maximum":1861.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1861.13}]}]},{"description":"Incision of kidney","code_information":[{"code":"50065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.64,"maximum":1972.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1972.64}]}]},{"description":"Incision of kidney","code_information":[{"code":"50070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1935.94,"maximum":1935.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1935.94}]}]},{"description":"Removal of kidney stone","code_information":[{"code":"50075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2376.43,"maximum":2376.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2376.43}]}]},{"description":"Removal of kidney stone","code_information":[{"code":"50080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1142.98,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1142.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kidney stone","code_information":[{"code":"50081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1836.7,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1836.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Revise kidney blood vessels","code_information":[{"code":"50100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1780.74,"maximum":1780.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1780.74}]}]},{"description":"Exploration of kidney","code_information":[{"code":"50120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1555.52,"maximum":1555.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1555.52}]}]},{"description":"Explore and drain kidney","code_information":[{"code":"50125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1608.56,"maximum":1608.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1608.56}]}]},{"description":"Removal of kidney stone","code_information":[{"code":"50130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1689.99,"maximum":1689.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1689.99}]}]},{"description":"Renal biopsy perq","code_information":[{"code":"50200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":204.49,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":204.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Renal biopsy open","code_information":[{"code":"50205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1243.73,"maximum":1243.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1243.73}]}]},{"description":"Remove kidney open","code_information":[{"code":"50220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1732.14,"maximum":1732.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1732.14}]}]},{"description":"Removal kidney open complex","code_information":[{"code":"50225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.13,"maximum":1938.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1938.13}]}]},{"description":"Removal kidney open radical","code_information":[{"code":"50230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2088.4,"maximum":2088.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2088.4}]}]},{"description":"Removal of kidney & ureter","code_information":[{"code":"50234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2125.14,"maximum":2125.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2125.14}]}]},{"description":"Removal of kidney & ureter","code_information":[{"code":"50236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2387.74,"maximum":2387.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2387.74}]}]},{"description":"Partial removal of kidney","code_information":[{"code":"50240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2171.46,"maximum":2171.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2171.46}]}]},{"description":"Cryoablate renal mass open","code_information":[{"code":"50250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1987.76,"maximum":1987.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1987.76}]}]},{"description":"Removal of kidney lesion","code_information":[{"code":"50280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1550.03,"maximum":1550.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1550.03}]}]},{"description":"Removal of kidney lesion","code_information":[{"code":"50290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1473.52,"maximum":1473.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1473.52}]}]},{"description":"Remove kidney living donor","code_information":[{"code":"50320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2523.06,"maximum":2523.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2523.06}]}]},{"description":"Removal of kidney","code_information":[{"code":"50340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1591.39,"maximum":1591.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1591.39}]}]},{"description":"Transplantation of kidney","code_information":[{"code":"50360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4005.93,"maximum":4005.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4005.93}]}]},{"description":"Transplantation of kidney","code_information":[{"code":"50365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4779.93,"maximum":4779.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4779.93}]}]},{"description":"Remove transplanted kidney","code_information":[{"code":"50370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2011.23,"maximum":2011.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2011.23}]}]},{"description":"Reimplantation of kidney","code_information":[{"code":"50380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3374.81,"maximum":3374.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3374.81}]}]},{"description":"Change ureter stent percut","code_information":[{"code":"50382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.77,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Remove ureter stent percut","code_information":[{"code":"50384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.92,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Change stent via transureth","code_information":[{"code":"50385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":349.25,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Remove stent via transureth","code_information":[{"code":"50386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.4,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Change nephroureteral cath","code_information":[{"code":"50387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.53,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Remove renal tube w/fluoro","code_information":[{"code":"50389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.4,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of kidney lesion","code_information":[{"code":"50390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":152.1,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Instll rx agnt into rnal tub","code_information":[{"code":"50391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.53,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Measure kidney pressure","code_information":[{"code":"50396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.06,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of kidney/ureter","code_information":[{"code":"50400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1887.9,"maximum":1887.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1887.9}]}]},{"description":"Revision of kidney/ureter","code_information":[{"code":"50405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2277.5,"maximum":2277.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2277.5}]}]},{"description":"Njx px nfrosgrm &/urtrgrm","code_information":[{"code":"50430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.19,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Njx px nfrosgrm &/urtrgrm","code_information":[{"code":"50431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.09,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Plmt nephrostomy catheter","code_information":[{"code":"50432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.69,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Plmt nephroureteral catheter","code_information":[{"code":"50433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":408.57,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":408.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Convert nephrostomy catheter","code_information":[{"code":"50434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":306.79,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":306.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Exchange nephrostomy cath","code_information":[{"code":"50435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.71,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Dilat xst trc ndurlgc px","code_information":[{"code":"50436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":245.4,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Dilat xst trc new access rcs","code_information":[{"code":"50437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.83,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Repair of kidney wound","code_information":[{"code":"50500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2116.51,"maximum":2116.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2116.51}]}]},{"description":"Close kidney-skin fistula","code_information":[{"code":"50520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1908.59,"maximum":1908.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1908.59}]}]},{"description":"Close nephrovisceral fistula","code_information":[{"code":"50525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2416.85,"maximum":2416.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2416.85}]}]},{"description":"Close nephrovisceral fistula","code_information":[{"code":"50526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2587.25,"maximum":2587.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2587.25}]}]},{"description":"Revision of horseshoe kidney","code_information":[{"code":"50540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1874.2,"maximum":1874.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1874.2}]}]},{"description":"Laparo ablate renal cyst","code_information":[{"code":"50541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1500.38,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1500.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ablate renal mass","code_information":[{"code":"50542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1905.23,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1905.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparo partial nephrectomy","code_information":[{"code":"50543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2431.92,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2431.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy pyeloplasty","code_information":[{"code":"50544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2023.18,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2023.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparo Radical Nephrectomy","code_information":[{"code":"50545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2177.06,"maximum":2177.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.06}]}]},{"description":"Laparoscopic nephrectomy","code_information":[{"code":"50546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1967.93,"maximum":1967.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1967.93}]}]},{"description":"Laparo removal donor kidney","code_information":[{"code":"50547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2679.79,"maximum":2679.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2679.79}]}]},{"description":"Laparo remove w/ureter","code_information":[{"code":"50548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2187.56,"maximum":2187.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2187.56}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":476.5,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":476.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":508.76,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & biopsy","code_information":[{"code":"50555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":553.51,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":553.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":560.1,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":560.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":638.31,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":638.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Renal scope w/tumor resect","code_information":[{"code":"50562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":938.7,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":938.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":794.65,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":794.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":777.63,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":860.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & biopsy","code_information":[{"code":"50574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":913.78,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":913.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1153.74,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1153.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":911.57,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":911.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":981.05,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":981.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Fragmenting of kidney stone","code_information":[{"code":"50590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":941.77,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":941.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Perc rf ablate renal tumor","code_information":[{"code":"50592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":552.81,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":552.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Perc cryo ablate renal tum","code_information":[{"code":"50593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":738.79,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":738.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of ureter","code_information":[{"code":"50600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1534.87,"maximum":1534.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1534.87}]}]},{"description":"Insert ureteral support","code_information":[{"code":"50605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1651.48,"maximum":1651.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1651.48}]}]},{"description":"Endoluminal bx urtr rnl plvs","code_information":[{"code":"50606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":224.91,"maximum":224.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":224.91}]}]},{"description":"Removal of ureter stone","code_information":[{"code":"50610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1546.31,"maximum":1546.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1546.31}]}]},{"description":"Removal of ureter stone","code_information":[{"code":"50620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1478.59,"maximum":1478.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1478.59}]}]},{"description":"Removal of ureter stone","code_information":[{"code":"50630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1461.07,"maximum":1461.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1461.07}]}]},{"description":"Removal of ureter","code_information":[{"code":"50650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1698.49,"maximum":1698.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1698.49}]}]},{"description":"Removal of ureter","code_information":[{"code":"50660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1867.12,"maximum":1867.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1867.12}]}]},{"description":"Injection for ureter x-ray","code_information":[{"code":"50684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":82.95,"maximum":82.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82.95}]}]},{"description":"Measure ureter pressure","code_information":[{"code":"50686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Change of ureter tube/stent","code_information":[{"code":"50688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.25,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Injection for ureter x-ray","code_information":[{"code":"50690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.2,"maximum":115.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.2}]}]},{"description":"Plmt ureteral stent prq","code_information":[{"code":"50693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.03,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":327.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Plmt ureteral stent prq","code_information":[{"code":"50694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":427.18,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Plmt ureteral stent prq","code_information":[{"code":"50695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":547.58,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":547.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ureter","code_information":[{"code":"50700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1517.78,"maximum":1517.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1517.78}]}]},{"description":"Ureteral embolization/occl","code_information":[{"code":"50705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":287.27,"maximum":287.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":287.27}]}]},{"description":"Balloon dilate urtrl strix","code_information":[{"code":"50706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":289.47,"maximum":289.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":289.47}]}]},{"description":"Release of ureter","code_information":[{"code":"50715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1983.18,"maximum":1983.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1983.18}]}]},{"description":"Release of ureter","code_information":[{"code":"50722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1671.2,"maximum":1671.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1671.2}]}]},{"description":"Release/revise ureter","code_information":[{"code":"50725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1800.98,"maximum":1800.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1800.98}]}]},{"description":"Revise ureter","code_information":[{"code":"50727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.99,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revise ureter","code_information":[{"code":"50728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1152.09,"maximum":1152.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1152.09}]}]},{"description":"Fusion of ureter & kidney","code_information":[{"code":"50740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2014.73,"maximum":2014.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2014.73}]}]},{"description":"Fusion of ureter & kidney","code_information":[{"code":"50750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1884.03,"maximum":1884.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1884.03}]}]},{"description":"Fusion of ureters","code_information":[{"code":"50760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1846.46,"maximum":1846.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1846.46}]}]},{"description":"Splicing of ureters","code_information":[{"code":"50770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1884.03,"maximum":1884.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1884.03}]}]},{"description":"Reimplant ureter in bladder","code_information":[{"code":"50780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1822.33,"maximum":1822.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1822.33}]}]},{"description":"Reimplant ureter in bladder","code_information":[{"code":"50782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1757.75,"maximum":1757.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.75}]}]},{"description":"Reimplant ureter in bladder","code_information":[{"code":"50783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1840.9,"maximum":1840.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1840.9}]}]},{"description":"Reimplant ureter in bladder","code_information":[{"code":"50785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1987.04,"maximum":1987.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1987.04}]}]},{"description":"Implant ureter in bowel","code_information":[{"code":"50800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1512.18,"maximum":1512.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1512.18}]}]},{"description":"Fusion of ureter & bowel","code_information":[{"code":"50810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2313.3,"maximum":2313.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2313.3}]}]},{"description":"Urine shunt to intestine","code_information":[{"code":"50815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2002.96,"maximum":2002.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2002.96}]}]},{"description":"Construct bowel bladder","code_information":[{"code":"50820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2145.74,"maximum":2145.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2145.74}]}]},{"description":"Construct bowel bladder","code_information":[{"code":"50825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2685.67,"maximum":2685.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2685.67}]}]},{"description":"Revise urine flow","code_information":[{"code":"50830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2935.46,"maximum":2935.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2935.46}]}]},{"description":"Replace ureter by bowel","code_information":[{"code":"50840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2014.92,"maximum":2014.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2014.92}]}]},{"description":"Appendico-vesicostomy","code_information":[{"code":"50845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2055.62,"maximum":2055.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.62}]}]},{"description":"Transplant ureter to skin","code_information":[{"code":"50860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1549.46,"maximum":1549.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1549.46}]}]},{"description":"Repair of ureter","code_information":[{"code":"50900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1382.82,"maximum":1382.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1382.82}]}]},{"description":"Closure ureter/skin fistula","code_information":[{"code":"50920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1446.18,"maximum":1446.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1446.18}]}]},{"description":"Biopsy abdominal mass","code_information":[{"code":"49180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.53,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Sclerotx fluid collection","code_information":[{"code":"49185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.49,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Opn exc/dstr ntra-abd 5 cm/<","code_information":[{"code":"49186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2152.12,"maximum":2152.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2152.12}]}]},{"description":"Opn exc/dstr ntra-abd 5.1-10","code_information":[{"code":"49187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2749.32,"maximum":2749.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2749.32}]}]},{"description":"Opn exc/dst ntra-abd 10.1-20","code_information":[{"code":"49188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3285.12,"maximum":3285.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3285.12}]}]},{"description":"Opn exc/dst ntra-abd 20.1-30","code_information":[{"code":"49189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3821.7,"maximum":3821.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3821.7}]}]},{"description":"Opn exc/dstr ntra-abd >30 cm","code_information":[{"code":"49190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4711.95,"maximum":4711.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4711.95}]}]},{"description":"Excise sacral spine tumor","code_information":[{"code":"49215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3616.74,"maximum":3616.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3616.74}]}]},{"description":"Excision of umbilicus","code_information":[{"code":"49250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":986.17,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal of omentum","code_information":[{"code":"49255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1308.88,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1308.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Diag laparo separate proc","code_information":[{"code":"49320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":545.8,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":545.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy biopsy","code_information":[{"code":"49321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":568.91,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":568.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy aspiration","code_information":[{"code":"49322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":617.84,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo drain lymphocele","code_information":[{"code":"49323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1056.07,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1056.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Lap insert tunnel ip cath","code_information":[{"code":"49324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.48,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":634.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Lap Revision Perm IP Cath","code_information":[{"code":"49325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":677.45,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":677.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Lap w/Omentopexy Add-on","code_information":[{"code":"49326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":305.44,"maximum":305.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.44}]}]},{"description":"Lap ins device for rt","code_information":[{"code":"49327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.72,"maximum":211.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.72}]}]},{"description":"Air injection into abdomen","code_information":[{"code":"49400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.05,"maximum":146.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.05}]}]},{"description":"Remove foreign body adbomen","code_information":[{"code":"49402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1409.05,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1409.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid colxn visc","code_information":[{"code":"49405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":312.98,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":312.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid peri/retro","code_information":[{"code":"49406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":312.41,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":312.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid trns/vgnl","code_information":[{"code":"49407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.97,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Ins mark abd/pel for rt perq","code_information":[{"code":"49411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":302.41,"maximum":7220.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1543.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2315.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1574.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6427.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7220.12,"additional_payer_notes":"APC"}]}]},{"description":"Ins device for rt guide open","code_information":[{"code":"49412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.89,"maximum":133.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.89}]}]},{"description":"Insert tun ip cath perc","code_information":[{"code":"49418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":323.67,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":323.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Insert tun ip cath w/port","code_information":[{"code":"49419","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":678.64,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Ins tun ip cath for dial opn","code_information":[{"code":"49421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":368.15,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Remove tunneled ip cath","code_information":[{"code":"49422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":358.92,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":358.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Exchange drainage catheter","code_information":[{"code":"49423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.23,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Assess cyst contrast inject","code_information":[{"code":"49424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.65,"maximum":59.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.65}]}]},{"description":"Insert abdomen-venous drain","code_information":[{"code":"49425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1288.18,"maximum":1288.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.18}]}]},{"description":"Revise abdomen-venous shunt","code_information":[{"code":"49426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1106.99,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1106.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Injection abdominal shunt","code_information":[{"code":"49427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.0,"maximum":64.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.0}]}]},{"description":"Ligation of shunt","code_information":[{"code":"49428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":709.96,"maximum":709.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":709.96}]}]},{"description":"Removal of shunt","code_information":[{"code":"49429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":753.5,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":753.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insert Subq Exten to IP Cath","code_information":[{"code":"49435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.7,"maximum":192.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.7}]}]},{"description":"Embedded IP Cath Exit-Site","code_information":[{"code":"49436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":306.81,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":306.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube perc","code_information":[{"code":"49440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.57,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Place duod/jej tube perc","code_information":[{"code":"49441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.93,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Place cecostomy tube perc","code_information":[{"code":"49442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":335.1,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Change g-tube to g-j perc","code_information":[{"code":"49446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":235.26,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Replace g/c tube perc","code_information":[{"code":"49450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.09,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Replace duod/jej tube perc","code_information":[{"code":"49451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.24,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Replace g-j tube perc","code_information":[{"code":"49452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.89,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Fix g/colon tube w/device","code_information":[{"code":"49460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.93,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Fluoro exam of g/colon tube","code_information":[{"code":"49465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.72,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Rpr hern preemie reduc","code_information":[{"code":"49491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1318.66,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1318.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hern premie blocked","code_information":[{"code":"49492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1582.63,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1582.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia baby reduc","code_information":[{"code":"49495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":678.83,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia baby blocked","code_information":[{"code":"49496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1020.46,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1020.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia init reduce","code_information":[{"code":"49500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":691.75,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":691.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia init blocked","code_information":[{"code":"49501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1005.76,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1005.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Prp i/hern init reduc >5 yr","code_information":[{"code":"49505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":867.13,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":867.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Prp i/hern init block >5 yr","code_information":[{"code":"49507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":973.31,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":973.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair ing hernia reduce","code_information":[{"code":"49520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1047.34,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair ing hernia blocked","code_information":[{"code":"49521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1186.09,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1186.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Repair ing hernia sliding","code_information":[{"code":"49525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":951.49,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":951.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Repair lumbar hernia","code_information":[{"code":"49540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1113.84,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1113.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Rpr rem hernia init reduce","code_information":[{"code":"49550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":958.58,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":958.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fem hernia init blocked","code_information":[{"code":"49553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1046.82,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1046.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair fem hernia reduce","code_information":[{"code":"49555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1001.45,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1001.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair fem hernia blocked","code_information":[{"code":"49557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1191.18,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1191.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st < 3 cm rdc","code_information":[{"code":"49591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":561.19,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":561.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st < 3 ncr/strn","code_information":[{"code":"49592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":780.49,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":780.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st 3-10 rdc","code_information":[{"code":"49593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":938.99,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":938.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and radiotracer","code_information":[{"code":"52250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.46,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":388.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":341.92,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":341.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.25,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & revise urethra","code_information":[{"code":"52270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.06,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & revise urethra","code_information":[{"code":"52275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.74,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.92,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":428.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":523.49,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":523.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.97,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy implant stent","code_information":[{"code":"52282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":546.3,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":546.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.79,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cysto rx balo cath urtl strx","code_information":[{"code":"52284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.23,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.5,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy chemodenervation","code_information":[{"code":"52287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.3,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.58,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":395.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.54,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":469.93,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":469.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.28,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.9,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":444.78,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Remove bladder stone","code_information":[{"code":"52317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":561.77,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":561.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Remove bladder stone","code_information":[{"code":"52318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":766.18,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.95,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy stone removal","code_information":[{"code":"52325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.06,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":518.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy inject material","code_information":[{"code":"52327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.28,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":426.76,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.42,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Create passage to kidney","code_information":[{"code":"52334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":298.24,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cysto W/Ureter Stricture Tx","code_information":[{"code":"52341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.08,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cysto W/Up Stricture Tx","code_information":[{"code":"52342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":501.04,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cysto W/Renal Stricture Tx","code_information":[{"code":"52343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":557.88,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":557.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cysto/uretero stricture tx","code_information":[{"code":"52344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":598.37,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":598.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cysto/Uretero W/Up Stricture","code_information":[{"code":"52345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":638.29,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":638.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Renal Strict","code_information":[{"code":"52346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.91,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":721.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero & or pyeloscope","code_information":[{"code":"52351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":491.19,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":491.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero w/stone remove","code_information":[{"code":"52352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":574.28,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":574.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Lithotripsy","code_information":[{"code":"52353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":633.93,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":633.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Biopsy","code_information":[{"code":"52354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":675.94,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":675.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Excise Tumor","code_information":[{"code":"52355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":757.38,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":757.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Cysto/uretero w/lithotripsy","code_information":[{"code":"52356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":673.24,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":673.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Congen Repr","code_information":[{"code":"52400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":781.11,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":781.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystourethro cut ejacul duct","code_information":[{"code":"52402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":429.11,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":429.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystourethro w/implant","code_information":[{"code":"52441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.93,"maximum":340.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.93}]}]},{"description":"Cystourethro w/addl implant","code_information":[{"code":"52442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":82.52,"maximum":82.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82.52}]}]},{"description":"Incision of prostate","code_information":[{"code":"52450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":785.37,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":785.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revision of bladder neck","code_information":[{"code":"52500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":814.88,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":814.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Prostatectomy (TURP)","code_information":[{"code":"52601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1193.92,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1193.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Remove prostate regrowth","code_information":[{"code":"52630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":671.76,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":671.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Relieve bladder contracture","code_information":[{"code":"52640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":536.68,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":536.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery of prostate","code_information":[{"code":"52647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1071.24,"maximum":1071.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1071.24}]}]},{"description":"Laser surgery of prostate","code_information":[{"code":"52648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1139.05,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1139.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Prostate laser enucleation","code_information":[{"code":"52649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1353.7,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1353.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of prostate abscess","code_information":[{"code":"52700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":730.45,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":730.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":245.0,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":494.16,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":494.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.86,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.51,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urethra abscess","code_information":[{"code":"53040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":648.98,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":648.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urethra abscess","code_information":[{"code":"53060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.68,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urinary leakage","code_information":[{"code":"53080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":695.35,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":695.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urinary leakage","code_information":[{"code":"53085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1067.36,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1067.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of urethra","code_information":[{"code":"53200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.6,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra","code_information":[{"code":"53210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.53,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1284.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra","code_information":[{"code":"53215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1519.46,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1519.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of urethra lesion","code_information":[{"code":"53220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":745.73,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":745.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra lesion","code_information":[{"code":"53230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1004.18,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1004.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra lesion","code_information":[{"code":"53235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1045.0,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1045.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Surgery for urethra pouch","code_information":[{"code":"53240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":701.96,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":701.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra gland","code_information":[{"code":"53250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":656.55,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":656.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of urethra lesion","code_information":[{"code":"53260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.55,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of urethra lesion","code_information":[{"code":"53265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":312.55,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":312.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra gland","code_information":[{"code":"53270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":306.24,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":306.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra defect","code_information":[{"code":"53275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":431.25,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":431.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revise urethra stage 1","code_information":[{"code":"53400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1316.47,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1316.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Revise urethra stage 2","code_information":[{"code":"53405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1432.51,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1432.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"53410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1603.01,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1603.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"53415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1845.77,"maximum":1845.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1845.77}]}]},{"description":"Reconstruct urethra stage 1","code_information":[{"code":"53420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1377.5,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1377.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra stage 2","code_information":[{"code":"53425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1532.65,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1532.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"53430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.65,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra/bladder","code_information":[{"code":"53431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1884.0,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1884.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Male sling procedure","code_information":[{"code":"53440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1236.36,"maximum":68821.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14713.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22070.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1236.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15007.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61267.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68821.82,"additional_payer_notes":"APC"}]}]},{"description":"Remove/revise male sling","code_information":[{"code":"53442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1294.44,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1294.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Insert tandem cuff","code_information":[{"code":"53444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.03,"maximum":108114.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23113.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34670.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23576.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96248.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108114.92,"additional_payer_notes":"APC"}]}]},{"description":"Insert uro/ves nck sphincter","code_information":[{"code":"53445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1245.35,"maximum":108114.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23113.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34670.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1245.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23576.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96248.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108114.92,"additional_payer_notes":"APC"}]}]},{"description":"Remove uro sphincter","code_information":[{"code":"53446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1058.58,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1058.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Remove/replace ur sphincter","code_information":[{"code":"53447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1323.19,"maximum":108114.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23113.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34670.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1323.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23576.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96248.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108114.92,"additional_payer_notes":"APC"}]}]},{"description":"Remov/replc ur sphinctr comp","code_information":[{"code":"53448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2085.06,"maximum":2085.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2085.06}]}]},{"description":"Repair uro sphincter","code_information":[{"code":"53449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1010.04,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1010.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Revision of urethra","code_information":[{"code":"53450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":677.33,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":677.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revision of urethra","code_information":[{"code":"53460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":755.02,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":755.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Urethrlys transvag w/ scope","code_information":[{"code":"53500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1227.78,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1227.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":803.01,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":803.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":802.46,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1042.81,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1042.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.77,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1305.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra defect","code_information":[{"code":"53520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.04,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":922.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":104.33,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.85,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.03,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.94,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.72,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.55,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.7,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Prostatic microwave thermotx","code_information":[{"code":"53850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.71,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Prostatic rf thermotx","code_information":[{"code":"53852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":630.74,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":630.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Trurl dstrj prst8 tiss rf wv","code_information":[{"code":"53854","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":630.74,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":630.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Insert prost urethral stent","code_information":[{"code":"53855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.84,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Transurethral rf treatment","code_information":[{"code":"53860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":368.01,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cysto insj dev ischmc rmdlg","code_information":[{"code":"53865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.23,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Cathj rmvl dev ischmc rmdlg","code_information":[{"code":"53866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.36,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Slitting of prepuce","code_information":[{"code":"54000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":184.83,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Slitting of prepuce","code_information":[{"code":"54001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.98,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Drain penis lesion","code_information":[{"code":"54015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":500.21,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":500.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":178.14,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.79,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Closure ureter/bowel fistula","code_information":[{"code":"50930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1799.88,"maximum":1799.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1799.88}]}]},{"description":"Release of ureter","code_information":[{"code":"50940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1455.5,"maximum":1455.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1455.5}]}]},{"description":"Laparoscopy ureterolithotomy","code_information":[{"code":"50945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1585.33,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1585.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo New Ureter/Bladder","code_information":[{"code":"50947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2255.13,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2255.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparo New Ureter/Bladder","code_information":[{"code":"50948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2083.85,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2083.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy of ureter","code_information":[{"code":"50951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":497.24,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":497.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy of ureter","code_information":[{"code":"50953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":530.03,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":530.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & biopsy","code_information":[{"code":"50955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":571.02,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":571.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":573.78,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":573.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":510.97,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":510.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy","code_information":[{"code":"50970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.04,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & catheter","code_information":[{"code":"50972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.81,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":579.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & biopsy","code_information":[{"code":"50974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":765.09,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":754.71,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":754.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":576.0,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":576.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Incise & treat bladder","code_information":[{"code":"51020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":776.68,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Incise & drain bladder","code_information":[{"code":"51040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":483.34,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Incise bladder/drain ureter","code_information":[{"code":"51045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":810.33,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":810.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder stone","code_information":[{"code":"51050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":780.56,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":780.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ureter stone","code_information":[{"code":"51060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":961.36,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":961.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Remove ureter calculus","code_information":[{"code":"51065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.03,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bladder abscess","code_information":[{"code":"51080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":677.3,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":677.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Drain bladder by needle","code_information":[{"code":"51100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.39,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Drain bladder by trocar/cath","code_information":[{"code":"51101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.07,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Drain bl w/cath insertion","code_information":[{"code":"51102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":230.13,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder cyst","code_information":[{"code":"51500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1050.46,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1050.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder lesion","code_information":[{"code":"51520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":982.15,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":982.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder lesion","code_information":[{"code":"51525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1406.26,"maximum":1406.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1406.26}]}]},{"description":"Removal of bladder lesion","code_information":[{"code":"51530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1264.25,"maximum":1264.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1264.25}]}]},{"description":"Repair of ureter lesion","code_information":[{"code":"51535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1280.61,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1280.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of bladder","code_information":[{"code":"51550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1577.11,"maximum":1577.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1577.11}]}]},{"description":"Partial removal of bladder","code_information":[{"code":"51555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2060.57,"maximum":2060.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2060.57}]}]},{"description":"Revise bladder & ureter(s)","code_information":[{"code":"51565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2105.25,"maximum":2105.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2105.25}]}]},{"description":"Removal of bladder","code_information":[{"code":"51570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2399.69,"maximum":2399.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2399.69}]}]},{"description":"Removal of bladder & nodes","code_information":[{"code":"51575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2957.45,"maximum":2957.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2957.45}]}]},{"description":"Remove bladder/revise tract","code_information":[{"code":"51580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3089.94,"maximum":3089.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3089.94}]}]},{"description":"Removal of bladder & nodes","code_information":[{"code":"51585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3434.95,"maximum":3434.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3434.95}]}]},{"description":"Remove bladder/revise tract","code_information":[{"code":"51590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3145.06,"maximum":3145.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3145.06}]}]},{"description":"Remove bladder/revise tract","code_information":[{"code":"51595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3557.76,"maximum":3557.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3557.76}]}]},{"description":"Remove bladder/create pouch","code_information":[{"code":"51596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3842.88,"maximum":3842.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3842.88}]}]},{"description":"Removal of pelvic structures","code_information":[{"code":"51597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3742.04,"maximum":3742.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3742.04}]}]},{"description":"Injection for bladder x-ray","code_information":[{"code":"51600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.03,"maximum":70.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.03}]}]},{"description":"Preparation for bladder xray","code_information":[{"code":"51605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.81,"maximum":62.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.81}]}]},{"description":"Injection for bladder x-ray","code_information":[{"code":"51610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.42,"maximum":106.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.42}]}]},{"description":"Irrigation of bladder","code_information":[{"code":"51700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.65,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Insert bladder catheter","code_information":[{"code":"51701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.99,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Insert temp bladder cath","code_information":[{"code":"51702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.47,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Insert bladder cath complex","code_information":[{"code":"51703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.06,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Change of bladder tube","code_information":[{"code":"51705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.71,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Change of bladder tube","code_information":[{"code":"51710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.03,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopic injection/implant","code_information":[{"code":"51715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":324.91,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":324.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of bladder lesion","code_information":[{"code":"51720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.57,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Ins trurl ablt trnsdc thr us","code_information":[{"code":"51721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.45,"maximum":353.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.45}]}]},{"description":"Simple cystometrogram","code_information":[{"code":"51725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.23,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Complex cystometrogram","code_information":[{"code":"51726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.63,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":315.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Cystometrogram w/up","code_information":[{"code":"51727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":383.89,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":383.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Cystometrogram w/vp","code_information":[{"code":"51728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":384.98,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":384.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Cystometrogram w/vp&up","code_information":[{"code":"51729","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":381.17,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":381.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Urine flow measurement","code_information":[{"code":"51736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.19,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Electro-uroflowmetry first","code_information":[{"code":"51741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.73,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Anal/urinary muscle study","code_information":[{"code":"51784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.99,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Anal/urinary muscle study","code_information":[{"code":"51785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.63,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":490.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Urinary reflex study","code_information":[{"code":"51792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":319.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Intraabdominal pressure test","code_information":[{"code":"51797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.61,"maximum":206.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":206.61}]}]},{"description":"Us urine capacity measure","code_information":[{"code":"51798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.94,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Revision of bladder/urethra","code_information":[{"code":"51800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1698.7,"maximum":1698.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1698.7}]}]},{"description":"Revision of urinary tract","code_information":[{"code":"51820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1776.68,"maximum":1776.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1776.68}]}]},{"description":"Attach bladder/urethra","code_information":[{"code":"51840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1140.26,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1140.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Attach bladder/urethra","code_information":[{"code":"51841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1318.47,"maximum":1318.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1318.47}]}]},{"description":"Repair bladder neck","code_information":[{"code":"51845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":959.86,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":959.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair of bladder wound","code_information":[{"code":"51860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1221.41,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1221.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Repair of bladder wound","code_information":[{"code":"51865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1465.7,"maximum":1465.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1465.7}]}]},{"description":"Repair of bladder opening","code_information":[{"code":"51880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":765.73,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder/vagina lesion","code_information":[{"code":"51900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1354.27,"maximum":1354.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1354.27}]}]},{"description":"Close bladder-uterus fistula","code_information":[{"code":"51920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1255.33,"maximum":1255.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1255.33}]}]},{"description":"Hysterectomy/bladder repair","code_information":[{"code":"51925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1761.49,"maximum":1761.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1761.49}]}]},{"description":"Correction of bladder defect","code_information":[{"code":"51940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2674.25,"maximum":2674.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2674.25}]}]},{"description":"Revision of bladder & bowel","code_information":[{"code":"51960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2260.96,"maximum":2260.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2260.96}]}]},{"description":"Construct bladder opening","code_information":[{"code":"51980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1172.94,"maximum":1172.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1172.94}]}]},{"description":"Laparo urethral suspension","code_information":[{"code":"51990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1221.58,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1221.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo sling operation","code_information":[{"code":"51992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1368.98,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1368.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy","code_information":[{"code":"52000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.6,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy removal of clots","code_information":[{"code":"52001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":465.01,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":465.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & ureter catheter","code_information":[{"code":"52005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.36,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and biopsy","code_information":[{"code":"52007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.85,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & duct catheter","code_information":[{"code":"52010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":269.82,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy w/biopsy(s)","code_information":[{"code":"52204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":230.01,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":284.23,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.5,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":398.84,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":398.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":467.18,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":467.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":633.93,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":633.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Incise sperm duct pouch","code_information":[{"code":"55605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":864.66,"maximum":864.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":864.66}]}]},{"description":"Remove sperm duct pouch","code_information":[{"code":"55650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1180.56,"maximum":1180.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1180.56}]}]},{"description":"Remove sperm pouch lesion","code_information":[{"code":"55680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":575.21,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":575.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of prostate","code_information":[{"code":"55700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":210.96,"maximum":210.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210.96}]}]},{"description":"Biopsy of prostate","code_information":[{"code":"55705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.71,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Prostate saturation sampling","code_information":[{"code":"55706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":620.08,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of prostate abscess","code_information":[{"code":"55720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":745.24,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":745.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of prostate abscess","code_information":[{"code":"55725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":983.65,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":983.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of prostate","code_information":[{"code":"55801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1793.1,"maximum":1793.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.1}]}]},{"description":"Extensive prostate surgery","code_information":[{"code":"55810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2134.4,"maximum":2134.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.4}]}]},{"description":"Extensive prostate surgery","code_information":[{"code":"55812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2622.81,"maximum":2622.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2622.81}]}]},{"description":"Extensive prostate surgery","code_information":[{"code":"55815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2870.96,"maximum":2870.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2870.96}]}]},{"description":"Removal of prostate","code_information":[{"code":"55821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1374.72,"maximum":1374.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1374.72}]}]},{"description":"Removal of prostate","code_information":[{"code":"55831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1409.66,"maximum":1409.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1409.66}]}]},{"description":"Extensive prostate surgery","code_information":[{"code":"55840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1914.92,"maximum":1914.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1914.92}]}]},{"description":"Extensive prostate surgery","code_information":[{"code":"55842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1910.73,"maximum":1910.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1910.73}]}]},{"description":"Extensive prostate surgery","code_information":[{"code":"55845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2223.78,"maximum":2223.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2223.78}]}]},{"description":"Surgical exposure prostate","code_information":[{"code":"55860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1433.2,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1433.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Extensive prostate surgery","code_information":[{"code":"55862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1791.1,"maximum":1791.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1791.1}]}]},{"description":"Extensive prostate surgery","code_information":[{"code":"55865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2181.18,"maximum":2181.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2181.18}]}]},{"description":"Laparo radical prostatectomy","code_information":[{"code":"55866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1953.65,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1953.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laps surg prst8ect smpl stot","code_information":[{"code":"55867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1716.45,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1716.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Cryoablate Prostate","code_information":[{"code":"55873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1256.59,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1256.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl plmt biodegrdabl matrl","code_information":[{"code":"55874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.37,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Transperi needle place pros","code_information":[{"code":"55875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1288.44,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Place rt device/marker pros","code_information":[{"code":"55876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.69,"maximum":7220.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1543.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2315.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1574.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6427.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7220.12,"additional_payer_notes":"APC"}]}]},{"description":"Abltj mal prst8 tiss hifu","code_information":[{"code":"55880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1606.3,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1606.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Ablt trurl prst8 tis thrm us","code_information":[{"code":"55881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":795.93,"maximum":795.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":795.93}]}]},{"description":"Ablt trurl prst8 tis trnsdcr","code_information":[{"code":"55882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":978.33,"maximum":68821.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14713.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22070.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":978.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15007.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61267.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68821.82,"additional_payer_notes":"APC"}]}]},{"description":"Place needles pelvic for rt","code_information":[{"code":"55920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":762.59,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":762.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"I & D of vulva/perineum","code_information":[{"code":"56405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.53,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of gland abscess","code_information":[{"code":"56420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.81,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Surgery for vulva lesion","code_information":[{"code":"56440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.77,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Lysis of labial lesion(s)","code_information":[{"code":"56441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.95,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Hymenotomy","code_information":[{"code":"56442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.96,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vulva lesions sim","code_information":[{"code":"56501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.99,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vulva lesion/s compl","code_information":[{"code":"56515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":349.83,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of vulva/perineum","code_information":[{"code":"56605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.61,"maximum":4804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1540.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4277.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4804.53,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of vulva/perineum","code_information":[{"code":"56606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.96,"maximum":46.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.96}]}]},{"description":"Partial removal of vulva","code_information":[{"code":"56620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":966.03,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Complete removal of vulva","code_information":[{"code":"56625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1100.56,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1100.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Extensive vulva surgery","code_information":[{"code":"56630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1580.59,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1580.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Extensive vulva surgery","code_information":[{"code":"56631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1956.98,"maximum":1956.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1956.98}]}]},{"description":"Extensive vulva surgery","code_information":[{"code":"56632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2362.48,"maximum":2362.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2362.48}]}]},{"description":"Extensive vulva surgery","code_information":[{"code":"56633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1904.19,"maximum":1904.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1904.19}]}]},{"description":"Extensive vulva surgery","code_information":[{"code":"56634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2137.91,"maximum":2137.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2137.91}]}]},{"description":"Extensive vulva surgery","code_information":[{"code":"56637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2504.51,"maximum":2504.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2504.51}]}]},{"description":"Extensive vulva surgery","code_information":[{"code":"56640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2514.84,"maximum":2514.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2514.84}]}]},{"description":"Partial removal of hymen","code_information":[{"code":"56700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":334.45,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":334.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina gland lesion","code_information":[{"code":"56740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":516.14,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":516.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Repair of vagina","code_information":[{"code":"56800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.54,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Repair clitoris","code_information":[{"code":"56805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1908.66,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1908.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Repair of perineum","code_information":[{"code":"56810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":446.51,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":446.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Exam of vulva w/scope","code_information":[{"code":"56820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.03,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Exam/biopsy of vulva w/scope","code_information":[{"code":"56821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":186.0,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":186.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of vagina","code_information":[{"code":"57000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.88,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic abscess","code_information":[{"code":"57010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":752.54,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":752.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic fluid","code_information":[{"code":"57020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.34,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"I & d vaginal hematoma pp","code_information":[{"code":"57022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":298.58,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"I & d vag hematoma non-ob","code_information":[{"code":"57023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":525.56,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":525.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vag lesions simple","code_information":[{"code":"57061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":189.97,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":189.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vag lesions complex","code_information":[{"code":"57065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":305.65,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of vagina","code_information":[{"code":"57100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.47,"maximum":4804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1540.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4277.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4804.53,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of vagina","code_information":[{"code":"57105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.65,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina wall partial","code_information":[{"code":"57106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":884.22,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":884.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina tissue part","code_information":[{"code":"57107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2394.45,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2394.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Vaginectomy partial w/nodes","code_information":[{"code":"57109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2851.39,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2851.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina wall complete","code_information":[{"code":"57110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1481.41,"maximum":1481.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1481.41}]}]},{"description":"Remove vagina tissue compl","code_information":[{"code":"57111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2851.39,"maximum":2851.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2851.39}]}]},{"description":"Closure of vagina","code_information":[{"code":"57120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":872.82,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":872.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina lesion","code_information":[{"code":"57130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":284.92,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina lesion","code_information":[{"code":"57135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.96,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":309.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Treat vagina infection","code_information":[{"code":"57150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.51,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Insert uteri tandem/ovoids","code_information":[{"code":"57155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.74,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Ins vag brachytx device","code_information":[{"code":"57156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.91,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":250.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Insert pessary/other device","code_information":[{"code":"57160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.31,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Fitting of diaphragm/cap","code_information":[{"code":"57170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.46,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Treat vaginal bleeding","code_information":[{"code":"57180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.8,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Repair of vagina","code_information":[{"code":"57200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":546.86,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":546.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Repair vagina/perineum","code_information":[{"code":"57210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":646.29,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":646.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Revision of urethra","code_information":[{"code":"57220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.93,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethral lesion","code_information":[{"code":"57230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":687.23,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":687.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder & vagina","code_information":[{"code":"57240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1008.94,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1008.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair rectum & vagina","code_information":[{"code":"57250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1012.06,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1012.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair of vagina","code_information":[{"code":"57260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1278.42,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1278.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Extensive repair of vagina","code_information":[{"code":"57265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1429.58,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1429.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Insert mesh/pelvic flr addon","code_information":[{"code":"57267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.88,"maximum":407.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.88}]}]},{"description":"Repair of bowel bulge","code_information":[{"code":"57268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":833.88,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":833.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair of bowel pouch","code_information":[{"code":"57270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1332.94,"maximum":1332.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1332.94}]}]},{"description":"Suspension of vagina","code_information":[{"code":"57280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1584.25,"maximum":1584.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1584.25}]}]},{"description":"Colpopexy extraperitoneal","code_information":[{"code":"57282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1139.41,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1139.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Colpopexy intraperitoneal","code_information":[{"code":"57283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1148.43,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1148.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair paravag defect open","code_information":[{"code":"57284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1374.81,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1374.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair paravag defect vag","code_information":[{"code":"57285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1137.74,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1137.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Revise/Remove Sling Repair","code_information":[{"code":"57287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1217.91,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1217.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder defect","code_information":[{"code":"57288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1223.77,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1223.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder & vagina","code_information":[{"code":"57289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1300.77,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1300.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Construction of vagina","code_information":[{"code":"57291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":904.26,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":904.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Construct vagina with graft","code_information":[{"code":"57292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1358.35,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1358.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Revise vag graft via vagina","code_information":[{"code":"57295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":825.45,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":825.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Revise vag graft open abd","code_information":[{"code":"57296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1571.73,"maximum":1571.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1571.73}]}]},{"description":"Repair rectum-vagina fistula","code_information":[{"code":"57300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1005.56,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1005.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Repair rectum-vagina fistula","code_information":[{"code":"57305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.99,"maximum":1595.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1595.99}]}]},{"description":"Fistula repair & colostomy","code_information":[{"code":"57307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1770.79,"maximum":1770.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1770.79}]}]},{"description":"Fistula repair transperine","code_information":[{"code":"57308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1094.85,"maximum":1094.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1094.85}]}]},{"description":"Repair urethrovaginal lesion","code_information":[{"code":"57310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":812.98,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":812.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair urethrovaginal lesion","code_information":[{"code":"57311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":915.71,"maximum":915.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":915.71}]}]},{"description":"Repair bladder-vagina lesion","code_information":[{"code":"57320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":927.23,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":927.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder-vagina lesion","code_information":[{"code":"57330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1260.68,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1260.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Repair vagina","code_information":[{"code":"57335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1928.25,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1928.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of vagina","code_information":[{"code":"57400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.77,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic examination","code_information":[{"code":"57410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.95,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Remove vaginal foreign body","code_information":[{"code":"57415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":288.25,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Exam of vagina w/scope","code_information":[{"code":"57420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":147.81,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Exam/biopsy of vag w/scope","code_information":[{"code":"57421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.15,"maximum":4804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1540.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4277.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4804.53,"additional_payer_notes":"APC"}]}]},{"description":"Repair paravag defect lap","code_information":[{"code":"57423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1520.84,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1520.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Cryosurgery penis lesion(s)","code_information":[{"code":"54056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":187.38,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Laser surg penis lesion(s)","code_information":[{"code":"54057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.71,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Excision of penis lesion(s)","code_information":[{"code":"54060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.74,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":287.46,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":287.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of penis","code_information":[{"code":"54100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.28,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of penis","code_information":[{"code":"54105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.95,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1027.65,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Treat penis lesion graft","code_information":[{"code":"54111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1311.34,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1311.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Treat penis lesion graft","code_information":[{"code":"54112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1536.93,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1536.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.22,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":706.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of penis","code_information":[{"code":"54120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1042.29,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1042.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of penis","code_information":[{"code":"54125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1359.35,"maximum":1359.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1359.35}]}]},{"description":"Remove penis & nodes","code_information":[{"code":"54130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1952.22,"maximum":1952.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1952.22}]}]},{"description":"Remove penis & nodes","code_information":[{"code":"54135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2464.97,"maximum":2464.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2464.97}]}]},{"description":"Circumcision w/regionl block","code_information":[{"code":"54150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.83,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Circumcision neonate","code_information":[{"code":"54160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.65,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Circum 28 days or older","code_information":[{"code":"54161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.88,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":325.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Lysis penil circumic lesion","code_information":[{"code":"54162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":330.78,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":330.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Repair of circumcision","code_information":[{"code":"54163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":363.3,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":363.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.01,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":877.79,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":877.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.87,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Prepare penis study","code_information":[{"code":"54230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.56,"maximum":131.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.56}]}]},{"description":"Revision of penis","code_information":[{"code":"54300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1061.93,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1061.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revision of penis","code_information":[{"code":"54304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1227.64,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1227.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1177.3,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1177.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1343.94,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1343.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1627.69,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1627.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1171.75,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1171.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.29,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1586.64,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1586.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1544.55,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1544.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revise penis/urethra","code_information":[{"code":"54328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1534.7,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1534.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revise penis/urethra","code_information":[{"code":"54332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1654.95,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1654.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revise penis/urethra","code_information":[{"code":"54336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1943.94,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1943.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Secondary urethral surgery","code_information":[{"code":"54340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":937.94,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":937.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Secondary urethral surgery","code_information":[{"code":"54344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1547.82,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1547.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Secondary urethral surgery","code_information":[{"code":"54348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1654.93,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1654.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra/penis","code_information":[{"code":"54352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2307.52,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2307.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Penis plastic surgery","code_information":[{"code":"54360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1185.01,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1185.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Repair penis","code_information":[{"code":"54380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1313.33,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1313.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Repair penis","code_information":[{"code":"54385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1526.41,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1526.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Repair penis and bladder","code_information":[{"code":"54390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2030.34,"maximum":2030.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2030.34}]}]},{"description":"Revision of penis","code_information":[{"code":"54420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.91,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1154.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revision of penis","code_information":[{"code":"54430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1052.63,"maximum":1052.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1052.63}]}]},{"description":"Revision of penis","code_information":[{"code":"54435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":685.52,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Repair corporeal tear","code_information":[{"code":"54437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1119.65,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1119.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Preputial stretching","code_information":[{"code":"54450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.42,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of testis","code_information":[{"code":"54500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.3,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of testis","code_information":[{"code":"54505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.04,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Excise Lesion Testis","code_information":[{"code":"54512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":888.27,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":888.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of testis","code_information":[{"code":"54520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.84,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":542.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Orchiectomy partial","code_information":[{"code":"54522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":967.51,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":967.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of testis","code_information":[{"code":"54530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.02,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Extensive testis surgery","code_information":[{"code":"54535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1222.7,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1222.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Exploration for testis","code_information":[{"code":"54550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":811.26,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":811.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Exploration for testis","code_information":[{"code":"54560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1130.32,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1130.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Reduce testis torsion","code_information":[{"code":"54600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.9,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Suspension of testis","code_information":[{"code":"54620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":490.88,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":490.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Suspension of testis","code_information":[{"code":"54640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":713.06,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Orchiopexy (Fowler-Stephens)","code_information":[{"code":"54650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1172.28,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1172.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Repair testis injury","code_information":[{"code":"54670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.71,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":676.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Relocation of testis(es)","code_information":[{"code":"54680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1293.17,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1293.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy orchiectomy","code_information":[{"code":"54690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1077.47,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1077.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy orchiopexy","code_information":[{"code":"54692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1239.83,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1239.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of scrotum","code_information":[{"code":"54700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.49,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of epididymis","code_information":[{"code":"54800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":204.87,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":204.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove epididymis lesion","code_information":[{"code":"54830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":616.65,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Remove epididymis lesion","code_information":[{"code":"54840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":532.7,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":532.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Removal of epididymis","code_information":[{"code":"54860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":692.66,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":692.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of epididymis","code_information":[{"code":"54861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":936.32,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":936.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Explore Epididymis","code_information":[{"code":"54865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.5,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of spermatic ducts","code_information":[{"code":"54900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1315.52,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1315.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of spermatic ducts","code_information":[{"code":"54901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1733.54,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1733.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hydrocele","code_information":[{"code":"55000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.67,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydrocele","code_information":[{"code":"55040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":560.38,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":560.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydroceles","code_information":[{"code":"55041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":843.87,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":843.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hydrocele","code_information":[{"code":"55060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":628.65,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of scrotum abscess","code_information":[{"code":"55100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.52,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Explore scrotum","code_information":[{"code":"55110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":644.39,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":644.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of scrotum lesion","code_information":[{"code":"55120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.37,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Removal of scrotum","code_information":[{"code":"55150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":815.31,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":815.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revision of scrotum","code_information":[{"code":"55175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":605.16,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revision of scrotum","code_information":[{"code":"55180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1133.82,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Removal of sperm duct(s)","code_information":[{"code":"55250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":381.25,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":381.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydrocele","code_information":[{"code":"55500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":647.38,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":647.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Removal of sperm cord lesion","code_information":[{"code":"55520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":761.61,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":761.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revise spermatic cord veins","code_information":[{"code":"55530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":582.83,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":582.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Revise spermatic cord veins","code_information":[{"code":"55535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":711.25,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":711.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Revise hernia & sperm veins","code_information":[{"code":"55540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":920.26,"maximum":18676.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5989.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":920.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4072.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16626.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18676.66,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ligate spermatic vein","code_information":[{"code":"55550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":710.18,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":710.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Incise sperm duct pouch","code_information":[{"code":"55600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":697.58,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":697.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy tubal cautery","code_information":[{"code":"58670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":611.58,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":611.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy tubal block","code_information":[{"code":"58671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":611.58,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":611.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy fimbrioplasty","code_information":[{"code":"58672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1197.8,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1197.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy salpingostomy","code_information":[{"code":"58673","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1299.82,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1299.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laps abltj uterine fibroids","code_information":[{"code":"58674","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1334.52,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of fallopian tube","code_information":[{"code":"58700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1319.28,"maximum":1319.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1319.28}]}]},{"description":"Removal of ovary/tube(s)","code_information":[{"code":"58720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1251.38,"maximum":1251.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1251.38}]}]},{"description":"Adhesiolysis tube ovary","code_information":[{"code":"58740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1487.74,"maximum":1487.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1487.74}]}]},{"description":"Create new tubal opening","code_information":[{"code":"58770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1413.0,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1413.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of ovarian cyst(s)","code_information":[{"code":"58800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":520.87,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":520.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of ovarian cyst(s)","code_information":[{"code":"58805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.99,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":702.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Drain ovary abscess open","code_information":[{"code":"58820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":558.32,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":558.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Drain ovary abscess percut","code_information":[{"code":"58822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1173.32,"maximum":1173.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1173.32}]}]},{"description":"Transposition ovary(s)","code_information":[{"code":"58825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1164.62,"maximum":1164.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1164.62}]}]},{"description":"Biopsy of ovary(s)","code_information":[{"code":"58900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":718.25,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":718.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ovary(s)","code_information":[{"code":"58920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1172.33,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1172.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ovarian cyst(s)","code_information":[{"code":"58925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1265.27,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1265.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ovary(s)","code_information":[{"code":"58940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":915.05,"maximum":915.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":915.05}]}]},{"description":"Removal of ovary(s)","code_information":[{"code":"58943","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1976.79,"maximum":1976.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1976.79}]}]},{"description":"Resect ovarian malignancy","code_information":[{"code":"58950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1895.26,"maximum":1895.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1895.26}]}]},{"description":"Resect ovarian malignancy","code_information":[{"code":"58951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2372.41,"maximum":2372.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2372.41}]}]},{"description":"Resect ovarian malignancy","code_information":[{"code":"58952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2704.76,"maximum":2704.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.76}]}]},{"description":"Tah rad dissect for debulk","code_information":[{"code":"58953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3289.26,"maximum":3289.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3289.26}]}]},{"description":"Tah rad debulk/lymph remove","code_information":[{"code":"58954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3559.76,"maximum":3559.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3559.76}]}]},{"description":"Bso omentectomy w/tah","code_information":[{"code":"58956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2238.76,"maximum":2238.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2238.76}]}]},{"description":"Resect Recur Gyn Mal w/Lym","code_information":[{"code":"58958","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2712.43,"maximum":2712.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2712.43}]}]},{"description":"Exploration of abdomen","code_information":[{"code":"58960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.43,"maximum":1643.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.43}]}]},{"description":"Amniocentesis diagnostic","code_information":[{"code":"59000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.51,"maximum":4804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1540.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4277.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4804.53,"additional_payer_notes":"APC"}]}]},{"description":"Amniocentesis therapeutic","code_information":[{"code":"59001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":290.27,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":290.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Fetal cord puncture prenatal","code_information":[{"code":"59012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.74,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":327.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Chorion biopsy","code_information":[{"code":"59015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.17,"maximum":4804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1540.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4277.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4804.53,"additional_payer_notes":"APC"}]}]},{"description":"Fetal contract stress test","code_information":[{"code":"59020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.37,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Fetal non-stress test","code_information":[{"code":"59025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.06,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Fetal scalp blood sample","code_information":[{"code":"59030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.64,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Fetal monitor w/report","code_information":[{"code":"59050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.55,"maximum":81.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.55}]}]},{"description":"Fetal monitor/interpret only","code_information":[{"code":"59051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.96,"maximum":67.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.96}]}]},{"description":"Transabdom amnioinfus w/us","code_information":[{"code":"59070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.84,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":503.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Umbilical cord occlud w/us","code_information":[{"code":"59072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.84,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":848.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Fetal fluid drainage w/us","code_information":[{"code":"59074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.84,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":503.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Fetal shunt placement w/us","code_information":[{"code":"59076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.84,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":848.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Remove uterus lesion","code_information":[{"code":"59100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1406.3,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1406.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1341.11,"maximum":1341.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1341.11}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1341.66,"maximum":1341.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1341.66}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1556.4,"maximum":1556.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1556.4}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1477.5,"maximum":1477.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1477.5}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":686.73,"maximum":686.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":686.73}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1301.43,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1301.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1272.13,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1272.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"D & c after delivery","code_information":[{"code":"59160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.08,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":308.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Insert cervical dilator","code_information":[{"code":"59200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.83,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Episiotomy or vaginal repair","code_information":[{"code":"59300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.31,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cervix","code_information":[{"code":"59320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.88,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cervix","code_information":[{"code":"59325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":393.46,"maximum":393.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.46}]}]},{"description":"Repair of uterus","code_information":[{"code":"59350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.34,"maximum":453.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.34}]}]},{"description":"Obstetrical care","code_information":[{"code":"59409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.22,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1305.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Obstetrical care","code_information":[{"code":"59410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1767.28,"maximum":1767.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1767.28}]}]},{"description":"Deliver placenta","code_information":[{"code":"59414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.36,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Care after delivery","code_information":[{"code":"59430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.63,"maximum":291.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":291.63}]}]},{"description":"Remove uterus after cesarean","code_information":[{"code":"59525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":783.27,"maximum":783.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":783.27}]}]},{"description":"Treatment of miscarriage","code_information":[{"code":"59812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":506.93,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":506.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Care of miscarriage","code_information":[{"code":"59820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":637.15,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":637.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of miscarriage","code_information":[{"code":"59821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.54,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":622.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Treat uterus infection","code_information":[{"code":"59830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":762.28,"maximum":762.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":762.28}]}]},{"description":"Abortion","code_information":[{"code":"59840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.01,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Abortion","code_information":[{"code":"59841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.99,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Abortion","code_information":[{"code":"59850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":646.57,"maximum":646.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":646.57}]}]},{"description":"Abortion","code_information":[{"code":"59851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":705.7,"maximum":705.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.7}]}]},{"description":"Abortion","code_information":[{"code":"59852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":967.1,"maximum":967.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":967.1}]}]},{"description":"Abortion","code_information":[{"code":"59855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.3,"maximum":699.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.3}]}]},{"description":"Abortion","code_information":[{"code":"59856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":818.91,"maximum":818.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.91}]}]},{"description":"Abortion","code_information":[{"code":"59857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":953.75,"maximum":953.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":953.75}]}]},{"description":"Evacuate mole of uterus","code_information":[{"code":"59870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":879.39,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":879.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Remove cerclage suture","code_information":[{"code":"59871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.93,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Drain thyroid/tongue cyst","code_information":[{"code":"60000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":263.5,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of thyroid","code_information":[{"code":"60100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.63,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":123.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid lesion","code_information":[{"code":"60200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1104.32,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1104.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Partial thyroid excision","code_information":[{"code":"60210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1169.37,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1169.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Partial thyroid excision","code_information":[{"code":"60212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1688.15,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1688.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of thyroid","code_information":[{"code":"60220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1165.88,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1165.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of thyroid","code_information":[{"code":"60225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1547.51,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1547.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Removal of thyroid","code_information":[{"code":"60240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1509.02,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1509.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Removal of thyroid","code_information":[{"code":"60252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2164.99,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2164.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Extensive thyroid surgery","code_information":[{"code":"60254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2731.88,"maximum":2731.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2731.88}]}]},{"description":"Repeat thyroid surgery","code_information":[{"code":"60260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1787.58,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1787.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of thyroid","code_information":[{"code":"60270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2231.24,"maximum":2231.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2231.24}]}]},{"description":"Removal of thyroid","code_information":[{"code":"60271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1734.38,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1734.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid duct lesion","code_information":[{"code":"60280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":752.95,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":752.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid duct lesion","code_information":[{"code":"60281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":985.66,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":985.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Aspir/inj thyroid cyst","code_information":[{"code":"60300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.76,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Explore parathyroid glands","code_information":[{"code":"60500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1597.08,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Re-explore parathyroids","code_information":[{"code":"60502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2144.43,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2144.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Explore parathyroid glands","code_information":[{"code":"60505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2292.86,"maximum":2292.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2292.86}]}]},{"description":"Autotransplant parathyroid","code_information":[{"code":"60512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":391.93,"maximum":391.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":391.93}]}]},{"description":"Removal of thymus gland","code_information":[{"code":"60520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.29,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of thymus gland","code_information":[{"code":"60521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1830.76,"maximum":1830.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1830.76}]}]},{"description":"Removal of thymus gland","code_information":[{"code":"60522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2214.0,"maximum":2214.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2214.0}]}]},{"description":"Explore adrenal gland","code_information":[{"code":"60540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1771.92,"maximum":1771.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.92}]}]},{"description":"Explore adrenal gland","code_information":[{"code":"60545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2040.64,"maximum":2040.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2040.64}]}]},{"description":"Remove carotid body lesion","code_information":[{"code":"60600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2198.13,"maximum":2198.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2198.13}]}]},{"description":"Remove carotid body lesion","code_information":[{"code":"60605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2632.62,"maximum":2632.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2632.62}]}]},{"description":"Laparoscopy adrenalectomy","code_information":[{"code":"60650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1958.83,"maximum":1958.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1958.83}]}]},{"description":"Abltj 1/+thyr ndul 1lobe prq","code_information":[{"code":"60660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":517.57,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":517.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Abltj 1/+thyr ndul addl prq","code_information":[{"code":"60661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":358.52,"maximum":358.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":358.52}]}]},{"description":"Remove cranial cavity fluid","code_information":[{"code":"61000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.13,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Remove cranial cavity fluid","code_information":[{"code":"61001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":178.9,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Remove brain cavity fluid","code_information":[{"code":"61020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.73,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Injection into brain canal","code_information":[{"code":"61026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.85,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Remove brain canal fluid","code_information":[{"code":"61050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.73,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Injection into brain canal","code_information":[{"code":"61055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.88,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Brain canal shunt procedure","code_information":[{"code":"61070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.11,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Twist drill hole","code_information":[{"code":"61105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":781.78,"maximum":781.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":781.78}]}]},{"description":"Drill skull for implantation","code_information":[{"code":"61107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.8,"maximum":511.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":511.8}]}]},{"description":"Drill skull for drainage","code_information":[{"code":"61108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1514.11,"maximum":1514.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1514.11}]}]},{"description":"Burr hole for puncture","code_information":[{"code":"61120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1256.66,"maximum":1256.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1256.66}]}]},{"description":"Pierce skull for biopsy","code_information":[{"code":"61140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2119.77,"maximum":2119.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2119.77}]}]},{"description":"Pierce skull for drainage","code_information":[{"code":"61150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2247.58,"maximum":2247.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2247.58}]}]},{"description":"Pierce skull for drainage","code_information":[{"code":"61151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1657.78,"maximum":1657.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1657.78}]}]},{"description":"Pierce skull & remove clot","code_information":[{"code":"61154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2131.19,"maximum":2131.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2131.19}]}]},{"description":"Pierce skull for drainage","code_information":[{"code":"61156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2064.92,"maximum":2064.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2064.92}]}]},{"description":"Pierce skull implant device","code_information":[{"code":"61210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.14,"maximum":600.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.14}]}]},{"description":"Insert brain-fluid device","code_information":[{"code":"61215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":869.08,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":869.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Pierce skull & explore","code_information":[{"code":"61250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1451.77,"maximum":1451.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1451.77}]}]},{"description":"Pierce skull & explore","code_information":[{"code":"61253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1657.78,"maximum":1657.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1657.78}]}]},{"description":"Open skull for exploration","code_information":[{"code":"61304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2722.38,"maximum":2722.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2722.38}]}]},{"description":"Open skull for exploration","code_information":[{"code":"61305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3326.39,"maximum":3326.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3326.39}]}]},{"description":"Open skull for drainage","code_information":[{"code":"61312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3426.37,"maximum":3426.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.37}]}]},{"description":"Open skull for drainage","code_information":[{"code":"61313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3294.57,"maximum":3294.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3294.57}]}]},{"description":"Open skull for drainage","code_information":[{"code":"61314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3030.76,"maximum":3030.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3030.76}]}]},{"description":"Open skull for drainage","code_information":[{"code":"61315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3426.24,"maximum":3426.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3426.24}]}]},{"description":"Implt cran bone flap to abdo","code_information":[{"code":"61316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.63,"maximum":143.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.63}]}]},{"description":"Open skull for drainage","code_information":[{"code":"61320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3143.99,"maximum":3143.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.99}]}]},{"description":"Open skull for drainage","code_information":[{"code":"61321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3521.0,"maximum":3521.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.0}]}]},{"description":"Decompressive craniotomy","code_information":[{"code":"61322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3943.52,"maximum":3943.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3943.52}]}]},{"description":"Decompressive lobectomy","code_information":[{"code":"61323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3924.57,"maximum":3924.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3924.57}]}]},{"description":"Decompress eye socket","code_information":[{"code":"61330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2979.42,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2979.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Explore orbit/remove lesion","code_information":[{"code":"61333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3341.56,"maximum":3341.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3341.56}]}]},{"description":"Subtemporal decompression","code_information":[{"code":"61340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2396.69,"maximum":2396.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2396.69}]}]},{"description":"Incise skull (press relief)","code_information":[{"code":"61343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3628.54,"maximum":3628.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3628.54}]}]},{"description":"Relieve cranial pressure","code_information":[{"code":"61345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3388.16,"maximum":3388.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3388.16}]}]},{"description":"Incise skull for surgery","code_information":[{"code":"61450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3182.7,"maximum":3182.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3182.7}]}]},{"description":"Incise skull for brain wound","code_information":[{"code":"61458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3345.44,"maximum":3345.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3345.44}]}]},{"description":"Incise skull for surgery","code_information":[{"code":"61460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3491.2,"maximum":3491.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3491.2}]}]},{"description":"Laparoscopy surg colpopexy","code_information":[{"code":"57425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.8,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1595.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Revise prosth vag graft lap","code_information":[{"code":"57426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1433.68,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1433.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Exam of cervix w/scope","code_information":[{"code":"57452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.41,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Bx/curett of cervix w/scope","code_information":[{"code":"57454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.25,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of cervix w/scope","code_information":[{"code":"57455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":178.38,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Endocerv curettage w/scope","code_information":[{"code":"57456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.28,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Bx of cervix w/scope leep","code_information":[{"code":"57460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.33,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Conz of cervix w/scope leep","code_information":[{"code":"57461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.08,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Cam cervix uteri drg colp","code_information":[{"code":"57465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.81,"maximum":69.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.81}]}]},{"description":"Biopsy of cervix","code_information":[{"code":"57500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.75,"maximum":4804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1540.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":123.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4277.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4804.53,"additional_payer_notes":"APC"}]}]},{"description":"Endocervical curettage","code_information":[{"code":"57505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.59,"maximum":4804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1540.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4277.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4804.53,"additional_payer_notes":"APC"}]}]},{"description":"Cauterization of cervix","code_information":[{"code":"57510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.45,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Cryocautery of cervix","code_information":[{"code":"57511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":242.34,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery of cervix","code_information":[{"code":"57513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.26,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Conization of cervix","code_information":[{"code":"57520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":489.71,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":489.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Conization of cervix","code_information":[{"code":"57522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.17,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Removal of cervix","code_information":[{"code":"57530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":617.27,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Removal of cervix radical","code_information":[{"code":"57531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2992.32,"maximum":2992.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2992.32}]}]},{"description":"Removal of residual cervix","code_information":[{"code":"57540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1299.34,"maximum":1299.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1299.34}]}]},{"description":"Remove cervix/repair pelvis","code_information":[{"code":"57545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1367.61,"maximum":1367.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1367.61}]}]},{"description":"Removal of residual cervix","code_information":[{"code":"57550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.94,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Remove cervix/repair vagina","code_information":[{"code":"57555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1017.21,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1017.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Remove cervix repair bowel","code_information":[{"code":"57556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.94,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":965.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"D&C oF Cervical Stump","code_information":[{"code":"57558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":210.82,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cervix","code_information":[{"code":"57700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.23,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":584.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cervix","code_information":[{"code":"57720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":550.67,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":550.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of cervical canal","code_information":[{"code":"57800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.03,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of uterus lining","code_information":[{"code":"58100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.14,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Bx done w/colposcopy add-on","code_information":[{"code":"58110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.03,"maximum":66.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.03}]}]},{"description":"Dilation and curettage","code_information":[{"code":"58120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":384.24,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":384.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Myomectomy abdom method","code_information":[{"code":"58140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1511.13,"maximum":1511.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1511.13}]}]},{"description":"Myomectomy vag method","code_information":[{"code":"58145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.94,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Myomectomy abdom complex","code_information":[{"code":"58146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1892.05,"maximum":1892.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1892.05}]}]},{"description":"Total hysterectomy","code_information":[{"code":"58150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1674.09,"maximum":1674.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1674.09}]}]},{"description":"Total hysterectomy","code_information":[{"code":"58152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2028.46,"maximum":2028.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2028.46}]}]},{"description":"Partial hysterectomy","code_information":[{"code":"58180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1579.87,"maximum":1579.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1579.87}]}]},{"description":"Extensive hysterectomy","code_information":[{"code":"58200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2221.12,"maximum":2221.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.12}]}]},{"description":"Extensive hysterectomy","code_information":[{"code":"58210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2992.63,"maximum":2992.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2992.63}]}]},{"description":"Removal of pelvis contents","code_information":[{"code":"58240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4819.72,"maximum":4819.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4819.72}]}]},{"description":"Vaginal hysterectomy","code_information":[{"code":"58260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1377.46,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1377.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst including t/o","code_information":[{"code":"58262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1522.72,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1522.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/t/o & vag repair","code_information":[{"code":"58263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1633.41,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1633.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/urinary repair","code_information":[{"code":"58267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1753.82,"maximum":1753.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1753.82}]}]},{"description":"Vag hyst w/enterocele repair","code_information":[{"code":"58270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1468.15,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1468.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Hysterectomy/revise vagina","code_information":[{"code":"58275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1628.41,"maximum":1628.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1628.41}]}]},{"description":"Hysterectomy/revise vagina","code_information":[{"code":"58280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1737.04,"maximum":1737.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1737.04}]}]},{"description":"Extensive hysterectomy","code_information":[{"code":"58285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2340.08,"maximum":2340.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2340.08}]}]},{"description":"Vag hyst complex","code_information":[{"code":"58290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1886.05,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1886.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst incl t/o complex","code_information":[{"code":"58291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2036.72,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2036.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst t/o & repair compl","code_information":[{"code":"58292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2145.36,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2145.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/enterocele compl","code_information":[{"code":"58294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1993.61,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1993.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Remove intrauterine device","code_information":[{"code":"58301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.06,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Catheter for hysterography","code_information":[{"code":"58340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.36,"maximum":95.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.36}]}]},{"description":"Insert heyman uteri capsule","code_information":[{"code":"58346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":827.71,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":827.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Endometr ablate thermal","code_information":[{"code":"58353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.82,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Endometrial cryoablation","code_information":[{"code":"58356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":576.64,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":576.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Suspension of uterus","code_information":[{"code":"58400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.04,"maximum":759.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.04}]}]},{"description":"Suspension of uterus","code_information":[{"code":"58410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1338.16,"maximum":1338.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1338.16}]}]},{"description":"Repair of ruptured uterus","code_information":[{"code":"58520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1310.34,"maximum":1310.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1310.34}]}]},{"description":"Revision of uterus","code_information":[{"code":"58540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.56,"maximum":1504.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1504.56}]}]},{"description":"Lsh uterus 250 g or less","code_information":[{"code":"58541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1201.55,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1201.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Lsh w/t/o ut 250 g or less","code_information":[{"code":"58542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1362.39,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1362.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"LSH Uterus Above 250 g","code_information":[{"code":"58543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1382.43,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1382.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"LSH w/t/o Uterus Above 250 g","code_information":[{"code":"58544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1487.19,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1487.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopic myomectomy","code_information":[{"code":"58545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1480.53,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1480.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-myomectomy complex","code_information":[{"code":"58546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1825.19,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1825.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Lap Radical Hyst","code_information":[{"code":"58548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3091.7,"maximum":3091.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3091.7}]}]},{"description":"Laparo-asst vag hysterectomy","code_information":[{"code":"58550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1450.63,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1450.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-vag hyst incl t/o","code_information":[{"code":"58552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1612.68,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1612.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-vag hyst complex","code_information":[{"code":"58553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1835.54,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1835.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-vag hyst w/t/o compl","code_information":[{"code":"58554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2137.74,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2137.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy dx sep proc","code_information":[{"code":"58555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy biopsy","code_information":[{"code":"58558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.54,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy lysis","code_information":[{"code":"58559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":463.18,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":463.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy resect septum","code_information":[{"code":"58560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":510.09,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":510.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy remove myoma","code_information":[{"code":"58561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":583.76,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy remove fb","code_information":[{"code":"58562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.7,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy ablation","code_information":[{"code":"58563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":401.53,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":401.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy sterilization","code_information":[{"code":"58565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.57,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":750.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Tlh uterus 250 g or less","code_information":[{"code":"58570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1328.73,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1328.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Tlh w/t/o 250 g or less","code_information":[{"code":"58571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1492.87,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1492.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Tlh uterus over 250 g","code_information":[{"code":"58572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1710.64,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1710.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Tlh w/t/o uterus over 250 g","code_information":[{"code":"58573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2000.25,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2000.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laps tot hyst resj mal","code_information":[{"code":"58575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3176.22,"maximum":3176.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3176.22}]}]},{"description":"Transcrv abltj utrn fibrd rf","code_information":[{"code":"58580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":664.14,"maximum":38681.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8269.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12404.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":664.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8435.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34435.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38681.58,"additional_payer_notes":"APC"}]}]},{"description":"Division of fallopian tube","code_information":[{"code":"58600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":610.51,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":610.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Division of fallopian tube","code_information":[{"code":"58605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":554.34,"maximum":554.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":554.34}]}]},{"description":"Ligate oviduct(s) add-on","code_information":[{"code":"58611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.8,"maximum":122.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.8}]}]},{"description":"Occlude fallopian tube(s)","code_information":[{"code":"58615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":415.35,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":415.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lysis","code_information":[{"code":"58660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1128.01,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1128.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy remove adnexa","code_information":[{"code":"58661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1071.66,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1071.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy excise lesions","code_information":[{"code":"58662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1172.35,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1172.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Removal of skull lesion","code_information":[{"code":"61500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2144.47,"maximum":2144.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2144.47}]}]},{"description":"Remove infected skull bone","code_information":[{"code":"61501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1876.19,"maximum":1876.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1876.19}]}]},{"description":"Removal of brain lesion","code_information":[{"code":"61510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3655.08,"maximum":3655.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3655.08}]}]},{"description":"Remove brain lining lesion","code_information":[{"code":"61512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4224.32,"maximum":4224.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4224.32}]}]},{"description":"Removal of brain abscess","code_information":[{"code":"61514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3181.65,"maximum":3181.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3181.65}]}]},{"description":"Removal of brain lesion","code_information":[{"code":"61516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3102.84,"maximum":3102.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3102.84}]}]},{"description":"Implt brain chemotx add-on","code_information":[{"code":"61517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.08,"maximum":143.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.08}]}]},{"description":"Removal of brain lesion","code_information":[{"code":"61518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4583.79,"maximum":4583.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4583.79}]}]},{"description":"Remove brain lining lesion","code_information":[{"code":"61519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4869.01,"maximum":4869.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4869.01}]}]},{"description":"Removal of brain lesion","code_information":[{"code":"61520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6141.55,"maximum":6141.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6141.55}]}]},{"description":"Removal of brain lesion","code_information":[{"code":"61521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5228.46,"maximum":5228.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5228.46}]}]},{"description":"Removal of brain abscess","code_information":[{"code":"61522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3625.62,"maximum":3625.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3625.62}]}]},{"description":"Removal of brain lesion","code_information":[{"code":"61524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3455.42,"maximum":3455.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3455.42}]}]},{"description":"Removal of brain lesion","code_information":[{"code":"61526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5488.46,"maximum":5488.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5488.46}]}]},{"description":"Removal of brain lesion","code_information":[{"code":"61530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5070.86,"maximum":5070.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5070.86}]}]},{"description":"Implant brain electrodes","code_information":[{"code":"61531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2049.21,"maximum":2049.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2049.21}]}]},{"description":"Implant brain electrodes","code_information":[{"code":"61533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2539.79,"maximum":2539.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2539.79}]}]},{"description":"Removal of brain lesion","code_information":[{"code":"61534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2745.85,"maximum":2745.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2745.85}]}]},{"description":"Remove brain electrodes","code_information":[{"code":"61535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1682.78,"maximum":1682.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1682.78}]}]},{"description":"Removal of brain lesion","code_information":[{"code":"61536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4263.62,"maximum":4263.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4263.62}]}]},{"description":"Removal of brain tissue","code_information":[{"code":"61537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4060.34,"maximum":4060.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4060.34}]}]},{"description":"Removal of brain tissue","code_information":[{"code":"61538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4393.78,"maximum":4393.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4393.78}]}]},{"description":"Removal of brain tissue","code_information":[{"code":"61539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3908.08,"maximum":3908.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3908.08}]}]},{"description":"Removal of brain tissue","code_information":[{"code":"61540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3605.05,"maximum":3605.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.05}]}]},{"description":"Incision of brain tissue","code_information":[{"code":"61541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3564.87,"maximum":3564.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3564.87}]}]},{"description":"Removal of brain tissue","code_information":[{"code":"61543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3603.36,"maximum":3603.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3603.36}]}]},{"description":"Resect/excise lesion skull","code_information":[{"code":"61615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4625.44,"maximum":4625.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4625.44}]}]},{"description":"Resect/excise lesion skull","code_information":[{"code":"61616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5458.34,"maximum":5458.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5458.34}]}]},{"description":"Repair dura","code_information":[{"code":"61618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2141.95,"maximum":2141.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2141.95}]}]},{"description":"Repair dura","code_information":[{"code":"61619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2354.15,"maximum":2354.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2354.15}]}]},{"description":"Endovasc tempory vessel occl","code_information":[{"code":"61623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":940.25,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":940.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Transcath occlusion cns","code_information":[{"code":"61624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1901.4,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1901.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Transcath occlusion non-cns","code_information":[{"code":"61626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1477.57,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1477.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Intracranial angioplasty","code_information":[{"code":"61630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2235.38,"maximum":2235.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2235.38}]}]},{"description":"Intracran angioplsty w/stent","code_information":[{"code":"61635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2446.19,"maximum":2446.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2446.19}]}]},{"description":"Dilate ic vasospasm init","code_information":[{"code":"61640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":767.21,"maximum":767.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":767.21}]}]},{"description":"Dilate ic vasospasm add-on","code_information":[{"code":"61641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":269.44,"maximum":269.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.44}]}]},{"description":"Dilate ic vasospasm add-on","code_information":[{"code":"61642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.87,"maximum":538.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":538.87}]}]},{"description":"Perq art m-thrombect &/nfs","code_information":[{"code":"61645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1381.38,"maximum":1381.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1381.38}]}]},{"description":"Evasc prlng admn rx agnt 1st","code_information":[{"code":"61650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":956.61,"maximum":956.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":956.61}]}]},{"description":"Evasc prlng admn rx agnt add","code_information":[{"code":"61651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":408.48,"maximum":408.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":408.48}]}]},{"description":"Intracranial vessel surgery","code_information":[{"code":"61680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3737.41,"maximum":3737.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3737.41}]}]},{"description":"Intracranial vessel surgery","code_information":[{"code":"61682","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6816.41,"maximum":6816.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6816.41}]}]},{"description":"Intracranial vessel surgery","code_information":[{"code":"61684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4698.42,"maximum":4698.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4698.42}]}]},{"description":"Intracranial vessel surgery","code_information":[{"code":"61686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7394.22,"maximum":7394.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7394.22}]}]},{"description":"Intracranial vessel surgery","code_information":[{"code":"61690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3617.98,"maximum":3617.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3617.98}]}]},{"description":"Intracranial vessel surgery","code_information":[{"code":"61692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6013.56,"maximum":6013.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.56}]}]},{"description":"Brain aneurysm repr complx","code_information":[{"code":"61697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6948.68,"maximum":6948.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6948.68}]}]},{"description":"Brain aneurysm repr complx","code_information":[{"code":"61698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7612.74,"maximum":7612.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7612.74}]}]},{"description":"Brain aneurysm repr simple","code_information":[{"code":"61700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5623.85,"maximum":5623.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5623.85}]}]},{"description":"Inner skull vessel surgery","code_information":[{"code":"61702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6624.48,"maximum":6624.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6624.48}]}]},{"description":"Clamp neck artery","code_information":[{"code":"61703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2266.03,"maximum":2266.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2266.03}]}]},{"description":"Revise circulation to head","code_information":[{"code":"61705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4303.2,"maximum":4303.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4303.2}]}]},{"description":"Revise circulation to head","code_information":[{"code":"61708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4210.49,"maximum":4210.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4210.49}]}]},{"description":"Revise circulation to head","code_information":[{"code":"61710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3554.0,"maximum":3554.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3554.0}]}]},{"description":"Fusion of skull arteries","code_information":[{"code":"61711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4312.06,"maximum":4312.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4312.06}]}]},{"description":"Mrgfus strtctc ablt trgt icr","code_information":[{"code":"61715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1977.6,"maximum":58124.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18639.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1977.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51744.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58124.31,"additional_payer_notes":"APC"}]}]},{"description":"Incise skull/brain surgery","code_information":[{"code":"61720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2118.58,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2118.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Incise skull/brain surgery","code_information":[{"code":"61735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2654.16,"maximum":2654.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2654.16}]}]},{"description":"Litt icr 1 traj 1 smpl les","code_information":[{"code":"61736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2011.8,"maximum":2011.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2011.8}]}]},{"description":"Litt icr mlt trj mlt/cplx ls","code_information":[{"code":"61737","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2387.93,"maximum":2387.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2387.93}]}]},{"description":"Incise skull/brain biopsy","code_information":[{"code":"61750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2344.16,"maximum":2344.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2344.16}]}]},{"description":"Brain biopsy w/ct/mr guide","code_information":[{"code":"61751","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2312.21,"maximum":2312.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2312.21}]}]},{"description":"Implant brain electrodes","code_information":[{"code":"61760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2635.73,"maximum":2635.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2635.73}]}]},{"description":"Incise skull for treatment","code_information":[{"code":"61770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2693.2,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2693.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Scan proc cranial intra","code_information":[{"code":"61781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":385.46,"maximum":385.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":385.46}]}]},{"description":"Scan proc cranial extra","code_information":[{"code":"61782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.16,"maximum":282.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.16}]}]},{"description":"Scan proc spinal","code_information":[{"code":"61783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.3,"maximum":378.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.3}]}]},{"description":"Treat trigeminal nerve","code_information":[{"code":"61790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1476.97,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1476.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Treat trigeminal tract","code_information":[{"code":"61791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1881.64,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1881.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Srs cranial lesion simple","code_information":[{"code":"61796","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1700.18,"maximum":1700.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1700.18}]}]},{"description":"Srs cran les simple addl","code_information":[{"code":"61797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":358.32,"maximum":358.32,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":358.32}]}]},{"description":"Srs cranial lesion complex","code_information":[{"code":"61798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2293.1,"maximum":2293.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2293.1}]}]},{"description":"Srs cran les complex addl","code_information":[{"code":"61799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":494.43,"maximum":494.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":494.43}]}]},{"description":"Apply srs headframe add-on","code_information":[{"code":"61800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":245.09,"maximum":245.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.09}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"61850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1646.41,"maximum":1646.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1646.41}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"61860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2596.73,"maximum":2596.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2596.73}]}]},{"description":"Implant neuroelectrode","code_information":[{"code":"61863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2506.23,"maximum":2506.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2506.23}]}]},{"description":"Implant neuroelectrde addl","code_information":[{"code":"61864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":462.42,"maximum":462.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.42}]}]},{"description":"Implant neuroelectrode","code_information":[{"code":"61867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3776.88,"maximum":3776.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3776.88}]}]},{"description":"Implant neuroelectrde addl","code_information":[{"code":"61868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":814.79,"maximum":814.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":814.79}]}]},{"description":"Revise/remove neuroelectrode","code_information":[{"code":"61880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":985.09,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":985.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Insrt/redo neurostim 1 array","code_information":[{"code":"61885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":884.51,"maximum":160964.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34412.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51618.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":884.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143297.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160964.87,"additional_payer_notes":"APC"}]}]},{"description":"Implant neurostim arrays","code_information":[{"code":"61886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1474.71,"maximum":160964.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34412.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51618.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1474.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143297.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160964.87,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroreceiver","code_information":[{"code":"61888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":662.17,"maximum":58124.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18639.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":662.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51744.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58124.31,"additional_payer_notes":"APC"}]}]},{"description":"Ins sk-mnt crnl nstm pg/rcvr","code_information":[{"code":"61889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2063.43,"maximum":2063.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2063.43}]}]},{"description":"Rev/rplcmt sk-mnt crnl nstm","code_information":[{"code":"61891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":978.15,"maximum":160964.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34412.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51618.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":978.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143297.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160964.87,"additional_payer_notes":"APC"}]}]},{"description":"Rmv sk-mnt crnl nstm pg/rcvr","code_information":[{"code":"61892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1360.63,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1360.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Treat skull fracture","code_information":[{"code":"62000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1728.29,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1728.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Treat skull fracture","code_information":[{"code":"62005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2120.2,"maximum":2120.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2120.2}]}]},{"description":"Treatment of head injury","code_information":[{"code":"62010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2557.71,"maximum":2557.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2557.71}]}]},{"description":"Repair brain fluid leakage","code_information":[{"code":"62100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2600.06,"maximum":2600.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2600.06}]}]},{"description":"Reduction of skull defect","code_information":[{"code":"62115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2809.8,"maximum":2809.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2809.8}]}]},{"description":"Reduction of skull defect","code_information":[{"code":"62117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3255.39,"maximum":3255.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3255.39}]}]},{"description":"Repair skull cavity lesion","code_information":[{"code":"62120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3425.2,"maximum":3425.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3425.2}]}]},{"description":"Incise skull repair","code_information":[{"code":"62121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2549.24,"maximum":2549.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2549.24}]}]},{"description":"Repair of skull defect","code_information":[{"code":"62140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1699.67,"maximum":1699.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1699.67}]}]},{"description":"Repair of skull defect","code_information":[{"code":"62141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1904.74,"maximum":1904.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1904.74}]}]},{"description":"Remove skull plate/flap","code_information":[{"code":"62142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1494.11,"maximum":1494.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1494.11}]}]},{"description":"Replace skull plate/flap","code_information":[{"code":"62143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1744.38,"maximum":1744.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1744.38}]}]},{"description":"Repair of skull & brain","code_information":[{"code":"62145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2328.37,"maximum":2328.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2328.37}]}]},{"description":"Repair of skull with graft","code_information":[{"code":"62146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2083.37,"maximum":2083.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2083.37}]}]},{"description":"Repair of skull with graft","code_information":[{"code":"62147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2371.53,"maximum":2371.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2371.53}]}]},{"description":"Retr bone flap to fix skull","code_information":[{"code":"62148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":205.99,"maximum":205.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.99}]}]},{"description":"Neuroendoscopy add-on","code_information":[{"code":"62160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":307.93,"maximum":307.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.93}]}]},{"description":"Dissect brain w/scope","code_information":[{"code":"62161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2533.96,"maximum":2533.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2533.96}]}]},{"description":"Remove colloid cyst w/scope","code_information":[{"code":"62162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3137.21,"maximum":3137.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3137.21}]}]},{"description":"Remove brain tumor w/scope","code_information":[{"code":"62164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3479.28,"maximum":3479.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3479.28}]}]},{"description":"Remove pituit tumor w/scope","code_information":[{"code":"62165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2504.78,"maximum":2504.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2504.78}]}]},{"description":"Establish brain cavity shunt","code_information":[{"code":"62180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2659.61,"maximum":2659.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2659.61}]}]},{"description":"Establish brain cavity shunt","code_information":[{"code":"62190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1556.96,"maximum":1556.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1556.96}]}]},{"description":"Establish brain cavity shunt","code_information":[{"code":"62192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1655.5,"maximum":1655.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1655.5}]}]},{"description":"Replace/irrigate catheter","code_information":[{"code":"62194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":830.55,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":830.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Establish brain cavity shunt","code_information":[{"code":"62200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2290.98,"maximum":2290.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2290.98}]}]},{"description":"Brain cavity shunt w/scope","code_information":[{"code":"62201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2027.12,"maximum":2027.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2027.12}]}]},{"description":"Establish brain cavity shunt","code_information":[{"code":"62220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1618.41,"maximum":1618.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1618.41}]}]},{"description":"Establish brain cavity shunt","code_information":[{"code":"62223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1714.12,"maximum":1714.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1714.12}]}]},{"description":"Replace/irrigate catheter","code_information":[{"code":"62225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":903.29,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":903.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Replace/revise brain shunt","code_information":[{"code":"62230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1399.91,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1399.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Csf Shunt Reprogram","code_information":[{"code":"62252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.31,"maximum":1602.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1426.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1602.14,"additional_payer_notes":"APC"}]}]},{"description":"Remove brain cavity shunt","code_information":[{"code":"62256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1023.11,"maximum":1023.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1023.11}]}]},{"description":"Replace brain cavity shunt","code_information":[{"code":"62258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1846.59,"maximum":1846.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1846.59}]}]},{"description":"Epidural lysis mult sessions","code_information":[{"code":"62263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":533.82,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":533.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Epidural lysis on single day","code_information":[{"code":"62264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":401.58,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":401.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Interdiscal perq aspir dx","code_information":[{"code":"62267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.48,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":250.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Drain spinal cord cyst","code_information":[{"code":"62268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":543.73,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":543.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy spinal cord","code_information":[{"code":"62269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":423.81,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Spinal fluid tap diagnostic","code_information":[{"code":"62270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.14,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Drain cerebro spinal fluid","code_information":[{"code":"62272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":152.67,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Inject epidural patch","code_information":[{"code":"62273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.35,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Treat spinal cord lesion","code_information":[{"code":"62280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":263.18,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat spinal cord lesion","code_information":[{"code":"62281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.76,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat spinal canal lesion","code_information":[{"code":"62282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.69,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Injection for myelogram","code_information":[{"code":"62284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.99,"maximum":134.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.99}]}]},{"description":"Percutaneous diskectomy","code_information":[{"code":"62287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":989.9,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":989.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Inject for spine disk x-ray","code_information":[{"code":"62290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.92,"maximum":255.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":255.92}]}]},{"description":"Inject for spine disk x-ray","code_information":[{"code":"62291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.62,"maximum":232.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.62}]}]},{"description":"Injection into disk lesion","code_information":[{"code":"62292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":956.94,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":956.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Injection into spinal artery","code_information":[{"code":"62294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":986.37,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.08,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.08,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.32,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.51,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":161.6,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.45,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.98,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.33,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.17,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.86,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.56,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.3,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Dx lmbr spi pnxr w/fluor/ct","code_information":[{"code":"62328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.43,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Ther spi pnxr csf fluor/ct","code_information":[{"code":"62329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.86,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Implant spinal canal cath","code_information":[{"code":"62350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":661.07,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":661.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Implant spinal canal cath","code_information":[{"code":"62351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1521.41,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1521.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spinal canal catheter","code_information":[{"code":"62355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":465.43,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":465.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Insert spine infusion device","code_information":[{"code":"62360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.51,"maximum":94018.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20100.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30150.37,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":519.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20502.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83699.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94018.91,"additional_payer_notes":"APC"}]}]},{"description":"Implant spine infusion pump","code_information":[{"code":"62361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":729.72,"maximum":94018.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20100.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30150.37,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":729.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20502.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83699.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94018.91,"additional_payer_notes":"APC"}]}]},{"description":"Implant spine infusion pump","code_information":[{"code":"62362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":638.79,"maximum":94018.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20100.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30150.37,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":638.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20502.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83699.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94018.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine infusion device","code_information":[{"code":"62365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":495.38,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":495.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Analyze spine infus pump","code_information":[{"code":"62367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.92,"maximum":1602.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1426.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1602.14,"additional_payer_notes":"APC"}]}]},{"description":"Analyze sp inf pump w/reprog","code_information":[{"code":"62368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.77,"maximum":1602.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1426.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1602.14,"additional_payer_notes":"APC"}]}]},{"description":"Anal sp inf pmp w/reprg&fill","code_information":[{"code":"62369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.3,"maximum":1602.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1426.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1602.14,"additional_payer_notes":"APC"}]}]},{"description":"Anl sp inf pmp w/mdreprg&fil","code_information":[{"code":"62370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.9,"maximum":1602.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1426.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1602.14,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 crvl","code_information":[{"code":"63001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2048.38,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2048.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 thrc","code_information":[{"code":"63003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2057.78,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2057.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 lmbr","code_information":[{"code":"63005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2005.33,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2005.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 scrl","code_information":[{"code":"63011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1805.02,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1805.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove & treat brain lesion","code_information":[{"code":"61544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3148.56,"maximum":3148.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3148.56}]}]},{"description":"Excision of brain tumor","code_information":[{"code":"61545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5269.81,"maximum":5269.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5269.81}]}]},{"description":"Removal of pituitary gland","code_information":[{"code":"61546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3822.39,"maximum":3822.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3822.39}]}]},{"description":"Removal of pituitary gland","code_information":[{"code":"61548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2594.39,"maximum":2594.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2594.39}]}]},{"description":"Release of skull seams","code_information":[{"code":"61550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.13,"maximum":2003.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.13}]}]},{"description":"Release of skull seams","code_information":[{"code":"61552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2477.49,"maximum":2477.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2477.49}]}]},{"description":"Incise skull/sutures","code_information":[{"code":"61556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2839.56,"maximum":2839.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2839.56}]}]},{"description":"Incise skull/sutures","code_information":[{"code":"61557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2807.64,"maximum":2807.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2807.64}]}]},{"description":"Excision of skull/sutures","code_information":[{"code":"61558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3126.95,"maximum":3126.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3126.95}]}]},{"description":"Excision of skull/sutures","code_information":[{"code":"61559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3980.72,"maximum":3980.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3980.72}]}]},{"description":"Excision of skull tumor","code_information":[{"code":"61563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3286.83,"maximum":3286.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3286.83}]}]},{"description":"Excision of skull tumor","code_information":[{"code":"61564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3987.18,"maximum":3987.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3987.18}]}]},{"description":"Removal of brain tissue","code_information":[{"code":"61566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3709.69,"maximum":3709.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3709.69}]}]},{"description":"Incision of brain tissue","code_information":[{"code":"61567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4226.3,"maximum":4226.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4226.3}]}]},{"description":"Remove foreign body brain","code_information":[{"code":"61570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3106.34,"maximum":3106.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3106.34}]}]},{"description":"Incise skull for brain wound","code_information":[{"code":"61571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3304.19,"maximum":3304.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.19}]}]},{"description":"Skull base/brainstem surgery","code_information":[{"code":"61575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4143.84,"maximum":4143.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4143.84}]}]},{"description":"Skull base/brainstem surgery","code_information":[{"code":"61576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6901.28,"maximum":6901.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6901.28}]}]},{"description":"Craniofacial approach skull","code_information":[{"code":"61580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4073.29,"maximum":4073.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4073.29}]}]},{"description":"Craniofacial approach skull","code_information":[{"code":"61581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4413.43,"maximum":4413.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4413.43}]}]},{"description":"Craniofacial approach skull","code_information":[{"code":"61582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4994.72,"maximum":4994.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4994.72}]}]},{"description":"Craniofacial approach skull","code_information":[{"code":"61583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4826.19,"maximum":4826.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.19}]}]},{"description":"Orbitocranial approach/skull","code_information":[{"code":"61584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4733.6,"maximum":4733.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4733.6}]}]},{"description":"Orbitocranial approach/skull","code_information":[{"code":"61585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5377.35,"maximum":5377.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5377.35}]}]},{"description":"Resect nasopharynx skull","code_information":[{"code":"61586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4140.39,"maximum":4140.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4140.39}]}]},{"description":"Infratemporal approach/skull","code_information":[{"code":"61590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4927.79,"maximum":4927.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4927.79}]}]},{"description":"Infratemporal approach/skull","code_information":[{"code":"61591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5047.3,"maximum":5047.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5047.3}]}]},{"description":"Orbitocranial approach/skull","code_information":[{"code":"61592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5194.13,"maximum":5194.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5194.13}]}]},{"description":"Transtemporal approach/skull","code_information":[{"code":"61595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3920.27,"maximum":3920.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3920.27}]}]},{"description":"Transcochlear approach/skull","code_information":[{"code":"61596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3979.78,"maximum":3979.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3979.78}]}]},{"description":"Transcondylar approach/skull","code_information":[{"code":"61597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4807.92,"maximum":4807.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4807.92}]}]},{"description":"Transpetrosal approach/skull","code_information":[{"code":"61598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4687.19,"maximum":4687.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4687.19}]}]},{"description":"Resect/excise cranial lesion","code_information":[{"code":"61600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3461.11,"maximum":3461.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3461.11}]}]},{"description":"Resect/excise cranial lesion","code_information":[{"code":"61601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3973.96,"maximum":3973.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3973.96}]}]},{"description":"Resect/excise cranial lesion","code_information":[{"code":"61605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3554.18,"maximum":3554.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3554.18}]}]},{"description":"Resect/excise cranial lesion","code_information":[{"code":"61606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4777.68,"maximum":4777.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4777.68}]}]},{"description":"Resect/excise cranial lesion","code_information":[{"code":"61607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4995.08,"maximum":4995.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4995.08}]}]},{"description":"Resect/excise cranial lesion","code_information":[{"code":"61608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5383.48,"maximum":5383.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.48}]}]},{"description":"Transect artery sinus","code_information":[{"code":"61611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":763.82,"maximum":763.82,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":763.82}]}]},{"description":"Remove aneurysm sinus","code_information":[{"code":"61613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5400.01,"maximum":5400.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5400.01}]}]},{"description":"N block other peripheral","code_information":[{"code":"64450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.77,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Njx aa&/strd nrv nrvtg si jt","code_information":[{"code":"64451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.46,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Njx aa&/strd gnclr nrv brnch","code_information":[{"code":"64454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.99,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"N block inj plantar digit","code_information":[{"code":"64455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.27,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Pvb thoracic single inj site","code_information":[{"code":"64461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.51,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Pvb thoracic 2nd+ inj site","code_information":[{"code":"64462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.38,"maximum":78.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.38}]}]},{"description":"Pvb thoracic cont infusion","code_information":[{"code":"64463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.61,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Thrc fascial pln blk uni njx","code_information":[{"code":"64466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.87,"maximum":107.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.87}]}]},{"description":"Thrc fascial pln blk uni nfs","code_information":[{"code":"64467","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.34,"maximum":124.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.34}]}]},{"description":"Thrc fascial pln blk bi njx","code_information":[{"code":"64468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.94,"maximum":119.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.94}]}]},{"description":"Thrc fascial pln blk bi nfs","code_information":[{"code":"64469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.39,"maximum":130.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130.39}]}]},{"description":"Lwr xtr fscl pln blk uni njx","code_information":[{"code":"64473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.38,"maximum":96.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.38}]}]},{"description":"Lwr xtr fscl pln blk uni nfs","code_information":[{"code":"64474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.94,"maximum":119.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.94}]}]},{"description":"Inj foramen epidural c/t","code_information":[{"code":"64479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.22,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Inj foramen epidural add-on","code_information":[{"code":"64480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.61,"maximum":100.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.61}]}]},{"description":"Inj foramen epidural l/s","code_information":[{"code":"64483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":181.97,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Inj foramen epidural add-on","code_information":[{"code":"64484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":82.62,"maximum":82.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82.62}]}]},{"description":"Tap block unil by injection","code_information":[{"code":"64486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":84.93,"maximum":84.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84.93}]}]},{"description":"Tap block uni by infusion","code_information":[{"code":"64487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.52,"maximum":97.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.52}]}]},{"description":"Tap block bi injection","code_information":[{"code":"64488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.61,"maximum":98.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.61}]}]},{"description":"Tap block bi by infusion","code_information":[{"code":"64489","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.73,"maximum":122.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.73}]}]},{"description":"Inj paravert f jnt c/t 1 lev","code_information":[{"code":"64490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":172.66,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":172.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Inj paravert f jnt c/t 2 lev","code_information":[{"code":"64491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.3,"maximum":97.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.3}]}]},{"description":"Inj paravert f jnt c/t 3 lev","code_information":[{"code":"64492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.87,"maximum":97.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.87}]}]},{"description":"Inj paravert f jnt l/s 1 lev","code_information":[{"code":"64493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.08,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Inj paravert f jnt l/s 2 lev","code_information":[{"code":"64494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.12,"maximum":83.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.12}]}]},{"description":"Inj paravert f jnt l/s 3 lev","code_information":[{"code":"64495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.71,"maximum":83.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.71}]}]},{"description":"N block spenopalatine gangl","code_information":[{"code":"64505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.43,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"N block stellate ganglion","code_information":[{"code":"64510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.03,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block inj hypogas plxs","code_information":[{"code":"64517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.63,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block lumbar/thoracic","code_information":[{"code":"64520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.24,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block inj celiac pelus","code_information":[{"code":"64530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.1,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.61,"maximum":58124.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18639.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51744.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58124.31,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":535.85,"maximum":33243.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10660.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":535.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29595.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33243.83,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":496.31,"maximum":33243.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10660.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":496.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29595.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33243.83,"additional_payer_notes":"APC"}]}]},{"description":"Neuroeltrd stim post tibial","code_information":[{"code":"64566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.65,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Inc for vagus n elect impl","code_information":[{"code":"64568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":999.0,"maximum":229762.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49120.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73681.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":999.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50103.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":204543.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":229762.29,"additional_payer_notes":"APC"}]}]},{"description":"Revise/repl vagus n eltrd","code_information":[{"code":"64569","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1285.01,"maximum":58124.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18639.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1285.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51744.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58124.31,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagus n eltrd","code_information":[{"code":"64570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1234.45,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1234.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.11,"maximum":58124.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18639.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":519.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51744.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58124.31,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":521.97,"maximum":101197.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21635.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32452.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22067.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90090.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101197.98,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1076.78,"maximum":33243.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10660.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1076.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29595.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33243.83,"additional_payer_notes":"APC"}]}]},{"description":"Opn mpltj hpglsl nstm ary pg","code_information":[{"code":"64582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1375.91,"maximum":160964.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34412.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51618.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1375.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143297.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160964.87,"additional_payer_notes":"APC"}]}]},{"description":"Rev/rplct hpglsl nstm ary pg","code_information":[{"code":"64583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1421.16,"maximum":58124.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18639.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51744.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58124.31,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl hpglsl nstim ary pg","code_information":[{"code":"64584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1199.03,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1199.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroelectrode","code_information":[{"code":"64585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":237.17,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Insrt/redo pn/gastr stimul","code_information":[{"code":"64590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":484.08,"maximum":101197.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21635.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32452.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":484.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22067.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90090.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101197.98,"additional_payer_notes":"APC"}]}]},{"description":"Revise/rmv pn/gastr stimul","code_information":[{"code":"64595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.58,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.6,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":704.79,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":704.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.65,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv saliv glands","code_information":[{"code":"64611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":186.04,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":186.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Destroy nerve face muscle","code_information":[{"code":"64612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.85,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv musc migraine","code_information":[{"code":"64615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.44,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv musc neck dyston","code_information":[{"code":"64616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.78,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Chemodener muscle larynx emg","code_information":[{"code":"64617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.88,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.61,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":293.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Dstrj nulyt agt gnclr nrv","code_information":[{"code":"64624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.93,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Rf abltj nrv nrvtg si jt","code_information":[{"code":"64625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.33,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Trml dstrj ios bvn 1st 2 l/s","code_information":[{"code":"64628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":673.97,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":673.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Trml dstrj ios bvn ea addl","code_information":[{"code":"64629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.12,"maximum":318.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.12}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":317.27,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block inj common digit","code_information":[{"code":"64632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.54,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Destroy cerv/thor facet jnt","code_information":[{"code":"64633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.27,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":315.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove lamina/facets lumbar","code_information":[{"code":"63012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1982.26,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1982.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 crvcl","code_information":[{"code":"63015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2465.66,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2465.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 thrc","code_information":[{"code":"63016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2530.0,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2530.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 lmbr","code_information":[{"code":"63017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2108.6,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2108.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine disk surgery","code_information":[{"code":"63020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1831.99,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1831.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Low back disk surgery","code_information":[{"code":"63030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1523.77,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1523.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Spinal disk surgery add-on","code_information":[{"code":"63035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":379.36,"maximum":379.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":379.36}]}]},{"description":"Laminotomy single cervical","code_information":[{"code":"63040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2280.08,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2280.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Laminotomy single lumbar","code_information":[{"code":"63042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2144.42,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2144.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 crvl","code_information":[{"code":"63045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2138.43,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2138.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 thrc","code_information":[{"code":"63046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2043.19,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2043.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 lmbr","code_information":[{"code":"63047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1838.47,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1838.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove spinal lamina add-on","code_information":[{"code":"63048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":343.9,"maximum":343.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.9}]}]},{"description":"Cervical laminoplsty 2/> seg","code_information":[{"code":"63050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2459.98,"maximum":2459.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2459.98}]}]},{"description":"C-laminoplasty w/graft/plate","code_information":[{"code":"63051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2794.1,"maximum":2794.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2794.1}]}]},{"description":"Lam facetc/frmt arthrd lum 1","code_information":[{"code":"63052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":422.09,"maximum":422.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":422.09}]}]},{"description":"Lam factc/frmt arthrd lum ea","code_information":[{"code":"63053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":373.84,"maximum":373.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":373.84}]}]},{"description":"Decompress spinal cord thrc","code_information":[{"code":"63055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2690.98,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2690.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spinal cord lmbr","code_information":[{"code":"63056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2461.81,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2461.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spine cord add-on","code_information":[{"code":"63057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":526.11,"maximum":526.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":526.11}]}]},{"description":"Decompress spinal cord thrc","code_information":[{"code":"63064","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2917.79,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2917.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spine cord add-on","code_information":[{"code":"63066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":336.07,"maximum":336.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.07}]}]},{"description":"Neck spine disk surgery","code_information":[{"code":"63075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2243.25,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2243.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine disk surgery","code_information":[{"code":"63076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":398.29,"maximum":398.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":398.29}]}]},{"description":"Spine disk surgery thorax","code_information":[{"code":"63077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2409.9,"maximum":2409.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2409.9}]}]},{"description":"Spine disk surgery thorax","code_information":[{"code":"63078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":338.24,"maximum":338.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":338.24}]}]},{"description":"Remove vert body dcmprn crvl","code_information":[{"code":"63081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2914.46,"maximum":2914.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2914.46}]}]},{"description":"Remove vertebral body add-on","code_information":[{"code":"63082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":433.97,"maximum":433.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":433.97}]}]},{"description":"Remove vert body dcmprn thrc","code_information":[{"code":"63085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3183.56,"maximum":3183.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3183.56}]}]},{"description":"Remove vertebral body add-on","code_information":[{"code":"63086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.36,"maximum":311.36,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.36}]}]},{"description":"Remov vertbr dcmprn thrclmbr","code_information":[{"code":"63087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3999.05,"maximum":3999.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3999.05}]}]},{"description":"Remove vertebral body add-on","code_information":[{"code":"63088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.55,"maximum":421.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.55}]}]},{"description":"Remove vert body dcmprn lmbr","code_information":[{"code":"63090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3200.4,"maximum":3200.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3200.4}]}]},{"description":"Remove vertebral body add-on","code_information":[{"code":"63091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.13,"maximum":285.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":285.13}]}]},{"description":"Remove vert body dcmprn thrc","code_information":[{"code":"63101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3833.91,"maximum":3833.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3833.91}]}]},{"description":"Remove vert body dcmprn lmbr","code_information":[{"code":"63102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3794.83,"maximum":3794.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3794.83}]}]},{"description":"Remove vertebral body add-on","code_information":[{"code":"63103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.07,"maximum":478.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.07}]}]},{"description":"Incise spinal cord tract(s)","code_information":[{"code":"63170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2653.68,"maximum":2653.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2653.68}]}]},{"description":"Drainage of spinal cyst","code_information":[{"code":"63172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2354.94,"maximum":2354.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2354.94}]}]},{"description":"Drainage of spinal cyst","code_information":[{"code":"63173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2869.43,"maximum":2869.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2869.43}]}]},{"description":"Incise spine nrv half segmnt","code_information":[{"code":"63185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2053.57,"maximum":2053.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2053.57}]}]},{"description":"Incise spine nrv >2 segmnts","code_information":[{"code":"63190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2050.72,"maximum":2050.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2050.72}]}]},{"description":"Incise spine accessory nerve","code_information":[{"code":"63191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2304.54,"maximum":2304.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2304.54}]}]},{"description":"Incise spine&cord 2 trx thrc","code_information":[{"code":"63197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2847.15,"maximum":2847.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2847.15}]}]},{"description":"Release spinal cord lumbar","code_information":[{"code":"63200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2574.87,"maximum":2574.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2574.87}]}]},{"description":"Revise spinal cord vsls crvl","code_information":[{"code":"63250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4896.8,"maximum":4896.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4896.8}]}]},{"description":"Revise spinal cord vsls thrc","code_information":[{"code":"63251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5006.91,"maximum":5006.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5006.91}]}]},{"description":"Revise spine cord vsl thrlmb","code_information":[{"code":"63252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5006.34,"maximum":5006.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5006.34}]}]},{"description":"Excise intraspinl lesion crv","code_information":[{"code":"63265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2761.49,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2761.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion thrc","code_information":[{"code":"63266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2846.68,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2846.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion lmbr","code_information":[{"code":"63267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2278.86,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2278.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion scrl","code_information":[{"code":"63268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2437.93,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2437.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion crvl","code_information":[{"code":"63270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3446.19,"maximum":3446.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3446.19}]}]},{"description":"Excise intrspinl lesion thrc","code_information":[{"code":"63271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3442.4,"maximum":3442.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3442.4}]}]},{"description":"Excise intrspinl lesion lmbr","code_information":[{"code":"63272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3127.17,"maximum":3127.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3127.17}]}]},{"description":"Excise intrspinl lesion scrl","code_information":[{"code":"63273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3103.07,"maximum":3103.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3103.07}]}]},{"description":"Bx/exc xdrl spine lesn crvl","code_information":[{"code":"63275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2984.04,"maximum":2984.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2984.04}]}]},{"description":"Bx/exc xdrl spine lesn thrc","code_information":[{"code":"63276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2965.07,"maximum":2965.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2965.07}]}]},{"description":"Bx/exc xdrl spine lesn lmbr","code_information":[{"code":"63277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2594.61,"maximum":2594.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2594.61}]}]},{"description":"Bx/exc xdrl spine lesn scrl","code_information":[{"code":"63278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2655.26,"maximum":2655.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2655.26}]}]},{"description":"Bx/exc idrl spine lesn crvl","code_information":[{"code":"63280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.49,"maximum":3506.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.49}]}]},{"description":"Bx/exc idrl spine lesn thrc","code_information":[{"code":"63281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3480.78,"maximum":3480.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3480.78}]}]},{"description":"Bx/exc idrl spine lesn lmbr","code_information":[{"code":"63282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3293.67,"maximum":3293.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3293.67}]}]},{"description":"Bx/exc idrl spine lesn scrl","code_information":[{"code":"63283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3164.3,"maximum":3164.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3164.3}]}]},{"description":"Bx/exc idrl imed lesn cervl","code_information":[{"code":"63285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4328.7,"maximum":4328.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4328.7}]}]},{"description":"Bx/exc idrl imed lesn thrc","code_information":[{"code":"63286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4279.59,"maximum":4279.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4279.59}]}]},{"description":"Bx/exc idrl imed lesn thrlmb","code_information":[{"code":"63287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4536.9,"maximum":4536.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4536.9}]}]},{"description":"Bx/exc xdrl/idrl lsn any lvl","code_information":[{"code":"63290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4613.31,"maximum":4613.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4613.31}]}]},{"description":"Repair laminectomy defect","code_information":[{"code":"63295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":541.03,"maximum":541.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":541.03}]}]},{"description":"Remove vert xdrl body crvcl","code_information":[{"code":"63300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3013.31,"maximum":3013.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3013.31}]}]},{"description":"Remove vert xdrl body thrc","code_information":[{"code":"63301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3512.75,"maximum":3512.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3512.75}]}]},{"description":"Remove vert xdrl body thrlmb","code_information":[{"code":"63302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3616.41,"maximum":3616.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3616.41}]}]},{"description":"Remov vert xdrl bdy lmbr/sac","code_information":[{"code":"63303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3833.25,"maximum":3833.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3833.25}]}]},{"description":"Remove vert idrl body crvcl","code_information":[{"code":"63304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3894.54,"maximum":3894.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3894.54}]}]},{"description":"Remove vert idrl body thrc","code_information":[{"code":"63305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4140.66,"maximum":4140.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4140.66}]}]},{"description":"Remov vert idrl bdy thrclmbr","code_information":[{"code":"63306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4070.68,"maximum":4070.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4070.68}]}]},{"description":"Remov vert idrl bdy lmbr/sac","code_information":[{"code":"63307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3984.47,"maximum":3984.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3984.47}]}]},{"description":"Remove vertebral body add-on","code_information":[{"code":"63308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":521.23,"maximum":521.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.23}]}]},{"description":"Remove spinal cord lesion","code_information":[{"code":"63600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1827.42,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1827.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Stimulation of spinal cord","code_information":[{"code":"63610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":955.18,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":955.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Srs spinal lesion","code_information":[{"code":"63620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1876.81,"maximum":1876.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1876.81}]}]},{"description":"Srs spinal lesion addl","code_information":[{"code":"63621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":412.0,"maximum":412.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":412.0}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"63650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":681.51,"maximum":33243.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10660.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":681.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29595.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33243.83,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"63655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1400.85,"maximum":101197.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21635.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32452.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1400.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22067.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90090.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101197.98,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine eltrd perq aray","code_information":[{"code":"63661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":545.18,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":545.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine eltrd plate","code_information":[{"code":"63662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.14,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1418.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Revise spine eltrd perq aray","code_information":[{"code":"63663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":741.0,"maximum":33243.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10660.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":741.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29595.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33243.83,"additional_payer_notes":"APC"}]}]},{"description":"Revise spine eltrd plate","code_information":[{"code":"63664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1478.26,"maximum":58124.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18639.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1478.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51744.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58124.31,"additional_payer_notes":"APC"}]}]},{"description":"Insrt/redo spine n generator","code_information":[{"code":"63685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":559.82,"maximum":160964.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34412.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51618.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":559.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143297.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160964.87,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroreceiver","code_information":[{"code":"63688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":495.22,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":495.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Repair of spinal herniation","code_information":[{"code":"63700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2190.74,"maximum":2190.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2190.74}]}]},{"description":"Repair of spinal herniation","code_information":[{"code":"63702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2392.35,"maximum":2392.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2392.35}]}]},{"description":"Repair of spinal herniation","code_information":[{"code":"63704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2781.05,"maximum":2781.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2781.05}]}]},{"description":"Repair of spinal herniation","code_information":[{"code":"63706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3081.94,"maximum":3081.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3081.94}]}]},{"description":"Repair spinal fluid leakage","code_information":[{"code":"63707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1575.24,"maximum":1575.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1575.24}]}]},{"description":"Repair spinal fluid leakage","code_information":[{"code":"63709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1852.46,"maximum":1852.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1852.46}]}]},{"description":"Graft repair of spine defect","code_information":[{"code":"63710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1803.45,"maximum":1803.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1803.45}]}]},{"description":"Install spinal shunt","code_information":[{"code":"63740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1650.79,"maximum":1650.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1650.79}]}]},{"description":"Install spinal shunt","code_information":[{"code":"63741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1122.11,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1122.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Revision of spinal shunt","code_information":[{"code":"63744","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1192.72,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1192.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Removal of spinal shunt","code_information":[{"code":"63746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1026.27,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1026.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"N block inj trigeminal","code_information":[{"code":"64400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.35,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"N block inj occipital","code_information":[{"code":"64405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.59,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"N block inj vagus","code_information":[{"code":"64408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.15,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"N block inj brachial plexus","code_information":[{"code":"64415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.89,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block cont infuse b plex","code_information":[{"code":"64416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.03,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block inj axillary","code_information":[{"code":"64417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.57,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block inj suprascapular","code_information":[{"code":"64418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.74,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"N block inj intercost sng","code_information":[{"code":"64420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.16,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"N block inj intercost mlt","code_information":[{"code":"64421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.96,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block inj ilio-ing/hypogi","code_information":[{"code":"64425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":89.09,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"N block inj pudendal","code_information":[{"code":"64430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.09,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block inj paracervical","code_information":[{"code":"64435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.43,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"N block inj sciatic sng","code_information":[{"code":"64445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.04,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"N blk inj sciatic cont inf","code_information":[{"code":"64446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.27,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":123.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block inj fem single","code_information":[{"code":"64447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.97,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"N block inj fem cont inf","code_information":[{"code":"64448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.8,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"N block inj lumbar plexus","code_information":[{"code":"64449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.56,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1583.61,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1583.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1779.63,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1779.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eye wound","code_information":[{"code":"65270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":227.58,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eye wound","code_information":[{"code":"65272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":571.17,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":571.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eye wound","code_information":[{"code":"65273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.39,"maximum":613.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.39}]}]},{"description":"Repair of eye wound","code_information":[{"code":"65275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":745.43,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":745.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eye wound","code_information":[{"code":"65280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1081.05,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1081.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eye wound","code_information":[{"code":"65285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1783.62,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1783.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eye wound","code_information":[{"code":"65286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":800.5,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":800.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eye socket wound","code_information":[{"code":"65290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":791.18,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":791.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Removal of eye lesion","code_information":[{"code":"65400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":980.05,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":980.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of cornea","code_information":[{"code":"65410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.0,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Removal of eye lesion","code_information":[{"code":"65420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":618.75,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":618.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Removal of eye lesion","code_information":[{"code":"65426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":778.85,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":778.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Corneal smear","code_information":[{"code":"65430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.86,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Curette/treat cornea","code_information":[{"code":"65435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.95,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Curette/treat cornea","code_information":[{"code":"65436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":601.71,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of corneal lesion","code_information":[{"code":"65450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.97,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":528.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cornea","code_information":[{"code":"65600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":556.81,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":556.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Corneal transplant","code_information":[{"code":"65710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1843.18,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1843.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Corneal transplant","code_information":[{"code":"65730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2021.37,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2021.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Corneal transplant","code_information":[{"code":"65750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2032.67,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2032.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Corneal transplant","code_information":[{"code":"65755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2026.05,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2026.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Corneal trnspl endothelial","code_information":[{"code":"65756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1913.32,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1913.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Revise cornea with implant","code_information":[{"code":"65770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2273.86,"maximum":75669.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16177.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24265.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2273.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67363.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75669.07,"additional_payer_notes":"APC"}]}]},{"description":"Correction of astigmatism","code_information":[{"code":"65772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":658.9,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":658.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Correction of astigmatism","code_information":[{"code":"65775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":930.83,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":930.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Cover eye w/membrane","code_information":[{"code":"65778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.19,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Cover eye w/membrane suture","code_information":[{"code":"65779","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":170.47,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":170.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Ocular reconst transplant","code_information":[{"code":"65780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":960.75,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":960.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Ocular reconst transplant","code_information":[{"code":"65781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2146.86,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2146.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Ocular reconst transplant","code_information":[{"code":"65782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1854.72,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1854.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Impltj ntrstrml crnl rng seg","code_information":[{"code":"65785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.44,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":721.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of eye","code_information":[{"code":"65800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.82,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of eye","code_information":[{"code":"65810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":752.62,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":752.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of eye","code_information":[{"code":"65815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":774.46,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Relieve inner eye pressure","code_information":[{"code":"65820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1324.42,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1324.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Incision of eye","code_information":[{"code":"65850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1362.06,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1362.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Trabeculoplasty laser surg","code_information":[{"code":"65855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":332.5,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner eye adhesions","code_information":[{"code":"65860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.43,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner eye adhesions","code_information":[{"code":"65865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":773.21,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":773.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner eye adhesions","code_information":[{"code":"65870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":963.15,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":963.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner eye adhesions","code_information":[{"code":"65875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1025.87,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1025.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner eye adhesions","code_information":[{"code":"65880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1077.28,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1077.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Remove eye lesion","code_information":[{"code":"65900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1597.68,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Remove implant of eye","code_information":[{"code":"65920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1281.27,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1281.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Remove blood clot from eye","code_information":[{"code":"65930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.18,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of eye","code_information":[{"code":"66020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.79,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of eye","code_information":[{"code":"66030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":181.02,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Remove eye lesion","code_information":[{"code":"66130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.67,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Glaucoma surgery","code_information":[{"code":"66150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.88,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1418.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Glaucoma surgery","code_information":[{"code":"66155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1417.8,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1417.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Glaucoma surgery","code_information":[{"code":"66160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1593.8,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1593.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Glaucoma surgery","code_information":[{"code":"66170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1770.13,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1770.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Incision of eye","code_information":[{"code":"66172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1932.94,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1932.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Translum dil eye canal","code_information":[{"code":"66174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.06,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Trnslum dil eye canal w/stnt","code_information":[{"code":"66175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1171.81,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1171.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Aqueous shunt eye w/o graft","code_information":[{"code":"66179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1748.45,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1748.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Aqueous shunt eye w/graft","code_information":[{"code":"66180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.44,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Insert ant drainage device","code_information":[{"code":"66183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1663.81,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1663.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Revision of aqueous shunt","code_information":[{"code":"66184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.08,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Revise aqueous shunt eye","code_information":[{"code":"66185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1376.63,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1376.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft eye lesion","code_information":[{"code":"66225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1512.63,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1512.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Follow-up surgery of eye","code_information":[{"code":"66250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":901.14,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":901.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Destroy c/th facet jnt addl","code_information":[{"code":"64634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.39,"maximum":109.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.39}]}]},{"description":"Destroy lumb/sac facet jnt","code_information":[{"code":"64635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.31,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":315.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Destroy l/s facet jnt addl","code_information":[{"code":"64636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.24,"maximum":96.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.24}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.64,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv 1 extremity 1-4","code_information":[{"code":"64642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.78,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv 1 extrem 1-4 ea","code_information":[{"code":"64643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.39,"maximum":113.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.39}]}]},{"description":"Chemodenerv 1 extrem 5/> mus","code_information":[{"code":"64644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.56,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv 1 extrem 5/> ea","code_information":[{"code":"64645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.84,"maximum":132.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.84}]}]},{"description":"Chemodenerv trunk musc 1-5","code_information":[{"code":"64646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.39,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":191.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv trunk musc 6/>","code_information":[{"code":"64647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.05,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv eccrine glands","code_information":[{"code":"64650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.53,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv eccrine glands","code_information":[{"code":"64653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.93,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.87,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":363.21,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":363.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger/toe nerve","code_information":[{"code":"64702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":860.58,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":860.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Revise hand/foot nerve","code_information":[{"code":"64704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":542.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Revise arm/leg nerve","code_information":[{"code":"64708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":844.83,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":844.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Revision of sciatic nerve","code_information":[{"code":"64712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":988.86,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":988.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm nerve(s)","code_information":[{"code":"64713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1328.05,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1328.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Revise low back nerve(s)","code_information":[{"code":"64714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1274.56,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1274.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cranial nerve","code_information":[{"code":"64716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.97,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":845.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Revise ulnar nerve at elbow","code_information":[{"code":"64718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.95,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Revise ulnar nerve at wrist","code_information":[{"code":"64719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.04,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Carpal tunnel surgery","code_information":[{"code":"64721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":733.84,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":733.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Relieve pressure on nerve(s)","code_information":[{"code":"64722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":620.16,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Release foot/toe nerve","code_information":[{"code":"64726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.42,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Internal nerve revision","code_information":[{"code":"64727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.23,"maximum":291.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":291.23}]}]},{"description":"Incision of brow nerve","code_information":[{"code":"64732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":765.51,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Incision of cheek nerve","code_information":[{"code":"64734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":863.66,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":863.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Incision of chin nerve","code_information":[{"code":"64736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":556.82,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":556.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Incision of jaw nerve","code_information":[{"code":"64738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.45,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":742.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tongue nerve","code_information":[{"code":"64740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.61,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Incision of facial nerve","code_information":[{"code":"64742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":812.58,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":812.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Incise nerve back of head","code_information":[{"code":"64744","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":849.59,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":849.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Incise diaphragm nerve","code_information":[{"code":"64746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.92,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Incision of vagus nerve","code_information":[{"code":"64760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":863.66,"maximum":863.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":863.66}]}]},{"description":"Incise hip/thigh nerve","code_information":[{"code":"64763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":854.99,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":854.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Incise hip/thigh nerve","code_information":[{"code":"64766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1053.03,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1053.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Sever cranial nerve","code_information":[{"code":"64771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1008.9,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1008.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Incision of spinal nerve","code_information":[{"code":"64772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":926.28,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":926.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove skin nerve lesion","code_information":[{"code":"64774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":715.25,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":715.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove digit nerve lesion","code_information":[{"code":"64776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":671.16,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":671.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Digit nerve surgery add-on","code_information":[{"code":"64778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.17,"maximum":293.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":293.17}]}]},{"description":"Remove limb nerve lesion","code_information":[{"code":"64782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":764.88,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Limb nerve surgery add-on","code_information":[{"code":"64783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.35,"maximum":350.35,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.35}]}]},{"description":"Remove nerve lesion","code_information":[{"code":"64784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1207.72,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1207.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove sciatic nerve lesion","code_information":[{"code":"64786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1655.0,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1655.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Implant nerve end","code_information":[{"code":"64787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":383.49,"maximum":383.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":383.49}]}]},{"description":"Remove skin nerve lesion","code_information":[{"code":"64788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":680.26,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":680.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nerve lesion","code_information":[{"code":"64790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1419.23,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1419.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nerve lesion","code_information":[{"code":"64792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1781.91,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1781.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of nerve","code_information":[{"code":"64795","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.03,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":325.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Sympathectomy cervical","code_information":[{"code":"64802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.23,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1418.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1989.06,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1989.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1818.28,"maximum":1818.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1818.28}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1291.41,"maximum":1291.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1291.41}]}]},{"description":"Sympathectomy digital artery","code_information":[{"code":"64820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1273.23,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1273.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1166.83,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1166.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1166.83,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1166.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Sympathectomy supfc palmar","code_information":[{"code":"64823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1319.41,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1319.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair of digit nerve","code_information":[{"code":"64831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1159.02,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1159.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair nerve add-on","code_information":[{"code":"64832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":539.67,"maximum":539.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":539.67}]}]},{"description":"Repair of hand or foot nerve","code_information":[{"code":"64834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1240.5,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1240.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hand or foot nerve","code_information":[{"code":"64835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1355.03,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1355.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hand or foot nerve","code_information":[{"code":"64836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1355.03,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1355.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair nerve add-on","code_information":[{"code":"64837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":590.64,"maximum":590.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":590.64}]}]},{"description":"Repair of leg nerve","code_information":[{"code":"64840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.18,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1595.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Repair/transpose nerve","code_information":[{"code":"64856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.28,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Repair arm/leg nerve","code_information":[{"code":"64857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.16,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair sciatic nerve","code_information":[{"code":"64858","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.53,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1938.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Nerve surgery","code_information":[{"code":"64859","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":401.05,"maximum":401.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":401.05}]}]},{"description":"Repair of arm nerves","code_information":[{"code":"64861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2177.68,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2533.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair of low back nerves","code_information":[{"code":"64862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2262.63,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Repair of facial nerve","code_information":[{"code":"64864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1416.63,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1416.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Repair of facial nerve","code_information":[{"code":"64865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1771.96,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1771.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of facial/other nerve","code_information":[{"code":"64866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2038.17,"maximum":2038.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2038.17}]}]},{"description":"Fusion of facial/other nerve","code_information":[{"code":"64868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1625.91,"maximum":1625.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1625.91}]}]},{"description":"Subsequent repair of nerve","code_information":[{"code":"64872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.0,"maximum":188.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.0}]}]},{"description":"Incision of iris","code_information":[{"code":"66500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":633.55,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":633.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Incision of iris","code_information":[{"code":"66505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":689.68,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":689.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Remove iris and lesion","code_information":[{"code":"66600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1454.87,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1454.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Removal of iris","code_information":[{"code":"66605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.64,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Removal of iris","code_information":[{"code":"66625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":695.35,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":695.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Removal of iris","code_information":[{"code":"66630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":919.14,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":919.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Removal of iris","code_information":[{"code":"66635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":927.38,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":927.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Repair iris & ciliary body","code_information":[{"code":"66680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.77,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":965.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Implantation iris prosthesis","code_information":[{"code":"66683","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.39,"maximum":85865.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18357.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27535.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1263.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76441.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85865.6,"additional_payer_notes":"APC"}]}]},{"description":"Destruction ciliary body","code_information":[{"code":"66700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":635.05,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":635.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Ciliary transsleral therapy","code_information":[{"code":"66710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":635.05,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":635.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Ciliary endoscopic ablation","code_information":[{"code":"66711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":821.41,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":821.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Destruction ciliary body","code_information":[{"code":"66720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":668.35,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":668.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Destruction ciliary body","code_information":[{"code":"66740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":635.05,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":635.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revision of iris","code_information":[{"code":"66761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":381.3,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":381.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Revision of iris","code_information":[{"code":"66762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.36,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":689.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of inner eye lesion","code_information":[{"code":"66770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.36,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":782.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Incision secondary cataract","code_information":[{"code":"66820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":749.19,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":749.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"After cataract laser surgery","code_information":[{"code":"66821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.66,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":503.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Reposition intraocular lens","code_information":[{"code":"66825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1337.47,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1337.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Removal of lens lesion","code_information":[{"code":"66830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1148.05,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1148.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Removal of lens material","code_information":[{"code":"66840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1120.72,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1120.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Removal of lens material","code_information":[{"code":"66850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1275.2,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1275.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Removal of lens material","code_information":[{"code":"66852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1355.58,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1355.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Extraction of lens","code_information":[{"code":"66920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1211.96,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1211.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Extraction of lens","code_information":[{"code":"66930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1384.48,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1384.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Extraction of lens","code_information":[{"code":"66940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1268.56,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1268.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Cataract surgery complex","code_information":[{"code":"66982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1205.58,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1205.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Cataract surg w/iol 1 stage","code_information":[{"code":"66984","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":880.24,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":880.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Insert lens prosthesis","code_information":[{"code":"66985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1244.92,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1244.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Exchange lens prosthesis","code_information":[{"code":"66986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1458.17,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1458.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Xcpsl ctrc rmvl cplx insj 1+","code_information":[{"code":"66989","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1383.79,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1383.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Ophthalmic endoscope add-on","code_information":[{"code":"66990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.19,"maximum":143.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.19}]}]},{"description":"Xcapsl ctrc rmvl insj 1+","code_information":[{"code":"66991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1107.75,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1107.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of eye fluid","code_information":[{"code":"67005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":776.03,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of eye fluid","code_information":[{"code":"67010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":885.39,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":885.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Release of eye fluid","code_information":[{"code":"67015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":974.93,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":974.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Replace eye fluid","code_information":[{"code":"67025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1020.66,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1020.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Implant eye drug system","code_information":[{"code":"67027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1368.22,"maximum":72783.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23340.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1368.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15871.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64794.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72783.65,"additional_payer_notes":"APC"}]}]},{"description":"Injection eye drug","code_information":[{"code":"67028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.65,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner eye strands","code_information":[{"code":"67030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":901.47,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":901.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery eye strands","code_information":[{"code":"67031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":572.72,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":572.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Removal of inner eye fluid","code_information":[{"code":"67036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1447.75,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1447.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Laser treatment of retina","code_information":[{"code":"67039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1549.39,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1549.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Laser treatment of retina","code_information":[{"code":"67040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1672.87,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1672.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Vit for macular pucker","code_information":[{"code":"67041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1844.04,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1844.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Vit for macular hole","code_information":[{"code":"67042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1844.04,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1844.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Vit for membrane dissect","code_information":[{"code":"67043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1946.2,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1946.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair detached retina crtx","code_information":[{"code":"67101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":461.37,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":461.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Repair detached retina pc","code_information":[{"code":"67105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.01,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Repair detached retina","code_information":[{"code":"67107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1813.92,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1813.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair detached retina","code_information":[{"code":"67108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1920.51,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1920.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair detached retina","code_information":[{"code":"67110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1314.02,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1314.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Repair retinal detach cplx","code_information":[{"code":"67113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2143.76,"maximum":27757.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8901.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2143.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24711.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27757.84,"additional_payer_notes":"APC"}]}]},{"description":"Release encircling material","code_information":[{"code":"67115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":808.74,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":808.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Remove eye implant material","code_information":[{"code":"67120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.9,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":897.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Remove eye implant material","code_information":[{"code":"67121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1459.75,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1459.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of retina","code_information":[{"code":"67141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.04,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of retina","code_information":[{"code":"67145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.04,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of retinal lesion","code_information":[{"code":"67208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.97,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":933.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of retinal lesion","code_information":[{"code":"67210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.36,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":806.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of retinal lesion","code_information":[{"code":"67218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2242.37,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2242.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of choroid lesion","code_information":[{"code":"67220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.36,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Ocular Photodynamic Ther","code_information":[{"code":"67221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":337.16,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":337.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Eye photodynamic ther add-on","code_information":[{"code":"67225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.27,"maximum":44.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.27}]}]},{"description":"Dstrj extensive retinopathy","code_information":[{"code":"67227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":412.57,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":412.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Treatment x10sv retinopathy","code_information":[{"code":"67228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":491.33,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":491.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Tr retinal les preterm inf","code_information":[{"code":"67229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.36,"maximum":2868.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1867.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2554.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2868.98,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce eye wall","code_information":[{"code":"67250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1449.13,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1449.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce/graft eye wall","code_information":[{"code":"67255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1114.72,"maximum":21561.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4609.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1114.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4701.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19194.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21561.42,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye muscle","code_information":[{"code":"67311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":740.79,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":740.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise two eye muscles","code_information":[{"code":"67312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1077.04,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1077.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye muscle","code_information":[{"code":"67314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":740.79,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":740.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise two eye muscles","code_information":[{"code":"67316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1150.28,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1150.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye muscle(s)","code_information":[{"code":"67318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1113.04,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1113.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye muscle(s) add-on","code_information":[{"code":"67320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":281.52,"maximum":281.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":281.52}]}]},{"description":"Eye surgery follow-up add-on","code_information":[{"code":"67331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.75,"maximum":203.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":203.75}]}]},{"description":"Rerevise eye muscles add-on","code_information":[{"code":"67332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.05,"maximum":329.05,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.05}]}]},{"description":"Repair & revise nerve add-on","code_information":[{"code":"64874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":281.15,"maximum":281.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":281.15}]}]},{"description":"Repair nerve/shorten bone","code_information":[{"code":"64876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.2,"maximum":318.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.2}]}]},{"description":"Nerve graft head/neck <=4 cm","code_information":[{"code":"64885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1764.11,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve graft head/neck >4 cm","code_information":[{"code":"64886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2113.32,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve graft hand/foot <=4 cm","code_information":[{"code":"64890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1781.13,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1781.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve graft hand/foot >4 cm","code_information":[{"code":"64891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1893.33,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1893.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve graft arm/leg <4 cm","code_information":[{"code":"64892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1733.21,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1733.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve graft arm/leg >4 cm","code_information":[{"code":"64893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1848.11,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1848.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Nerve graft hand/foot <=4 cm","code_information":[{"code":"64895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2181.03,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2181.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve graft hand/foot >4 cm","code_information":[{"code":"64896","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2352.51,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2352.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve graft arm/leg <=4 cm","code_information":[{"code":"64897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2086.18,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2086.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve graft arm/leg >4 cm","code_information":[{"code":"64898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2259.32,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2259.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve graft add-on","code_information":[{"code":"64901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":964.39,"maximum":964.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":964.39}]}]},{"description":"Nerve graft add-on","code_information":[{"code":"64902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1115.91,"maximum":1115.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1115.91}]}]},{"description":"Nerve pedicle transfer","code_information":[{"code":"64905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1639.76,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1639.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve pedicle transfer","code_information":[{"code":"64907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2139.64,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nerve repair w/allograft","code_information":[{"code":"64910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1260.39,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1260.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Neurorraphy w/vein autograft","code_information":[{"code":"64911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1690.63,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1690.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nrv rpr w/nrv algrft 1st","code_information":[{"code":"64912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1474.33,"maximum":45777.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14680.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1474.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40753.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45777.99,"additional_payer_notes":"APC"}]}]},{"description":"Nrv rpr w/nrv algrft ea addl","code_information":[{"code":"64913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.64,"maximum":278.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.64}]}]},{"description":"Revise eye","code_information":[{"code":"65091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1193.03,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1193.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye with implant","code_information":[{"code":"65093","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1182.54,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1182.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Removal of eye","code_information":[{"code":"65101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1366.8,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1366.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Remove eye/insert implant","code_information":[{"code":"65103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1413.24,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1413.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Remove eye/attach implant","code_information":[{"code":"65105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1539.32,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1539.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Removal of eye","code_information":[{"code":"65110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2129.86,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2129.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Remove eye/revise socket","code_information":[{"code":"65112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2442.67,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2442.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Remove eye/revise socket","code_information":[{"code":"65114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2549.81,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2549.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Revise ocular implant","code_information":[{"code":"65125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":479.65,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":479.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Insert ocular implant","code_information":[{"code":"65130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1372.32,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1372.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Insert ocular implant","code_information":[{"code":"65135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1388.74,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1388.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Attach ocular implant","code_information":[{"code":"65140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1494.02,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1494.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Revise ocular implant","code_information":[{"code":"65150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1124.62,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1124.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Reinsert ocular implant","code_information":[{"code":"65155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1555.74,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1555.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ocular implant","code_information":[{"code":"65175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1253.83,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1253.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.01,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.53,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.63,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.95,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1178.02,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1178.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"67882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":766.33,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair brow defect","code_information":[{"code":"67900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":821.03,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":821.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":955.65,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":955.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1175.4,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1175.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":779.75,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":779.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":965.7,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":965.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":819.15,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":819.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":701.32,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":701.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelid defect","code_information":[{"code":"67909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.22,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":712.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelid defect","code_information":[{"code":"67911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":907.91,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":907.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Correction eyelid w/implant","code_information":[{"code":"67912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":787.94,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":536.32,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":536.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":323.62,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":323.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.25,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":700.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67917","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":741.31,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":741.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":509.07,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":509.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.34,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":700.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid defect","code_information":[{"code":"67924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.38,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":742.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid wound","code_information":[{"code":"67930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.22,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Repair eyelid wound","code_information":[{"code":"67935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":710.58,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":710.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Remove eyelid foreign body","code_information":[{"code":"67938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":187.13,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"67950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.54,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":750.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"67961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":738.52,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":738.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"67966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1059.74,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1059.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of eyelid","code_information":[{"code":"67971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1164.62,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1164.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of eyelid","code_information":[{"code":"67973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1497.71,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1497.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of eyelid","code_information":[{"code":"67974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.43,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of eyelid","code_information":[{"code":"67975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1104.42,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1104.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Incise/drain eyelid lining","code_information":[{"code":"68020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":178.95,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of eyelid lesions","code_information":[{"code":"68040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.24,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of eyelid lining","code_information":[{"code":"68100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.07,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Remove eyelid lining lesion","code_information":[{"code":"68110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":242.1,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Remove eyelid lining lesion","code_information":[{"code":"68115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.82,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Remove eyelid lining lesion","code_information":[{"code":"68130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.81,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":670.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Remove eyelid lining lesion","code_information":[{"code":"68135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.33,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Treat eyelid by injection","code_information":[{"code":"68200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.67,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Revise/graft eyelid lining","code_information":[{"code":"68320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":876.91,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":876.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise/graft eyelid lining","code_information":[{"code":"68325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1063.4,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1063.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Revise/graft eyelid lining","code_information":[{"code":"68326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1044.74,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1044.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Revise/graft eyelid lining","code_information":[{"code":"68328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1141.0,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1141.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelid lining","code_information":[{"code":"68330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":748.81,"maximum":12038.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3860.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":748.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2625.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10717.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12038.44,"additional_payer_notes":"APC"}]}]},{"description":"Revise/graft eyelid lining","code_information":[{"code":"68335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1048.05,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1048.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Separate eyelid adhesions","code_information":[{"code":"68340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":645.41,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":645.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelid lining","code_information":[{"code":"68360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":667.09,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":667.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelid lining","code_information":[{"code":"68362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1061.19,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1061.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Harvest eye tissue alograft","code_information":[{"code":"68371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":668.11,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":668.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Incise/drain tear gland","code_information":[{"code":"68400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.37,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Incise/drain tear sac","code_information":[{"code":"68420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.19,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Incise tear duct opening","code_information":[{"code":"68440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.9,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tear gland","code_information":[{"code":"68500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1716.08,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1716.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal tear gland","code_information":[{"code":"68505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1708.44,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1708.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of tear gland","code_information":[{"code":"68510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":464.93,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":464.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tear sac","code_information":[{"code":"68520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1194.58,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1194.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of tear sac","code_information":[{"code":"68525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.43,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Clearance of tear duct","code_information":[{"code":"68530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.97,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":412.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove tear gland lesion","code_information":[{"code":"68540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1586.07,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1586.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Remove tear gland lesion","code_information":[{"code":"68550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.78,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1972.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Repair tear ducts","code_information":[{"code":"68700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":978.14,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":978.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Revise tear duct opening","code_information":[{"code":"68705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.94,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Create tear sac drain","code_information":[{"code":"68720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1311.0,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1311.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Create tear duct drain","code_information":[{"code":"68745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1317.55,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1317.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Create tear duct drain","code_information":[{"code":"68750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1388.64,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1388.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Close tear duct opening","code_information":[{"code":"68760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.27,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Close tear duct opening","code_information":[{"code":"68761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.4,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Close tear system fistula","code_information":[{"code":"68770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1017.01,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1017.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Dilate tear duct opening","code_information":[{"code":"68801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.18,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Probe nasolacrimal duct","code_information":[{"code":"68810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":208.82,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":208.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Probe nasolacrimal duct","code_information":[{"code":"68811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":220.87,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Probe nasolacrimal duct","code_information":[{"code":"68815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.01,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Probe nl duct w/balloon","code_information":[{"code":"68816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.81,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Explore/irrigate tear ducts","code_information":[{"code":"68840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.32,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":191.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Insj rx elut implt lac canal","code_information":[{"code":"68841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.96,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Injection for tear sac x-ray","code_information":[{"code":"68850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":84.1,"maximum":84.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84.1}]}]},{"description":"Drain external ear lesion","code_information":[{"code":"69000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.94,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":206.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Drain external ear lesion","code_information":[{"code":"69005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.95,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Drain outer ear canal lesion","code_information":[{"code":"69020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.83,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of external ear","code_information":[{"code":"69100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.41,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of external ear canal","code_information":[{"code":"69105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.78,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Remove external ear partial","code_information":[{"code":"69110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.35,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":538.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Removal of external ear","code_information":[{"code":"69120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.74,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":634.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear canal lesion(s)","code_information":[{"code":"69140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1472.24,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear canal lesion(s)","code_information":[{"code":"69145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":422.4,"maximum":15152.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3239.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4859.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":422.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13488.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15152.04,"additional_payer_notes":"APC"}]}]},{"description":"Extensive ear canal surgery","code_information":[{"code":"69150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.43,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Extensive ear/neck surgery","code_information":[{"code":"69155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2661.73,"maximum":2661.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2661.73}]}]},{"description":"Clear outer ear canal","code_information":[{"code":"69200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.52,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Clear outer ear canal","code_information":[{"code":"69205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.38,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.47,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.46,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Clean out mastoid cavity","code_information":[{"code":"69220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.05,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Clean out mastoid cavity","code_information":[{"code":"69222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":224.82,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":224.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Revise external ear","code_information":[{"code":"69300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":778.2,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":778.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild outer ear canal","code_information":[{"code":"69310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1824.61,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1824.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild outer ear canal","code_information":[{"code":"69320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2547.53,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2547.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Incision of eardrum","code_information":[{"code":"69420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":199.84,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Incision of eardrum","code_information":[{"code":"69421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.97,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Remove ventilating tube","code_information":[{"code":"69424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.88,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Create eardrum opening","code_information":[{"code":"69433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.48,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Create eardrum opening","code_information":[{"code":"69436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.19,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of middle ear","code_information":[{"code":"69440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1127.62,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1127.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Mastoidectomy","code_information":[{"code":"69501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1163.18,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1163.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Mastoidectomy","code_information":[{"code":"69502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1542.62,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1542.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove mastoid structures","code_information":[{"code":"69505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2008.78,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2008.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Extensive mastoid surgery","code_information":[{"code":"69511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2055.21,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Extensive mastoid surgery","code_information":[{"code":"69530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2751.32,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2751.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove part of temporal bone","code_information":[{"code":"69535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4358.38,"maximum":4358.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4358.38}]}]},{"description":"Remove ear lesion","code_information":[{"code":"69540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":212.77,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":212.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear lesion","code_information":[{"code":"69550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1738.09,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1738.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear lesion","code_information":[{"code":"69552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2594.6,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2594.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear lesion","code_information":[{"code":"69554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4141.52,"maximum":4141.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4141.52}]}]},{"description":"Mastoid surgery revision","code_information":[{"code":"69601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.97,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Mastoid surgery revision","code_information":[{"code":"69602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1775.44,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1775.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Mastoid surgery revision","code_information":[{"code":"69603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2099.96,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2099.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Mastoid surgery revision","code_information":[{"code":"69604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1814.71,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1814.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eardrum","code_information":[{"code":"69610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.81,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eardrum","code_information":[{"code":"69620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":817.52,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":817.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair eardrum structures","code_information":[{"code":"69631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1449.46,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1449.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild eardrum structures","code_information":[{"code":"69632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1764.06,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild eardrum structures","code_information":[{"code":"69633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1717.88,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1717.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair eardrum structures","code_information":[{"code":"69635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild eardrum structures","code_information":[{"code":"69636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2302.4,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2302.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Rebuild eardrum structures","code_information":[{"code":"69637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2292.58,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2292.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1700.01,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1700.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2180.87,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2180.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1995.06,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1995.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2466.57,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2466.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2420.75,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2420.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear & mastoid","code_information":[{"code":"69646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2561.24,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2561.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Release middle ear bone","code_information":[{"code":"69650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1311.6,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1311.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear bone","code_information":[{"code":"69660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1510.28,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1510.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear bone","code_information":[{"code":"69662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1880.65,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1880.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair middle ear structures","code_information":[{"code":"69666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1319.24,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1319.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Repair middle ear structures","code_information":[{"code":"69667","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1319.79,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1319.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Remove mastoid air cells","code_information":[{"code":"69670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1541.58,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1541.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove middle ear nerve","code_information":[{"code":"69676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1359.27,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1359.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Close mastoid fistula","code_information":[{"code":"69700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1089.47,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Nps surg dilat eust tube uni","code_information":[{"code":"69705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":284.84,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Nps surg dilat eust tube bi","code_information":[{"code":"69706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":397.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":397.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove/repair hearing aid","code_information":[{"code":"69711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1369.55,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1369.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Implant Temple Bone W/Stimul","code_information":[{"code":"69714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":813.53,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":813.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Impltj oi implt skl tc esp","code_information":[{"code":"69716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1018.87,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1018.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Temple Bone Implant Revision","code_information":[{"code":"69717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":921.11,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":921.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rplcmt oi implt tc esp","code_information":[{"code":"69719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1057.6,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Release facial nerve","code_information":[{"code":"69720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1929.72,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1929.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Release facial nerve","code_information":[{"code":"69725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3052.02,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3052.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl oi implt skl perq esp","code_information":[{"code":"69726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":782.53,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":782.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl oi implt skl tc esp","code_information":[{"code":"69727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":873.13,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":873.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Rmv ntr oi imp sktc esp>=100","code_information":[{"code":"69728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":973.51,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":973.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Impl oi implt sk tc esp>=100","code_information":[{"code":"69729","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1103.42,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1103.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Rplc oi implt sk tc esp>=100","code_information":[{"code":"69730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1126.98,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1126.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair facial nerve","code_information":[{"code":"69740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1895.69,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1895.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair facial nerve","code_information":[{"code":"69745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2019.25,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2019.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner ear","code_information":[{"code":"69801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":204.59,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":204.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Explore inner ear","code_information":[{"code":"69805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1684.34,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1684.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Explore inner ear","code_information":[{"code":"69806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1505.28,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1505.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove inner ear","code_information":[{"code":"69905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1498.47,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1498.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove inner ear & mastoid","code_information":[{"code":"69910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1618.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1618.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner ear nerve","code_information":[{"code":"69915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2455.34,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2455.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Implant cochlear device","code_information":[{"code":"69930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1983.28,"maximum":171994.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36770.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55155.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1983.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37506.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":153116.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171994.46,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner ear nerve","code_information":[{"code":"69950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2856.25,"maximum":2856.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2856.25}]}]},{"description":"Release facial nerve","code_information":[{"code":"69955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3210.33,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3210.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Release inner ear canal","code_information":[{"code":"69960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3079.63,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3079.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove inner ear lesion","code_information":[{"code":"69970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3472.95,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3472.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Microsurgery add-on","code_information":[{"code":"69990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.14,"maximum":355.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":355.14}]}]},{"description":"Contrast x-ray of brain","code_information":[{"code":"70010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.73,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of brain","code_information":[{"code":"70015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.14,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"X-ray eye for foreign body","code_information":[{"code":"70030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.56,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw <4views","code_information":[{"code":"70100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye muscle w/suture","code_information":[{"code":"67334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.09,"maximum":201.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.09}]}]},{"description":"Eye suture during surgery","code_information":[{"code":"67335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":302.29,"maximum":302.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.29}]}]},{"description":"Revise eye muscle add-on","code_information":[{"code":"67340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":471.17,"maximum":471.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":471.17}]}]},{"description":"Release eye tissue","code_information":[{"code":"67343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1095.11,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1095.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Destroy nerve of eye muscle","code_information":[{"code":"67345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.97,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":355.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy eye muscle","code_information":[{"code":"67346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":313.43,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":313.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Explore/biopsy eye socket","code_information":[{"code":"67400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1663.94,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1663.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Explore/drain eye socket","code_information":[{"code":"67405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1450.99,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1450.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat eye socket","code_information":[{"code":"67412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1582.94,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1582.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat eye socket","code_information":[{"code":"67413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1545.57,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1545.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Explr/decompress eye socket","code_information":[{"code":"67414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2331.61,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Aspiration orbital contents","code_information":[{"code":"67415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.69,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat eye socket","code_information":[{"code":"67420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2791.59,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2791.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat eye socket","code_information":[{"code":"67430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2223.42,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2223.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Explore/drain eye socket","code_information":[{"code":"67440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2157.97,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2157.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Explr/decompress eye socket","code_information":[{"code":"67445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2454.2,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2454.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Explore/biopsy eye socket","code_information":[{"code":"67450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2235.93,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2235.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Inject/treat eye socket","code_information":[{"code":"67500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.52,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Inject/treat eye socket","code_information":[{"code":"67505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.4,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Inject/treat eye socket","code_information":[{"code":"67515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.95,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Sprchoroidal spc njx rx agt","code_information":[{"code":"67516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.83,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Insert eye socket implant","code_information":[{"code":"67550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1744.45,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1744.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Revise eye socket implant","code_information":[{"code":"67560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1781.12,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1781.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Decompress optic nerve","code_information":[{"code":"67570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2042.12,"maximum":20507.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6576.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2042.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4471.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18256.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.59,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of eyelid abscess","code_information":[{"code":"67700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.28,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of eyelid","code_information":[{"code":"67710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.15,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Incision of eyelid fold","code_information":[{"code":"67715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.49,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Remove eyelid lesion","code_information":[{"code":"67800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.97,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove eyelid lesions","code_information":[{"code":"67801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.98,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Remove eyelid lesions","code_information":[{"code":"67805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.73,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove eyelid lesion(s)","code_information":[{"code":"67808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":598.8,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":598.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy eyelid & lid margin","code_information":[{"code":"67810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.44,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelashes","code_information":[{"code":"67820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.04,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelashes","code_information":[{"code":"67825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":199.52,"maximum":1655.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1473.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1655.7,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelashes","code_information":[{"code":"67830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":224.15,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":224.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelashes","code_information":[{"code":"67835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":718.93,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":718.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Remove eyelid lesion","code_information":[{"code":"67840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.81,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Treat eyelid lesion","code_information":[{"code":"67850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.91,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Closure of eyelid by suture","code_information":[{"code":"67875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.03,"maximum":5200.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1111.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1667.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1133.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4629.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5200.08,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"67880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.33,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":599.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Ct neck spine w/o & w/dye","code_information":[{"code":"72127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct chest spine w/o dye","code_information":[{"code":"72128","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct chest spine w/dye","code_information":[{"code":"72129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":187.59,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct chest spine w/o & w/dye","code_information":[{"code":"72130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct lumbar spine w/o dye","code_information":[{"code":"72131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct lumbar spine w/dye","code_information":[{"code":"72132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":186.49,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":186.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Ct lumbar spine w/o & w/dye","code_information":[{"code":"72133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Mri neck spine w/o dye","code_information":[{"code":"72141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.15,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri neck spine w/dye","code_information":[{"code":"72142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":316.62,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":316.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest spine w/o dye","code_information":[{"code":"72146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.68,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest spine w/dye","code_information":[{"code":"72147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":313.38,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":313.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri lumbar spine w/o dye","code_information":[{"code":"72148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.23,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri lumbar spine w/dye","code_information":[{"code":"72149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.03,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":309.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri neck spine w/o & w/dye","code_information":[{"code":"72156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":351.88,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":351.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest spine w/o & w/dye","code_information":[{"code":"72157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":352.95,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":352.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri lumbar spine w/o & w/dye","code_information":[{"code":"72158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.8,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mr angio spine w/o&w/dye","code_information":[{"code":"72159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":425.59,"maximum":425.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.59}]}]},{"description":"X-ray exam of pelvis","code_information":[{"code":"72170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.97,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of pelvis","code_information":[{"code":"72190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiograph pelv w/o&w/dye","code_information":[{"code":"72191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct pelvis w/o dye","code_information":[{"code":"72192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct pelvis w/dye","code_information":[{"code":"72193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":285.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct pelvis w/o & w/dye","code_information":[{"code":"72194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Mri Pelvis W/O Dye","code_information":[{"code":"72195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.59,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri pelvis w/dye","code_information":[{"code":"72196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.2,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri pelvis w/o & w/dye","code_information":[{"code":"72197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":386.58,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":386.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mr angio pelvis w/o & w/dye","code_information":[{"code":"72198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.26,"maximum":421.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.26}]}]},{"description":"X-ray exam si joints","code_information":[{"code":"72200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.18,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam si joints 3/> vws","code_information":[{"code":"72202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.61,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam sacrum tailbone","code_information":[{"code":"72220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.56,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Myelography neck spine","code_information":[{"code":"72240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.61,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Myelography thoracic spine","code_information":[{"code":"72255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.0,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Myelography l-s spine","code_information":[{"code":"72265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.14,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Myelogphy 2/> spine regions","code_information":[{"code":"72270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.43,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Discography cerv/thor spine","code_information":[{"code":"72285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.16,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"X-ray of lower spine disk","code_information":[{"code":"72295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.02,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of collar bone","code_information":[{"code":"73000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.11,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulder blade","code_information":[{"code":"73010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.94,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulder","code_information":[{"code":"73020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.28,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulder","code_information":[{"code":"73030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.73,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of shoulder","code_information":[{"code":"73040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.0,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulders","code_information":[{"code":"73050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.52,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of humerus","code_information":[{"code":"73060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.56,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of elbow","code_information":[{"code":"73070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.68,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of elbow","code_information":[{"code":"73080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.56,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of elbow","code_information":[{"code":"73085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.66,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of forearm","code_information":[{"code":"73090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.21,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of arm infant","code_information":[{"code":"73092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.47,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of wrist","code_information":[{"code":"73100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.73,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of wrist","code_information":[{"code":"73110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.67,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of wrist","code_information":[{"code":"73115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.17,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of hand","code_information":[{"code":"73120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.94,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of hand","code_information":[{"code":"73130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.15,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of finger(s)","code_information":[{"code":"73140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.49,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct upper extremity w/o dye","code_information":[{"code":"73200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct upper extremity w/dye","code_information":[{"code":"73201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.26,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Ct uppr extremity w/o&w/dye","code_information":[{"code":"73202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio upr extrm w/o&w/dye","code_information":[{"code":"73206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Mri Upper Extremity W/O Dye","code_information":[{"code":"73218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri Upper Extremity W/Dye","code_information":[{"code":"73219","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":420.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri uppr extremity w/o&w/dye","code_information":[{"code":"73220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint upr extrem w/o dye","code_information":[{"code":"73221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.57,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint upr extrem w/dye","code_information":[{"code":"73222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.22,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":388.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint upr extr w/o&w/dye","code_information":[{"code":"73223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":469.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mr angio upr extr w/o&w/dye","code_information":[{"code":"73225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":408.24,"maximum":408.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":408.24}]}]},{"description":"X-ray exam hip uni 1 view","code_information":[{"code":"73501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.56,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hip uni 2-3 views","code_information":[{"code":"73502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.17,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hip uni 4/> views","code_information":[{"code":"73503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.98,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hips bi 2 views","code_information":[{"code":"73521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.87,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hips bi 3-4 views","code_information":[{"code":"73522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.05,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hips bi 5/> views","code_information":[{"code":"73523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.45,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of hip","code_information":[{"code":"73525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.77,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of femur 1","code_information":[{"code":"73551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.21,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of femur 2/>","code_information":[{"code":"73552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.91,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of knee 1 or 2","code_information":[{"code":"73560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.27,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of knee 3","code_information":[{"code":"73562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.49,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam knee 4 or more","code_information":[{"code":"73564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.08,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of knees","code_information":[{"code":"73565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.49,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of knee joint","code_information":[{"code":"73580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.79,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of lower leg","code_information":[{"code":"73590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.03,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of leg infant","code_information":[{"code":"73592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.47,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of ankle","code_information":[{"code":"73600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.56,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of ankle","code_information":[{"code":"73610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.53,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of ankle","code_information":[{"code":"73615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.33,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of foot","code_information":[{"code":"73620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.15,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of foot","code_information":[{"code":"73630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.27,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of heel","code_information":[{"code":"73650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.59,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of toe(s)","code_information":[{"code":"73660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.85,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct lower extremity w/o dye","code_information":[{"code":"73700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct lower extremity w/dye","code_information":[{"code":"73701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":186.49,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":186.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw 4/> views","code_information":[{"code":"70110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.49,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of mastoids","code_information":[{"code":"70120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.23,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of mastoids","code_information":[{"code":"70130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.81,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of middle ear","code_information":[{"code":"70134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.1,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of facial bones","code_information":[{"code":"70140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.3,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of facial bones","code_information":[{"code":"70150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.84,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of nasal bones","code_information":[{"code":"70160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.7,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of eye sockets","code_information":[{"code":"70190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.37,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of eye sockets","code_information":[{"code":"70200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.84,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of sinuses","code_information":[{"code":"70210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.03,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of sinuses","code_information":[{"code":"70220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.44,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam pituitary saddle","code_information":[{"code":"70240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.47,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of skull","code_information":[{"code":"70250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.44,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of skull","code_information":[{"code":"70260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.96,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of teeth","code_information":[{"code":"70300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of teeth","code_information":[{"code":"70310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.11,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Full mouth x-ray of teeth","code_information":[{"code":"70320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.48,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw joint","code_information":[{"code":"70328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.73,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw joints","code_information":[{"code":"70330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.77,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw joint","code_information":[{"code":"70332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.54,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Magnetic image jaw joint","code_information":[{"code":"70336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray head for orthodontia","code_information":[{"code":"70350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.62,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Panoramic x-ray of jaws","code_information":[{"code":"70355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.62,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of neck","code_information":[{"code":"70360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.85,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Throat x-ray & fluoroscopy","code_information":[{"code":"70370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Speech evaluation complex","code_information":[{"code":"70371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.85,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of salivary gland","code_information":[{"code":"70380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.7,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of salivary duct","code_information":[{"code":"70390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":154.53,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":154.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct head/brain w/o dye","code_information":[{"code":"70450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.14,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct head/brain w/dye","code_information":[{"code":"70460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.84,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct head/brain w/o & w/dye","code_information":[{"code":"70470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":189.21,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":189.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct orbit/ear/fossa w/o dye","code_information":[{"code":"70480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct orbit/ear/fossa w/dye","code_information":[{"code":"70481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct orbit/ear/fossa w/o&w/dye","code_information":[{"code":"70482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct maxillofacial w/o dye","code_information":[{"code":"70486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct maxillofacial w/dye","code_information":[{"code":"70487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.81,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct maxillofacial w/o & w/dye","code_information":[{"code":"70488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct soft tissue neck w/o dye","code_information":[{"code":"70490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct soft tissue neck w/dye","code_information":[{"code":"70491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct sft tsue nck w/o & w/dye","code_information":[{"code":"70492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiography head","code_information":[{"code":"70496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiography neck","code_information":[{"code":"70498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Mri orbit/face/neck w/o dye","code_information":[{"code":"70540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri Orbit/Face/Neck W/Dye","code_information":[{"code":"70542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":317.17,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri orbt/fac/nck w/o &w/dye","code_information":[{"code":"70543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":394.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Head W/O Dye","code_information":[{"code":"70544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.57,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Head W/Dye","code_information":[{"code":"70545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":284.63,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mr angiograph head w/o&w/dye","code_information":[{"code":"70546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":431.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Neck W/O Dye","code_information":[{"code":"70547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":265.11,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Neck W/Dye","code_information":[{"code":"70548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":292.22,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":292.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mr angiograph neck w/o&w/dye","code_information":[{"code":"70549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":433.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain stem w/o dye","code_information":[{"code":"70551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.44,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain stem w/dye","code_information":[{"code":"70552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.65,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain stem w/o & w/dye","code_information":[{"code":"70553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.8,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Fmri brain by tech","code_information":[{"code":"70554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":463.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 1 view","code_information":[{"code":"71045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.18,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 2 views","code_information":[{"code":"71046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.94,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 3 views","code_information":[{"code":"71047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.15,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 4+ views","code_information":[{"code":"71048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.41,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam ribs uni 2 views","code_information":[{"code":"71100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.27,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam unilat ribs/chest","code_information":[{"code":"71101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.7,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam ribs bil 3 views","code_information":[{"code":"71110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam ribs/chest4/> vws","code_information":[{"code":"71111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.17,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam breastbone 2/>vws","code_information":[{"code":"71120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.03,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray strenoclavic jt 3/>vws","code_information":[{"code":"71130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.87,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct thorax w/o dye","code_information":[{"code":"71250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct thorax w/dye","code_information":[{"code":"71260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":186.49,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":186.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct thorax w/o & w/dye","code_information":[{"code":"71270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct thorax lung cancer scr c-","code_information":[{"code":"71271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiography chest","code_information":[{"code":"71275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest w/o dye","code_information":[{"code":"71550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":405.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri Chest W/Dye","code_information":[{"code":"71551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":483.65,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest w/o & w/dye","code_information":[{"code":"71552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":598.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri angio chest w or w/o dye","code_information":[{"code":"71555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":412.59,"maximum":412.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":412.59}]}]},{"description":"X-ray exam of spine 1 view","code_information":[{"code":"72020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.09,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam neck spine 2-3 vw","code_information":[{"code":"72040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.15,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam neck spine 4/5vws","code_information":[{"code":"72050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.67,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam neck spine 6/>vws","code_information":[{"code":"72052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.52,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thorac spine 2vws","code_information":[{"code":"72070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.94,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thorac spine 3vws","code_information":[{"code":"72072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.61,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thorac spine4/>vw","code_information":[{"code":"72074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.67,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thoracolmb 2/> vw","code_information":[{"code":"72080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.11,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 1 vw","code_information":[{"code":"72081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.87,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 2/3 vw","code_information":[{"code":"72082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.0,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 4/5 vw","code_information":[{"code":"72083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.45,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 6/> vw","code_information":[{"code":"72084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam l-s spine 2/3 vws","code_information":[{"code":"72100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.15,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam l-2 spine 4/>vws","code_information":[{"code":"72110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.96,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam l-s spine bending","code_information":[{"code":"72114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.9,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray bend only l-s spine","code_information":[{"code":"72120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct neck spine w/o dye","code_information":[{"code":"72125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct neck spine w/dye","code_information":[{"code":"72126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.42,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mr elastography","code_information":[{"code":"76391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":245.07,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of head","code_information":[{"code":"76506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ophth us b & quant a","code_information":[{"code":"76510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.7,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Ophth us quant a only","code_information":[{"code":"76511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.68,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ophth us b w/non-quant a","code_information":[{"code":"76512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.71,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye water bath","code_information":[{"code":"76513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.86,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye thickness","code_information":[{"code":"76514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.95,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.56,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.81,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.21,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Us exam of head and neck","code_information":[{"code":"76536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us exam chest","code_information":[{"code":"76604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.41,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ultrasound breast complete","code_information":[{"code":"76641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.51,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ultrasound breast limited","code_information":[{"code":"76642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.1,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Us exam abdom complete","code_information":[{"code":"76700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of abdomen","code_information":[{"code":"76705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.95,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us abdl aorta screen aaa","code_information":[{"code":"76706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us exam abdo back wall comp","code_information":[{"code":"76770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us exam abdo back wall lim","code_information":[{"code":"76775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.2,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us exam k transpl w/doppler","code_information":[{"code":"76776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us exam spinal canal","code_information":[{"code":"76800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ob us < 14 wks single fetus","code_information":[{"code":"76801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.32,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ob us < 14 wks addl fetus","code_information":[{"code":"76802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.61,"maximum":33.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.61}]}]},{"description":"Ob us >/= 14 wks sngl fetus","code_information":[{"code":"76805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ob us >/= 14 wks addl fetus","code_information":[{"code":"76810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.58,"maximum":65.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.58}]}]},{"description":"Ob us detailed sngl fetus","code_information":[{"code":"76811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.63,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Ob us detailed addl fetus","code_information":[{"code":"76812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":171.31,"maximum":171.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171.31}]}]},{"description":"Ob us nuchal meas 1 gest","code_information":[{"code":"76813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.33,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ob us nuchal meas add-on","code_information":[{"code":"76814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.91,"maximum":43.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.91}]}]},{"description":"Ob us limited fetus(s)","code_information":[{"code":"76815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.33,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ob us follow-up per fetus","code_information":[{"code":"76816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.14,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Transvaginal us obstetric","code_information":[{"code":"76817","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.62,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Fetal biophys profile w/nst","code_information":[{"code":"76818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.73,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Fetal biophys profil w/o nst","code_information":[{"code":"76819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.74,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Umbilical artery echo","code_information":[{"code":"76820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Middle cerebral artery echo","code_information":[{"code":"76821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.92,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":289.51,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":289.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":187.04,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.2,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.77,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Transvaginal us non-ob","code_information":[{"code":"76830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam uterus","code_information":[{"code":"76831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.1,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Us exam pelvic complete","code_information":[{"code":"76856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us exam pelvic limited","code_information":[{"code":"76857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.37,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us exam scrotum","code_information":[{"code":"76870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.3,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us transrectal","code_information":[{"code":"76872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Echograp trans r pros study","code_information":[{"code":"76873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us xtr non-vasc complete","code_information":[{"code":"76881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.33,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us xtr non-vasc lmtd","code_information":[{"code":"76882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.49,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us nrv&acc strux 1xtr compre","code_information":[{"code":"76883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.38,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us exam infant hips dynamic","code_information":[{"code":"76885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Us exam infant hips static","code_information":[{"code":"76886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Echo guide for artery repair","code_information":[{"code":"76936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Us guide vascular access","code_information":[{"code":"76937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.65,"maximum":40.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.65}]}]},{"description":"Echo guide for biopsy","code_information":[{"code":"76942","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.15,"maximum":47.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.15}]}]},{"description":"Echo guide for amniocentesis","code_information":[{"code":"76946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.94,"maximum":24.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.94}]}]},{"description":"Echo guidance radiotherapy","code_information":[{"code":"76965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.53,"maximum":45.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.53}]}]},{"description":"Us bone density measure","code_information":[{"code":"76977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.57,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Us trgt dyn mbubb 1st les","code_information":[{"code":"76978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.92,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":191.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Us trgt dyn mbubb ea addl","code_information":[{"code":"76979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.56,"maximum":135.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.56}]}]},{"description":"Use parenchyma","code_information":[{"code":"76981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Use 1st target lesion","code_information":[{"code":"76982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":104.64,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Use ea addl target lesion","code_information":[{"code":"76983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.08,"maximum":59.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.08}]}]},{"description":"Fluoroguide for Vein Device","code_information":[{"code":"77001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.49,"maximum":128.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.49}]}]},{"description":"Needle localization by xray","code_information":[{"code":"77002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.06,"maximum":142.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.06}]}]},{"description":"Fluoroguide for Spine Inject","code_information":[{"code":"77003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.44,"maximum":121.44,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.44}]}]},{"description":"CT Scan for Localization","code_information":[{"code":"77011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.4,"maximum":255.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":255.4}]}]},{"description":"Ct scan for needle biopsy","code_information":[{"code":"77012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.26,"maximum":93.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.26}]}]},{"description":"CT Scan for Therapy Guide","code_information":[{"code":"77014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.37,"maximum":120.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.37}]}]},{"description":"MR Guidance for Needle Place","code_information":[{"code":"77021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":562.29,"maximum":562.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":562.29}]}]},{"description":"Mri breast c- unilateral","code_information":[{"code":"77046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":239.64,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":239.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri breast c- bilateral","code_information":[{"code":"77047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.57,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri breast c-+ w/cad uni","code_information":[{"code":"77048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":392.53,"maximum":392.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":392.53}]}]},{"description":"Mri breast c-+ w/cad bi","code_information":[{"code":"77049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":387.67,"maximum":387.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":387.67}]}]},{"description":"X-Ray of Mammary Duct","code_information":[{"code":"77053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.62,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray of mammary ducts","code_information":[{"code":"77054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.6,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Breast tomosynthesis bi","code_information":[{"code":"77063","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.04,"maximum":39.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.04}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":23.1,"maximum":108.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.65,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108.05,"additional_payer_notes":"APC"}]}]},{"description":"Dx mammo incl cad uni","code_information":[{"code":"77065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.56,"maximum":142.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.56}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":85.11,"maximum":398.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":354.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":398.1,"additional_payer_notes":"APC"}]}]},{"description":"Dx mammo incl cad bi","code_information":[{"code":"77066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":181.62,"maximum":181.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.62}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":109.17,"maximum":510.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":163.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":454.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":510.64,"additional_payer_notes":"APC"}]}]},{"description":"Scr mammo bi incl cad","code_information":[{"code":"77067","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.19,"maximum":150.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.19}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":90.06,"maximum":421.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":135.09,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":421.26,"additional_payer_notes":"APC"}]}]},{"description":"X-Ray Stress View","code_information":[{"code":"77071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.64,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-Rays for Bone Age","code_information":[{"code":"77072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.09,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-rays bone length studies","code_information":[{"code":"77073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.58,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-rays bone survey limited","code_information":[{"code":"77074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.64,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct lwr extremity w/o&w/dye","code_information":[{"code":"73702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio lwr extr w/o&w/dye","code_information":[{"code":"73706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Mri Lower Extremity W/O Dye","code_information":[{"code":"73718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.06,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri Lower Extremity W/Dye","code_information":[{"code":"73719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.58,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":309.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri lwr extremity w/o&w/dye","code_information":[{"code":"73720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri jnt of lwr extre w/o dye","code_information":[{"code":"73721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.01,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri Joint Of Lwr Extr W/Dye","code_information":[{"code":"73722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.91,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint lwr extr w/o&w/dye","code_information":[{"code":"73723","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":467.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mr ang lwr ext w or w/o dye","code_information":[{"code":"73725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":418.0,"maximum":418.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":418.0}]}]},{"description":"X-ray exam abdomen 1 view","code_information":[{"code":"74018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.68,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam abdomen 2 views","code_information":[{"code":"74019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.27,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam abdomen 3+ views","code_information":[{"code":"74021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam series abdomen","code_information":[{"code":"74022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.37,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct abdomen w/o dye","code_information":[{"code":"74150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct abdomen w/dye","code_information":[{"code":"74160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":283.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct abdomen w/o & w/dye","code_information":[{"code":"74170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio abd&pelv w/o&w/dye","code_information":[{"code":"74174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":459.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio abdom w/o & w/dye","code_information":[{"code":"74175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct abd & pelvis w/o contrast","code_information":[{"code":"74176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":170.24,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":170.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct abd & pelv w/contrast","code_information":[{"code":"74177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":358.4,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":358.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Ct abd & pelv 1/> regns","code_information":[{"code":"74178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri abdomen w/o dye","code_information":[{"code":"74181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.44,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri Abdomen W/Dye","code_information":[{"code":"74182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":366.51,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":366.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri abdomen w/o & w/dye","code_information":[{"code":"74183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":388.75,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":388.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri angio abdom w orw/o dye","code_information":[{"code":"74185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.09,"maximum":419.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.09}]}]},{"description":"Contrst x-ray exam of throat","code_information":[{"code":"74210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.73,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray esophagus","code_information":[{"code":"74220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.06,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray xm esophagus 2cntrst","code_information":[{"code":"74221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.99,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Cine/vid x-ray throat/esoph","code_information":[{"code":"74230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.24,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray upper gi delay w/o kub","code_information":[{"code":"74240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.46,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray uppr gi tract","code_information":[{"code":"74246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.43,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray sm int f-thru std","code_information":[{"code":"74248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.6,"maximum":78.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.6}]}]},{"description":"X-ray exam of small bowel","code_information":[{"code":"74250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.37,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of small bowel","code_information":[{"code":"74251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct colonography dx","code_information":[{"code":"74261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct colonography dx w/dye","code_information":[{"code":"74262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct colonography screening","code_information":[{"code":"74263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":405.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.47,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":259.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray gallbladder","code_information":[{"code":"74290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":178.37,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.68,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.29,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.85,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray bladder","code_information":[{"code":"74430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.82,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"X-ray male genital tract","code_information":[{"code":"74440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.34,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray urethra/bladder","code_information":[{"code":"74455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.87,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray guide gu dilation","code_information":[{"code":"74485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.49,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Mri fetal sngl/1st gestation","code_information":[{"code":"74712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":405.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri fetal ea addl gestation","code_information":[{"code":"74713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.45,"maximum":185.45,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.45}]}]},{"description":"X-ray female genital tract","code_information":[{"code":"74740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.66,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac mri for morph","code_information":[{"code":"75557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac mri w/stress img","code_information":[{"code":"75559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.38,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac mri for morph w/dye","code_information":[{"code":"75561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":397.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Card mri w/stress img & dye","code_information":[{"code":"75563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.84,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Card mri veloc flow mapping","code_information":[{"code":"75565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.77,"maximum":54.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.77}]}]},{"description":"Ct hrt w/3d image","code_information":[{"code":"75572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.95,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Ct hrt w/3d image congen","code_information":[{"code":"75573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.19,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio hrt w/3d image","code_information":[{"code":"75574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.76,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"N-invas est c ffr sw aly cta","code_information":[{"code":"75580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1350.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Contrast exam thoracic aorta","code_information":[{"code":"75600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.53,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Contrast exam thoracic aorta","code_information":[{"code":"75605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.04,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Contrast exam abdominl aorta","code_information":[{"code":"75625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.42,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"X-ray aorta leg arteries","code_information":[{"code":"75630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.52,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Ct Angio Abdominal Arteries","code_information":[{"code":"75635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":298.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays spine","code_information":[{"code":"75705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":227.15,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays arm/leg","code_information":[{"code":"75710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.49,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays arms/legs","code_information":[{"code":"75716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.01,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays abdomen","code_information":[{"code":"75726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.77,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays adrenal gland","code_information":[{"code":"75731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.69,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays adrenals","code_information":[{"code":"75733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.19,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays pelvis","code_information":[{"code":"75736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":151.76,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays lung","code_information":[{"code":"75741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.83,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays lungs","code_information":[{"code":"75743","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.01,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays lung","code_information":[{"code":"75746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.53,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays chest","code_information":[{"code":"75756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.62,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"X-rays bone survey complete","code_information":[{"code":"77075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-rays bone survey infant","code_information":[{"code":"77076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Joint survey single view","code_information":[{"code":"77077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct bone density axial","code_information":[{"code":"77078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Dxa bone density axial","code_information":[{"code":"77080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Dxa bone density/peripheral","code_information":[{"code":"77081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.85,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Magnetic image bone marrow","code_information":[{"code":"77084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":397.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Tbs dxa cal w/i&r fx risk","code_information":[{"code":"77089","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.19,"maximum":65.19,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.19}]}]},{"description":"Tbs techl prep&transmis data","code_information":[{"code":"77090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.85,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Tbs techl calculation only","code_information":[{"code":"77091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.44,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Tbs i&r fx rsk qhp","code_information":[{"code":"77092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.88,"maximum":15.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.88}]}]},{"description":"Radiation therapy planning","code_information":[{"code":"77261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.04,"maximum":116.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.04}]}]},{"description":"Radiation therapy planning","code_information":[{"code":"77262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.43,"maximum":179.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.43}]}]},{"description":"Radiation therapy planning","code_information":[{"code":"77263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.92,"maximum":278.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.92}]}]},{"description":"Set radiation therapy field","code_information":[{"code":"77280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.89,"maximum":701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.12,"additional_payer_notes":"APC"}]}]},{"description":"Set radiation therapy field","code_information":[{"code":"77285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.57,"maximum":1953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":631.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1738.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.16,"additional_payer_notes":"APC"}]}]},{"description":"Set radiation therapy field","code_information":[{"code":"77290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.57,"maximum":1953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":582.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1738.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.16,"additional_payer_notes":"APC"}]}]},{"description":"Respirator motion mgmt simul","code_information":[{"code":"77293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":483.1,"maximum":483.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.1}]}]},{"description":"3-d radiotherapy plan","code_information":[{"code":"77295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.74,"maximum":7220.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1543.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2315.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1574.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6427.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7220.12,"additional_payer_notes":"APC"}]}]},{"description":"Radiation therapy dose plan","code_information":[{"code":"77300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.84,"maximum":701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.12,"additional_payer_notes":"APC"}]}]},{"description":"Radiotherapy dose plan imrt","code_information":[{"code":"77301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1543.59,"maximum":7220.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1543.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2315.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2323.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1574.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6427.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7220.12,"additional_payer_notes":"APC"}]}]},{"description":"Telethx isodose plan simple","code_information":[{"code":"77306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.59,"maximum":1953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":123.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1738.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.16,"additional_payer_notes":"APC"}]}]},{"description":"Telethx isodose plan cplx","code_information":[{"code":"77307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":224.41,"maximum":1953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":224.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1738.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.16,"additional_payer_notes":"APC"}]}]},{"description":"Brachytx isodose plan simple","code_information":[{"code":"77316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.97,"maximum":1953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1738.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.16,"additional_payer_notes":"APC"}]}]},{"description":"Brachytx isodose intermed","code_information":[{"code":"77317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":372.97,"maximum":1953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":372.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1738.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.16,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-ray each vessel","code_information":[{"code":"75774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.86,"maximum":81.86,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.86}]}]},{"description":"Nonvascular shunt x-ray","code_information":[{"code":"75809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.88,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray arm/leg","code_information":[{"code":"75820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.33,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray arms/legs","code_information":[{"code":"75822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.19,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray trunk","code_information":[{"code":"75825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray chest","code_information":[{"code":"75827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.19,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray kidney","code_information":[{"code":"75831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.2,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray kidneys","code_information":[{"code":"75833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.94,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray adrenal gland","code_information":[{"code":"75840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.89,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray adrenal glands","code_information":[{"code":"75842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.2,"maximum":144.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.2}]}]},{"description":"Vein x-ray neck","code_information":[{"code":"75860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.71,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray skull","code_information":[{"code":"75870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.69,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray skull epidural","code_information":[{"code":"75872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.89,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray eye socket","code_information":[{"code":"75880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.89,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver w/hemodynam","code_information":[{"code":"75885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.16,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver w/o hemodyn","code_information":[{"code":"75887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.16,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver w/hemodynam","code_information":[{"code":"75889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.63,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver","code_information":[{"code":"75891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.16,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Venous sampling by catheter","code_information":[{"code":"75893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.63,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Remove cva device obstruct","code_information":[{"code":"75901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.33,"maximum":325.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":325.33}]}]},{"description":"Remove cva lumen obstruct","code_information":[{"code":"75902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.51,"maximum":109.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.51}]}]},{"description":"Xray control catheter change","code_information":[{"code":"75984","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.71,"maximum":92.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.71}]}]},{"description":"Abscess drainage under x-ray","code_information":[{"code":"75989","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.07,"maximum":91.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.07}]}]},{"description":"Fluoroscope examination","code_information":[{"code":"76000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.53,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray nose to rectum","code_information":[{"code":"76010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.59,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Mr sfty implt&/fb asmt stf 1","code_information":[{"code":"76014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.88,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Mr sfty mplt&/fb asmt stf ea","code_information":[{"code":"76015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.1,"maximum":86.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.1}]}]},{"description":"Mr safety deter phys/qhp","code_information":[{"code":"76016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.71,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Mr sfty med physics xm cstmz","code_information":[{"code":"76017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mr safety implant elec prepj","code_information":[{"code":"76018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.02,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Mr safety implt pos&/immoblj","code_information":[{"code":"76019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of fistula","code_information":[{"code":"76080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.46,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam breast specimen","code_information":[{"code":"76098","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.53,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of body section","code_information":[{"code":"76100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.64,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cine/video x-rays","code_information":[{"code":"76120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray consultation","code_information":[{"code":"76140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.55,"maximum":66.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.55}]}]},{"description":"Med physic dos eval rad exps","code_information":[{"code":"76145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1600.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"3d render w/intrp postproces","code_information":[{"code":"76376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.56,"maximum":26.56,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.56}]}]},{"description":"3d render w/intrp postproces","code_information":[{"code":"76377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.27,"maximum":68.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.27}]}]},{"description":"CAT scan follow-up study","code_information":[{"code":"76380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Platelet survival","code_information":[{"code":"78191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.1,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Lymph system imaging","code_information":[{"code":"78195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":426.66,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Liver imaging","code_information":[{"code":"78201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":252.07,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":252.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Liver imaging with flow","code_information":[{"code":"78202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":277.56,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Liver and spleen imaging","code_information":[{"code":"78215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.33,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":255.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Liver & spleen image/flow","code_information":[{"code":"78216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.69,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Hepatobiliary system imaging","code_information":[{"code":"78226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":415.85,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":415.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Hepatobil syst image w/drug","code_information":[{"code":"78227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":565.46,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":565.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Salivary gland imaging","code_information":[{"code":"78230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.31,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Serial salivary imaging","code_information":[{"code":"78231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.48,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Salivary gland function exam","code_information":[{"code":"78232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":136.01,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Esophageal motility study","code_information":[{"code":"78258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":265.62,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Gastric mucosa imaging","code_information":[{"code":"78261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.98,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":250.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Gastroesophageal reflux exam","code_information":[{"code":"78262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.1,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.78,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":500.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.08,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Acute GI blood loss imaging","code_information":[{"code":"78278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":433.71,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":433.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Meckels divert exam","code_information":[{"code":"78290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":428.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Leveen/shunt patency exam","code_information":[{"code":"78291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":319.84,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone imaging limited area","code_information":[{"code":"78300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.47,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone imaging multiple areas","code_information":[{"code":"78305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":338.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":338.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone imaging whole body","code_information":[{"code":"78306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.85,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone imaging 3 phase","code_information":[{"code":"78315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":427.74,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone mineral single photon","code_information":[{"code":"78350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.68,"maximum":34.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.68}]}]},{"description":"Bone mineral dual photon","code_information":[{"code":"78351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.09,"maximum":24.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.09}]}]},{"description":"Cardiac shunt imaging","code_information":[{"code":"78428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.53,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Myocrd img pet 1 std w/ct","code_information":[{"code":"78429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.68,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Myocrd img pet rst/strs w/ct","code_information":[{"code":"78430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.68,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2566.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Myocrd img pet rst&strs ct","code_information":[{"code":"78431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2456.56,"maximum":11490.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2456.56,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3684.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3914.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2505.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10229.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11490.54,"additional_payer_notes":"APC"}]}]},{"description":"Myocrd img pet 2rtracer","code_information":[{"code":"78432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1692.46,"maximum":7916.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1692.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2538.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3269.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1726.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7047.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7916.5,"additional_payer_notes":"APC"}]}]},{"description":"Myocrd img pet 2rtracer ct","code_information":[{"code":"78433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2456.56,"maximum":11490.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2456.56,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3684.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3436.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2505.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10229.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11490.54,"additional_payer_notes":"APC"}]}]},{"description":"Aqmbf pet rest & rx stress","code_information":[{"code":"78434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1174.87,"maximum":1174.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1174.87}]}]},{"description":"Vascular flow imaging","code_information":[{"code":"78445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.67,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Ht muscle image spect sing","code_information":[{"code":"78451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.22,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":395.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Ht muscle image spect mult","code_information":[{"code":"78452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":564.36,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":564.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Ht muscle image planar sing","code_information":[{"code":"78453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":354.56,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":354.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Ht musc image planar mult","code_information":[{"code":"78454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":532.92,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":532.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Acute venous thrombus image","code_information":[{"code":"78456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.2,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Venous thrombosis imaging","code_information":[{"code":"78457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.66,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Ven thrombosis images bilat","code_information":[{"code":"78458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.67,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Heart muscle imaging (PET)","code_information":[{"code":"78459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1443.80,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2307.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Heart infarct image","code_information":[{"code":"78466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":208.68,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":208.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Heart infarct image (ef)","code_information":[{"code":"78468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.7,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Heart infarct image (3D)","code_information":[{"code":"78469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.38,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Gated heart planar single","code_information":[{"code":"78472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.38,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Gated heart multiple","code_information":[{"code":"78473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":316.6,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":316.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Heart first pass single","code_information":[{"code":"78481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":189.18,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":189.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Heart first pass multiple","code_information":[{"code":"78483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.48,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Heart image (pet) single","code_information":[{"code":"78491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.68,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2561.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Heart image (pet) multiple","code_information":[{"code":"78492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.68,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2580.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Heart image spect","code_information":[{"code":"78494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.98,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":250.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Heart first pass add-on","code_information":[{"code":"78496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.89,"maximum":30.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.89}]}]},{"description":"Lung ventilation imaging","code_information":[{"code":"78579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":237.98,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Lung perfusion imaging","code_information":[{"code":"78580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":290.56,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":290.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Lung ventilat&perfus imaging","code_information":[{"code":"78582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":402.29,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":402.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Lung perfusion differential","code_information":[{"code":"78597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.71,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Lung perf&ventilat diferentl","code_information":[{"code":"78598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.16,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Brain image < 4 views","code_information":[{"code":"78600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":237.43,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Brain image w/flow < 4 views","code_information":[{"code":"78601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":281.35,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":281.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Brain image 4+ views","code_information":[{"code":"78605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.49,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Brain image w/flow 4 + views","code_information":[{"code":"78606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":431.54,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":431.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Brain imaging (PET)","code_information":[{"code":"78608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.68,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2557.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Brain imaging (PET)","code_information":[{"code":"78609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.28,"maximum":116.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.28}]}]},{"description":"Brain flow imaging only","code_information":[{"code":"78610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":237.43,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Cerebrospinal fluid scan","code_information":[{"code":"78630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":439.13,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"CSF ventriculography","code_information":[{"code":"78635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":444.56,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"CSF shunt evaluation","code_information":[{"code":"78645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":429.38,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":429.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"CSF leakage imaging","code_information":[{"code":"78650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.09,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":355.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear exam of tear flow","code_information":[{"code":"78660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.4,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Kidney imaging morphol","code_information":[{"code":"78700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":221.15,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":221.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Kidney imaging with flow","code_information":[{"code":"78701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.53,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"K flow/funct image w/o drug","code_information":[{"code":"78707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.3,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"K flow/funct image w/drug","code_information":[{"code":"78708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.66,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"K flow/funct image multiple","code_information":[{"code":"78709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":434.78,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":434.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Kidney function study","code_information":[{"code":"78725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.15,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Urinary bladder retention","code_information":[{"code":"78730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.42,"maximum":95.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.42}]}]},{"description":"Ureteral reflux study","code_information":[{"code":"78740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.53,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Testicular imaging w/flow","code_information":[{"code":"78761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":261.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging limited area","code_information":[{"code":"78800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":321.48,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":321.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging mult areas","code_information":[{"code":"78801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.64,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging whole body","code_information":[{"code":"78802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":387.63,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":387.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging (3D)","code_information":[{"code":"78803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":469.51,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":469.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging whole body","code_information":[{"code":"78804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":605.52,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":851.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Iv inj ra drug dx study","code_information":[{"code":"78808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.2,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Pet image ltd area","code_information":[{"code":"78811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1443.80,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2304.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Pet image skull-thigh","code_information":[{"code":"78812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.68,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2590.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Pet image w/ct lmtd","code_information":[{"code":"78814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.68,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2610.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Pet image w/ct skull-thigh","code_information":[{"code":"78815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.68,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2629.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Pet image w/ct full body","code_information":[{"code":"78816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.68,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2631.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Rp loclzj tum spect w/ct 1","code_information":[{"code":"78830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":583.38,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Rp loclzj tum spect 2 areas","code_information":[{"code":"78831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":892.41,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":892.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Rp loclzj tum spect w/ct 2","code_information":[{"code":"78832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1147.74,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1147.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Rp quan meas single area","code_information":[{"code":"78835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.51,"maximum":109.51,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.51}]}]},{"description":"Nuclear rx oral admin","code_information":[{"code":"79005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":84.02,"maximum":1217.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1083.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1217.16,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear rx iv admin","code_information":[{"code":"79101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.26,"maximum":1217.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1083.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1217.16,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear rx intracav admin","code_information":[{"code":"79200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.62,"maximum":1217.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1083.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1217.16,"additional_payer_notes":"APC"}]}]},{"description":"Hematopoietic nuclear tx","code_information":[{"code":"79403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.77,"maximum":1217.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1083.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1217.16,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear rx intra-articular","code_information":[{"code":"79440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.5,"maximum":1217.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1083.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1217.16,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj sf 5-20","code_information":[{"code":"80503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.61,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj mod 21-40","code_information":[{"code":"80504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.14,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj high 41-60","code_information":[{"code":"80505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":145.05,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj prolng svc","code_information":[{"code":"80506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.96,"maximum":68.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.96}]}]},{"description":"Im admin 1st/only component","code_information":[{"code":"90460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.59,"maximum":37.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.59}]}]},{"description":"Im admin each addl component","code_information":[{"code":"90461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.24,"maximum":14.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.24}]}]},{"description":"Immunization admin","code_information":[{"code":"90471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.75,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Immunization admin each add","code_information":[{"code":"90472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.99,"maximum":23.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.99}]}]},{"description":"Psytx complex interactive","code_information":[{"code":"90785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.88,"maximum":20.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.88}]}]},{"description":"Psych diagnostic evaluation","code_information":[{"code":"90791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.94,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Psych diag eval w/med srvcs","code_information":[{"code":"90792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.94,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Psytx w pt 30 minutes","code_information":[{"code":"90832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.13,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Psytx w pt w e/m 30 min","code_information":[{"code":"90833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.3,"maximum":109.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.3}]}]},{"description":"Psytx w pt 45 minutes","code_information":[{"code":"90834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":154.53,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":154.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Psytx w pt w e/m 45 min","code_information":[{"code":"90836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":138.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94}]}]},{"description":"Psytx w pt 60 minutes","code_information":[{"code":"90837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.94,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Psytx w pt w e/m 60 min","code_information":[{"code":"90838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.52,"maximum":185.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.52}]}]},{"description":"Psytx crisis initial 60 min","code_information":[{"code":"90839","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.94,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":221.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Psytx crisis ea addl 30 min","code_information":[{"code":"90840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.83,"maximum":109.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.83}]}]},{"description":"Psychoanalysis","code_information":[{"code":"90845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.41,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Family psytx w/o pt 50 min","code_information":[{"code":"90846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.16,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Family psytx w/pt 50 min","code_information":[{"code":"90847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.31,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Multiple family group psytx","code_information":[{"code":"90849","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.91,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Group psychotherapy","code_information":[{"code":"90853","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.23,"maximum":529.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.29,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":169.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":471.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":529.93,"additional_payer_notes":"APC"}]}]},{"description":"Electroconvulsive therapy","code_information":[{"code":"90870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":171.28,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Psychophysiological therapy","code_information":[{"code":"90875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.8,"maximum":94.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.8}]}]},{"description":"Psy evaluation of records","code_information":[{"code":"90885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.71,"maximum":76.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.71}]}]},{"description":"Consultation with family","code_information":[{"code":"90887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.23,"maximum":117.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.23}]}]},{"description":"Bfb training 1st 15 min","code_information":[{"code":"90912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.32,"maximum":174.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":155.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174.56,"additional_payer_notes":"APC"}]}]},{"description":"Bfb training ea addl 15 min","code_information":[{"code":"90913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.98,"maximum":98.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":87.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98.13,"additional_payer_notes":"APC"}]}]},{"description":"Hemodialysis one evaluation","code_information":[{"code":"90935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.08,"maximum":3580.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1148.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":780.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3187.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3580.07,"additional_payer_notes":"APC"}]}]},{"description":"Hemodialysis repeated eval","code_information":[{"code":"90937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.52,"maximum":166.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166.52}]}]},{"description":"Dialysis one evaluation","code_information":[{"code":"90945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.58,"maximum":2176.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":465.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":698.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":474.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1937.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2176.59,"additional_payer_notes":"APC"}]}]},{"description":"Dialysis repeated eval","code_information":[{"code":"90947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.8,"maximum":198.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.8}]}]},{"description":"Esrd serv 4 visits p mo <2yr","code_information":[{"code":"90951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1894.69,"maximum":1894.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1894.69}]}]},{"description":"Esrd serv 4 vsts p mo 2-11","code_information":[{"code":"90954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1632.77,"maximum":1632.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1632.77}]}]},{"description":"Esrd srv 2-3 vsts p mo 2-11","code_information":[{"code":"90955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":853.01,"maximum":853.01,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":853.01}]}]},{"description":"Esrd srv 1 visit p mo 2-11","code_information":[{"code":"90956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.31,"maximum":570.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.31}]}]},{"description":"Esrd srv 4 vsts p mo 12-19","code_information":[{"code":"90957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1252.26,"maximum":1252.26,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1252.26}]}]},{"description":"Esrd srv 2-3 vsts p mo 12-19","code_information":[{"code":"90958","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":815.71,"maximum":815.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":815.71}]}]},{"description":"Esrd serv 1 vst p mo 12-19","code_information":[{"code":"90959","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":532.47,"maximum":532.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":532.47}]}]},{"description":"Esrd srv 4 visits p mo 20+","code_information":[{"code":"90960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.12,"maximum":580.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.12}]}]},{"description":"Esrd srv 2-3 vsts p mo 20+","code_information":[{"code":"90961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":481.53,"maximum":481.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":481.53}]}]},{"description":"Esrd serv 1 visit p mo 20+","code_information":[{"code":"90962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":332.52,"maximum":332.52,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.52}]}]},{"description":"Esrd home pt serv p mo <2yrs","code_information":[{"code":"90963","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":986.09,"maximum":986.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.09}]}]},{"description":"Esrd home pt serv p mo 2-11","code_information":[{"code":"90964","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.3,"maximum":845.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":845.3}]}]},{"description":"Esrd home pt serv p mo 12-19","code_information":[{"code":"90965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":814.02,"maximum":814.02,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":814.02}]}]},{"description":"Esrd home pt serv p mo 20+","code_information":[{"code":"90966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":481.53,"maximum":481.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":481.53}]}]},{"description":"Esrd home pt serv p day <2","code_information":[{"code":"90967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.47,"maximum":28.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.47}]}]},{"description":"Esrd home pt srv p day 2-11","code_information":[{"code":"90968","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.92,"maximum":27.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.92}]}]},{"description":"Esrd home pt srv p day 12-19","code_information":[{"code":"90969","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.39,"maximum":27.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.39}]}]},{"description":"Esrd home pt serv p day 20+","code_information":[{"code":"90970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.87,"maximum":15.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.87}]}]},{"description":"Hemoperfusion","code_information":[{"code":"90997","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.5,"maximum":143.5,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5}]}]},{"description":"Esophagus motility study","code_information":[{"code":"91010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.31,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Esophgl motil w/stim/perfus","code_information":[{"code":"91013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.02,"maximum":26.02,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.02}]}]},{"description":"Gastric motility studies","code_information":[{"code":"91020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.58,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Duodenal motility study","code_information":[{"code":"91022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.28,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Acid perfusion of esophagus","code_information":[{"code":"91030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.93,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Brachytx isodose complex","code_information":[{"code":"77318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.57,"maximum":1953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":504.69},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1738.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.16,"additional_payer_notes":"APC"}]}]},{"description":"Special teletx port plan","code_information":[{"code":"77321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.17,"maximum":1953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1738.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.16,"additional_payer_notes":"APC"}]}]},{"description":"Special radiation dosimetry","code_information":[{"code":"77331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.44,"maximum":701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.12,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment aid(s)","code_information":[{"code":"77332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.63,"maximum":701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.12,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment aid(s)","code_information":[{"code":"77333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.89,"maximum":701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.12,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment aid(s)","code_information":[{"code":"77334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.35,"maximum":1953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1738.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.16,"additional_payer_notes":"APC"}]}]},{"description":"Radiation physics consult","code_information":[{"code":"77336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.41,"maximum":701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.12,"additional_payer_notes":"APC"}]}]},{"description":"Design mlc device for imrt","code_information":[{"code":"77338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":404.34,"maximum":1953.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1738.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1953.16,"additional_payer_notes":"APC"}]}]},{"description":"Radiation physics consult","code_information":[{"code":"77370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.89,"maximum":701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.12,"additional_payer_notes":"APC"}]}]},{"description":"Srs multisource","code_information":[{"code":"77371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2049.55,"maximum":38420.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12320.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2049.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8378.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34203.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38420.01,"additional_payer_notes":"APC"}]}]},{"description":"Srs linear based","code_information":[{"code":"77372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1515.2,"maximum":38420.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12320.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1515.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8378.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34203.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38420.01,"additional_payer_notes":"APC"}]}]},{"description":"SBRT Delivery","code_information":[{"code":"77373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1590.97,"maximum":9327.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1994.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2991.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1590.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2033.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8303.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9327.12,"additional_payer_notes":"APC"}]}]},{"description":"Ntsty modul rad tx dlvr smpl","code_information":[{"code":"77385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":910.62,"maximum":910.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":910.62}]}]},{"description":"Ntsty modul rad tx dlvr cplx","code_information":[{"code":"77386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":910.62,"maximum":910.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":910.62}]}]},{"description":"Radiation treatment delivery","code_information":[{"code":"77401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.67,"maximum":66.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.67}]}]},{"description":"Radiation treatment delivery","code_information":[{"code":"77402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.78,"maximum":532.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":170.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":473.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":532.23,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment delivery","code_information":[{"code":"77407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.45,"maximum":2011.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":430.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":645.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":438.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1791.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2011.93,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment delivery","code_information":[{"code":"77412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.45,"maximum":2882.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":924.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2565.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.26,"additional_payer_notes":"APC"}]}]},{"description":"Radiology port images(s)","code_information":[{"code":"77417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.54,"maximum":26.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.54}]}]},{"description":"Radiation tx management x5","code_information":[{"code":"77427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":317.57,"maximum":317.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317.57}]}]},{"description":"Radiation therapy management","code_information":[{"code":"77431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.18,"maximum":179.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.18}]}]},{"description":"Stereotactic radiation trmt","code_information":[{"code":"77432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":704.34,"maximum":704.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":704.34}]}]},{"description":"SBRT Management","code_information":[{"code":"77435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1064.15,"maximum":1064.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1064.15}]}]},{"description":"Io radiation tx management","code_information":[{"code":"77469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":531.87,"maximum":531.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":531.87}]}]},{"description":"Special radiation treatment","code_information":[{"code":"77470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.39,"maximum":2882.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":924.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2565.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.26,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":616.20,"maximum":2882.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":924.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":890.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2565.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.26,"additional_payer_notes":"APC"}]}]},{"description":"Infuse radioactive materials","code_information":[{"code":"77750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.91,"maximum":2011.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":430.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":645.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.91},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":438.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1791.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2011.93,"additional_payer_notes":"APC"}]}]},{"description":"Apply intrcav radiat simple","code_information":[{"code":"77761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":362.09,"maximum":2882.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":924.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":362.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2565.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.26,"additional_payer_notes":"APC"}]}]},{"description":"Apply intrcav radiat interm","code_information":[{"code":"77762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.83,"maximum":2882.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":924.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2565.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.26,"additional_payer_notes":"APC"}]}]},{"description":"Apply intrcav radiat compl","code_information":[{"code":"77763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":549.03,"maximum":3633.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1165.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":549.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3234.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3633.06,"additional_payer_notes":"APC"}]}]},{"description":"Apply interstit radiat compl","code_information":[{"code":"77778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":764.8,"maximum":3633.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1165.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3234.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3633.06,"additional_payer_notes":"APC"}]}]},{"description":"Apply surf ldr radionuclide","code_information":[{"code":"77789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.78,"maximum":532.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":170.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":473.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":532.23,"additional_payer_notes":"APC"}]}]},{"description":"Radiation handling","code_information":[{"code":"77790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.85,"maximum":30.85,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.85}]}]},{"description":"Thyroid uptake measurement","code_information":[{"code":"78012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.61,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid imaging w/blood flow","code_information":[{"code":"78013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.1,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid imaging w/blood flow","code_information":[{"code":"78014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.1,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid met imaging","code_information":[{"code":"78015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":288.41,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid met imaging/studies","code_information":[{"code":"78016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.75,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid met imaging body","code_information":[{"code":"78018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":391.98,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":391.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid met uptake","code_information":[{"code":"78020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.17,"maximum":86.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.17}]}]},{"description":"Parathyroid planar imaging","code_information":[{"code":"78070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":369.73,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":369.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Parathyrd planar w/wo subtrj","code_information":[{"code":"78071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.26,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Parathyrd planar w/spect&ct","code_information":[{"code":"78072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":515.04,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":515.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Adrenal cortex & medulla img","code_information":[{"code":"78075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":588.24,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":588.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow imaging ltd","code_information":[{"code":"78102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.44,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow imaging mult","code_information":[{"code":"78103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.58,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":226.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow imaging body","code_information":[{"code":"78104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":306.84,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":306.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Plasma volume single","code_information":[{"code":"78110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.78,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Plasma volume multiple","code_information":[{"code":"78111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.23,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Red cell mass single","code_information":[{"code":"78120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.78,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Red cell mass multiple","code_information":[{"code":"78121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.51,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Red cell survival study","code_information":[{"code":"78130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.1,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Red cell sequestration","code_information":[{"code":"78140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.74,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Spleen imaging","code_information":[{"code":"78185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.77,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Vemp tst i&r cervical&ocular","code_information":[{"code":"92519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.52,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Laryngeal function studies","code_information":[{"code":"92520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.7,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of speech fluency","code_information":[{"code":"92521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.91,"maximum":621.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":199.36,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":221.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":553.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":621.69,"additional_payer_notes":"APC"}]}]},{"description":"Evaluate speech production","code_information":[{"code":"92522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.52,"maximum":521.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":464.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":521.63,"additional_payer_notes":"APC"}]}]},{"description":"Speech sound lang comprehen","code_information":[{"code":"92523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.89,"maximum":1056.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":940.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1056.6,"additional_payer_notes":"APC"}]}]},{"description":"Behavral qualit analys voice","code_information":[{"code":"92524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.24,"maximum":510.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":163.86,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":454.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":510.97,"additional_payer_notes":"APC"}]}]},{"description":"Oral function therapy","code_information":[{"code":"92526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.89,"maximum":392.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":125.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":349.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":392.4,"additional_payer_notes":"APC"}]}]},{"description":"Caloric vstblr test w/rec","code_information":[{"code":"92537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.07,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Caloric vstblr test w/rec","code_information":[{"code":"92538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.28,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Basic vestibular evaluation","code_information":[{"code":"92540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.15,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Spontaneous nystagmus test","code_information":[{"code":"92541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.04,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Positional nystagmus test","code_information":[{"code":"92542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.48,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Optokinetic nystagmus test","code_information":[{"code":"92544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.95,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Oscillating tracking test","code_information":[{"code":"92545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.95,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Sinusoidal rotational test","code_information":[{"code":"92546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Supplemental electrical test","code_information":[{"code":"92547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.81,"maximum":16.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.81}]}]},{"description":"Posturography","code_information":[{"code":"92548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.21,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Cdp-sot 6 cond w/i&r mct&adt","code_information":[{"code":"92549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.06,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Tympanometry & reflex thresh","code_information":[{"code":"92550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.56,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Pure tone hearing test air","code_information":[{"code":"92551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.59,"maximum":20.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.59}]}]},{"description":"Pure tone audiometry air","code_information":[{"code":"92552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.05,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Audiometry air & bone","code_information":[{"code":"92553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.6,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Speech threshold audiometry","code_information":[{"code":"92555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.34,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Speech audiometry complete","code_information":[{"code":"92556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensive hearing test","code_information":[{"code":"92557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.03,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Loudness balance test","code_information":[{"code":"92562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.78,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Tone decay hearing test","code_information":[{"code":"92563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Stenger test pure tone","code_information":[{"code":"92565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.77,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Tympanometry","code_information":[{"code":"92567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.5,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Acoustic refl threshold tst","code_information":[{"code":"92568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.66,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Acoustic immitance testing","code_information":[{"code":"92570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.1,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Filtered speech hearing test","code_information":[{"code":"92571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Staggered spondaic word test","code_information":[{"code":"92572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.71,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Sensorineural acuity test","code_information":[{"code":"92575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Synthetic sentence test","code_information":[{"code":"92576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Stenger test speech","code_information":[{"code":"92577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.4,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Visual audiometry (vra)","code_information":[{"code":"92579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.25,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Conditioning play audiometry","code_information":[{"code":"92582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Select picture audiometry","code_information":[{"code":"92583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Electrocochleography","code_information":[{"code":"92584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Evoked auditory test limited","code_information":[{"code":"92587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.95,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Evoked auditory tst complete","code_information":[{"code":"92588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.11,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Cochlear implt f/up exam <7","code_information":[{"code":"92601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Reprogram cochlear implt 7/>","code_information":[{"code":"92602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.83,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Cochlear implt f/up exam 7/>","code_information":[{"code":"92603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Reprogram cochlear implt 7/>","code_information":[{"code":"92604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.92,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Ex for nonspeech device rx","code_information":[{"code":"92605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.17,"maximum":140.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.17}]}]},{"description":"Non-speech device service","code_information":[{"code":"92606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.2,"maximum":111.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.2}]}]},{"description":"Ex for speech device rx 1hr","code_information":[{"code":"92607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.8,"maximum":569.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":182.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":204.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":507.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":569.72,"additional_payer_notes":"APC"}]}]},{"description":"Ex for speech device rx addl","code_information":[{"code":"92608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.59,"maximum":222.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":198.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":222.6,"additional_payer_notes":"APC"}]}]},{"description":"Use of speech device service","code_information":[{"code":"92609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.13,"maximum":477.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":153.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":170.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":425.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":477.71,"additional_payer_notes":"APC"}]}]},{"description":"Evaluate swallowing function","code_information":[{"code":"92610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.8,"maximum":270.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":240.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":270.36,"additional_payer_notes":"APC"}]}]},{"description":"Motion fluoroscopy/swallow","code_information":[{"code":"92611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.02,"maximum":425.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":136.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":379.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":425.75,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy swallow (fees) vid","code_information":[{"code":"92612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.02,"maximum":252.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":224.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":252.68,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy swallow (fees) i&r","code_information":[{"code":"92613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.67,"maximum":59.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.67}]}]},{"description":"Laryngoscopic sensory vid","code_information":[{"code":"92614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.99,"maximum":252.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":224.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopic sensory i&r","code_information":[{"code":"92615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.1,"maximum":53.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.1}]}]},{"description":"Fees w/laryngeal sense test","code_information":[{"code":"92616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.7,"maximum":372.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":119.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":331.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":372.8,"additional_payer_notes":"APC"}]}]},{"description":"Fees w/laryngeal sense i&r","code_information":[{"code":"92617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.7,"maximum":65.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.7}]}]},{"description":"Ex for nonspeech dev rx add","code_information":[{"code":"92618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.03,"maximum":52.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.03}]}]},{"description":"Dx aly aud oi snd prcsr 1st","code_information":[{"code":"92622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.47,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Dx aly aud oi snd prcsr each","code_information":[{"code":"92623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.47,"maximum":28.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.47}]}]},{"description":"Aud brainstem implt programg","code_information":[{"code":"92640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Aep scr auditory potential","code_information":[{"code":"92650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.03,"maximum":43.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.03}]}]},{"description":"Aep hearing status deter i&r","code_information":[{"code":"92651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.35,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Aep thrshld est mlt freq i&r","code_information":[{"code":"92652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.47,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Aep neurodiagnostic i&r","code_information":[{"code":"92653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.63,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Prq cardiac angioplast 1 art","code_information":[{"code":"92920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":843.94,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":843.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Prq card angio/athrect 1 art","code_information":[{"code":"92924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1005.21,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1005.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Prq card stent w/angio 1 vsl","code_information":[{"code":"92928","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":937.7,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":937.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Prq card stent/ath/angio","code_information":[{"code":"92933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1052.6,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1052.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Prq revasc byp graft 1 vsl","code_information":[{"code":"92937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":937.15,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":937.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Prq card revasc mi 1 vsl","code_information":[{"code":"92941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1053.74,"maximum":1053.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1053.74}]}]},{"description":"Prq card revasc chronic 1vsl","code_information":[{"code":"92943","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1053.7,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1053.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Heart/lung resuscitation cpr","code_information":[{"code":"92950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":297.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Cardioversion electric ext","code_information":[{"code":"92960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.55,"maximum":3447.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1105.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":751.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3069.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3447.72,"additional_payer_notes":"APC"}]}]},{"description":"Cardioassist internal","code_information":[{"code":"92970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.25,"maximum":301.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.25}]}]},{"description":"Cardioassist external","code_information":[{"code":"92971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.15,"maximum":160.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160.15}]}]},{"description":"Perq trluml coronry lithotrp","code_information":[{"code":"92972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":235.83,"maximum":235.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":235.83}]}]},{"description":"Prq coronary mech thrombect","code_information":[{"code":"92973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":280.61,"maximum":280.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.61}]}]},{"description":"Cath place cardio brachytx","code_information":[{"code":"92974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.64,"maximum":256.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.64}]}]},{"description":"Dissolve clot heart vessel","code_information":[{"code":"92975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.25,"maximum":599.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":599.25}]}]},{"description":"Dissolve clot heart vessel","code_information":[{"code":"92977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.76,"maximum":90.76,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.76}]}]},{"description":"Revision of aortic valve","code_information":[{"code":"92986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2128.81,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2128.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Revision of mitral valve","code_information":[{"code":"92987","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2194.81,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2194.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Revision of pulmonary valve","code_information":[{"code":"92990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1757.68,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Pul art balloon repr percut","code_information":[{"code":"92997","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.71,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Pul art balloon repr percut","code_information":[{"code":"92998","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":508.49,"maximum":508.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.49}]}]},{"description":"Electrocardiogram complete","code_information":[{"code":"93000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.42,"maximum":23.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.42}]}]},{"description":"Electrocardiogram tracing","code_information":[{"code":"93005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.28,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Electrocardiogram report","code_information":[{"code":"93010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.14,"maximum":13.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.14}]}]},{"description":"Cardiovascular stress test","code_information":[{"code":"93015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.37,"maximum":119.37,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.37}]}]},{"description":"Cardiovascular stress test","code_information":[{"code":"93017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.31,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular stress test","code_information":[{"code":"93018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.04,"maximum":23.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.04}]}]},{"description":"Cardiac drug stress test","code_information":[{"code":"93024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.92,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Microvolt t-wave assess","code_information":[{"code":"93025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Rhythm ECG with report","code_information":[{"code":"93040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.78,"maximum":21.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.78}]}]},{"description":"Rhythm ecg tracing","code_information":[{"code":"93041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.81,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Rhythm ecg report","code_information":[{"code":"93042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.97,"maximum":10.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.97}]}]},{"description":"Art pressure waveform analys","code_information":[{"code":"93050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Therapy activation ipnss","code_information":[{"code":"93150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.93,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Interrog&prgrmg ipnss","code_information":[{"code":"93151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.07,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Interrog&prgrmg ipnss polysm","code_information":[{"code":"93152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.93,"maximum":1602.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1426.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1602.14,"additional_payer_notes":"APC"}]}]},{"description":"Interrog w/o prgrmg ipnss","code_information":[{"code":"93153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.04,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.71,"maximum":114.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.71}]}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.25,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.84,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.63,"maximum":29.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.63}]}]},{"description":"Remote 30 day ecg rev/report","code_information":[{"code":"93228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.04,"maximum":41.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.04}]}]},{"description":"Remote 30 day ecg tech supp","code_information":[{"code":"93229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1248.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>48hr<7d recording","code_information":[{"code":"93242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.97,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>48hr<7d rev&interpj","code_information":[{"code":"93244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.3,"maximum":37.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.3}]}]},{"description":"Ext ecg>7d<15d recording","code_information":[{"code":"93246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.97,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>7d<15d rev&interpj","code_information":[{"code":"93248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.13,"maximum":41.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.13}]}]},{"description":"Prgrmg dev eval impltbl sys","code_information":[{"code":"93260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Interrogate subq defib","code_information":[{"code":"93261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr wrls p-art prs snr","code_information":[{"code":"93264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"ECG record/review","code_information":[{"code":"93268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.23,"maximum":274.23,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.23}]}]},{"description":"Remote 30 day ecg rev/report","code_information":[{"code":"93270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.0,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Ecg/monitoring and analysis","code_information":[{"code":"93271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.02,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Ecg/review interpret only","code_information":[{"code":"93272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.94,"maximum":38.94,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.94}]}]},{"description":"ECG/signal-averaged","code_information":[{"code":"93278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.44,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Pm device progr eval sngl","code_information":[{"code":"93279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Pm device progr eval dual","code_information":[{"code":"93280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Pm device progr eval multi","code_information":[{"code":"93281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg eval implantable dfb","code_information":[{"code":"93282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg eval implantable dfb","code_information":[{"code":"93283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg eval implantable dfb","code_information":[{"code":"93284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Ilr device eval progr","code_information":[{"code":"93285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Peri-px pacemaker device evl","code_information":[{"code":"93286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":48.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79}]}]},{"description":"Peri-px device eval & prgr","code_information":[{"code":"93287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":48.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79}]}]},{"description":"Pm device eval in person","code_information":[{"code":"93288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Interrog device eval heart","code_information":[{"code":"93289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Icm device eval","code_information":[{"code":"93290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Ilr device interrogate","code_information":[{"code":"93291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Wcd device interrogate","code_information":[{"code":"93292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Pm phone r-strip device eval","code_information":[{"code":"93293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Pm device interrogate remote","code_information":[{"code":"93294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.65,"maximum":47.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.65}]}]},{"description":"Dev interrog remote 1/2/mlt","code_information":[{"code":"93295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.63,"maximum":58.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.63}]}]},{"description":"Pm/icd remote tech serv","code_information":[{"code":"93296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.52,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Icm device interrogat remote","code_information":[{"code":"93297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Ilr device interrogat remote","code_information":[{"code":"93298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Gastroesophageal reflux test","code_information":[{"code":"91034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.01,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"G-esoph reflx tst w/electrod","code_information":[{"code":"91035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.74,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.74},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Esoph imped function test","code_information":[{"code":"91037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.3,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Esoph imped funct test > 1hr","code_information":[{"code":"91038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":540.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Esoph balloon distension tst","code_information":[{"code":"91040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":724.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Breath hydrogen/methane test","code_information":[{"code":"91065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.07,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Gi tract capsule endoscopy","code_information":[{"code":"91110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":953.86,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":953.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Esophageal Capsule Endoscopy","code_information":[{"code":"91111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1275.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Gi wireless capsule measure","code_information":[{"code":"91112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2309.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Gi trc img intral colon i&r","code_information":[{"code":"91113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.09,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1191.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Colon motility 6 hr study","code_information":[{"code":"91117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":220.44,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Rectal sensation test","code_information":[{"code":"91120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.53,"maximum":699.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.53}]}]},{"description":"Anal pressure record","code_information":[{"code":"91122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":303.06,"maximum":303.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":303.06}]}]},{"description":"Electrogastrography","code_information":[{"code":"91132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":636.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Electrogastrography W/Test","code_information":[{"code":"91133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":658.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Liver elastography","code_information":[{"code":"91200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.52,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam new patient","code_information":[{"code":"92002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.43,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam new patient","code_information":[{"code":"92004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam establish patient","code_information":[{"code":"92012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.03,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam&tx estab pt 1/>vst","code_information":[{"code":"92014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.15,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Determine refractive state","code_information":[{"code":"92015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.13,"maximum":30.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.13}]}]},{"description":"New eye exam & treatment","code_information":[{"code":"92018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.7,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam & treatment","code_information":[{"code":"92019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.77,"maximum":12401.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2651.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3977.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11040.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.82,"additional_payer_notes":"APC"}]}]},{"description":"Special eye evaluation","code_information":[{"code":"92020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.85,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Corneal Topography","code_information":[{"code":"92025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.18,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Special eye evaluation","code_information":[{"code":"92060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.44,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Orthoptic/pleoptic training","code_information":[{"code":"92065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.24,"maximum":53.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.24}]}]},{"description":"Orthop traing supvj phys/qhp","code_information":[{"code":"92066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.37,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.71,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.82,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.62,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Serial tonometry exam(s)","code_information":[{"code":"92100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.03,"maximum":52.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.03}]}]},{"description":"Cmptr ophth dx img ant segmt","code_information":[{"code":"92132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.28,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Cmptr ophth img optic nerve","code_information":[{"code":"92133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.28,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Cptr ophth dx img post segmt","code_information":[{"code":"92134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.83,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Ophthalmic biometry","code_information":[{"code":"92136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.18,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Cptrz oph img pst sg rta oct","code_information":[{"code":"92137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.03,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Corneal hysteresis deter","code_information":[{"code":"92145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.45,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Opscpy extnd rta draw uni/bi","code_information":[{"code":"92201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.66,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Opscpy extnd on/mac draw","code_information":[{"code":"92202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.54,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Remote dx retinal imaging","code_information":[{"code":"92227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.71,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Remote retinal imaging mgmt","code_information":[{"code":"92228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.66,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam with photos","code_information":[{"code":"92230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.44,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescein angrph uni/bi","code_information":[{"code":"92235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.14,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Icg angiography uni/bi","code_information":[{"code":"92240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":308.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescein icg angiography","code_information":[{"code":"92242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":440.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam with photos","code_information":[{"code":"92250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.56,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Ophthalmoscopy/dynamometry","code_information":[{"code":"92260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.5,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Eye muscle evaluation","code_information":[{"code":"92265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Electro-oculography","code_information":[{"code":"92270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.94,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Full field erg w/i&r","code_information":[{"code":"92273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.65,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Multifocal erg w/i&r","code_information":[{"code":"92274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.17,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Color vision examination","code_information":[{"code":"92283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Dark adaptation eye exam","code_information":[{"code":"92284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.34,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Eye photography","code_information":[{"code":"92285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.52,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Internal eye photography","code_information":[{"code":"92286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.71,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Internal eye photography","code_information":[{"code":"92287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Ear and throat examination","code_information":[{"code":"92502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.26,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Ear microscopy examination","code_information":[{"code":"92504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.33,"maximum":15.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.33}]}]},{"description":"Speech/hearing therapy","code_information":[{"code":"92507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.95,"maximum":355.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":113.93,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":316.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":355.26,"additional_payer_notes":"APC"}]}]},{"description":"Speech/hearing therapy","code_information":[{"code":"92508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.92,"maximum":111.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":99.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111.89,"additional_payer_notes":"APC"}]}]},{"description":"Nasopharyngoscopy","code_information":[{"code":"92511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.29,"maximum":1041.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":333.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":926.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1041.22,"additional_payer_notes":"APC"}]}]},{"description":"Nasal function studies","code_information":[{"code":"92512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.35,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Facial nerve function test","code_information":[{"code":"92516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.66,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Vemp test i&r cervical","code_information":[{"code":"92517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.46,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Vemp test i&r ocular","code_information":[{"code":"92518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.53,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Lower extremity study","code_information":[{"code":"93926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Upper extremity study","code_information":[{"code":"93930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":259.11,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":259.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Upper extremity study","code_information":[{"code":"93931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Extremity study","code_information":[{"code":"93970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.76,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Extremity study","code_information":[{"code":"93971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.86,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Penile vascular study","code_information":[{"code":"93980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.33,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Penile vascular study","code_information":[{"code":"93981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.24,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Dup-scan hemo compl bi std","code_information":[{"code":"93985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":338.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Dup-scan hemo compl uni std","code_information":[{"code":"93986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Doppler flow testing","code_information":[{"code":"93990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Breathing capacity test","code_information":[{"code":"94010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.44,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Spirometry up to 2 yrs old","code_information":[{"code":"94011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.43,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Spirmtry w/brnchdil inf-2 yr","code_information":[{"code":"94012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.44,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Meas lung vol thru 2 yrs","code_information":[{"code":"94013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.13,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Patient recorded spirometry","code_information":[{"code":"94014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.52,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Patient recorded spirometry","code_information":[{"code":"94015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.03,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Review patient spirometry","code_information":[{"code":"94016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.65,"maximum":115.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.97,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":102.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115.3,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of wheezing","code_information":[{"code":"94060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of wheezing","code_information":[{"code":"94070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.06,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Vital capacity test","code_information":[{"code":"94150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.21,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Lung function test (MBC/MVV)","code_information":[{"code":"94200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.04,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory flow volume loop","code_information":[{"code":"94375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.65,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Hypoxia response curve","code_information":[{"code":"94450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.57,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Hast w/report","code_information":[{"code":"94452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.62,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Hast w/oxygen titrate","code_information":[{"code":"94453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.67,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Surfactant Admin Thru Tube","code_information":[{"code":"94610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.4,"maximum":1142.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":366.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1016.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1142.26,"additional_payer_notes":"APC"}]}]},{"description":"Exercise tst brncspsm","code_information":[{"code":"94617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.83,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Pulmonary stress testing","code_information":[{"code":"94618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.59,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Exercise tst brncspsm wo ecg","code_information":[{"code":"94619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Pulm stress test/complex","code_information":[{"code":"94621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.17,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Phy/qhp op pulm rhb w/o mntr","code_information":[{"code":"94625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.99,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Phy/qhp op pulm rhb w/mntr","code_information":[{"code":"94626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.18,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Airway inhalation treatment","code_information":[{"code":"94640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.0,"maximum":1142.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":366.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1016.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1142.26,"additional_payer_notes":"APC"}]}]},{"description":"Cbt 1st hour","code_information":[{"code":"94644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.76,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.76},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Cbt each addl hour","code_information":[{"code":"94645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.63,"maximum":27.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.63}]}]},{"description":"Evaluate pt use of inhaler","code_information":[{"code":"94664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.23,"maximum":1142.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":366.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1016.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1142.26,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis o2","code_information":[{"code":"94680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.57,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis o2/co2","code_information":[{"code":"94681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.86,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.86},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis","code_information":[{"code":"94690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Pulm funct tst plethysmograp","code_information":[{"code":"94726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Pulm function test by gas","code_information":[{"code":"94727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.2,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Pulm funct test oscillometry","code_information":[{"code":"94728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.58,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Co/membane diffuse capacity","code_information":[{"code":"94729","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.98,"maximum":76.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.98}]}]},{"description":"Measure blood oxygen level","code_information":[{"code":"94760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.95,"maximum":5.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.95}]}]},{"description":"Measure blood oxygen level","code_information":[{"code":"94761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.48,"maximum":6.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.48}]}]},{"description":"Measure blood oxygen level","code_information":[{"code":"94762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.11,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Percut allergy skin tests","code_information":[{"code":"95004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.95,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled Nitric Oxide Meas","code_information":[{"code":"95012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.35,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Perq & icut allg test venoms","code_information":[{"code":"95017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.0,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Perq&ic allg test drugs/biol","code_information":[{"code":"95018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.49,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Icut allergy test drug/bug","code_information":[{"code":"95024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1.6,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Icut allergy titrate-airborn","code_information":[{"code":"95027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.57,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Icut allergy test-delayed","code_information":[{"code":"95028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.04,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Allergy patch tests","code_information":[{"code":"95044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.11,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Photo patch test","code_information":[{"code":"95052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.19,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Photosensitivity tests","code_information":[{"code":"95056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.17,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Eye allergy tests","code_information":[{"code":"95060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.51,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Nose allergy test","code_information":[{"code":"95065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial allergy tests","code_information":[{"code":"95070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.41,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Ingest challenge ini 120 min","code_information":[{"code":"95076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.04,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Ingest challenge addl 60 min","code_information":[{"code":"95079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.71,"maximum":110.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.71}]}]},{"description":"Immunotherapy one injection","code_information":[{"code":"95115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.33,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Immunotherapy injections","code_information":[{"code":"95117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.04,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.47,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.47,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.47,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.47,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.47,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.47,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.47,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.47,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Rapid desensitization","code_information":[{"code":"95180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.1,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Cont gluc mntr pt prov eqp","code_information":[{"code":"95249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Glucose monitoring cont","code_information":[{"code":"95250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Gluc monitor cont phys i&r","code_information":[{"code":"95251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.41,"maximum":56.41,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.41}]}]},{"description":"Eeg phys/qhp 2-12 hr w/o vid","code_information":[{"code":"95717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":172.83,"maximum":172.83,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":172.83}]}]},{"description":"Eeg phys/qhp 2-12 hr w/veeg","code_information":[{"code":"95718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.11,"maximum":217.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.11}]}]},{"description":"Eeg phys/qhp ea incr w/o vid","code_information":[{"code":"95719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":259.81,"maximum":259.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":259.81}]}]},{"description":"Eeg phy/qhp ea incr w/veeg","code_information":[{"code":"95720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":333.67,"maximum":333.67,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.67}]}]},{"description":"Eeg phy/qhp>36<60 hr w/o vid","code_information":[{"code":"95721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":332.6,"maximum":332.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.6}]}]},{"description":"Eeg phy/qhp>36<60 hr w/veeg","code_information":[{"code":"95722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":404.77,"maximum":404.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.77}]}]},{"description":"Eeg phy/qhp>60<84 hr w/o vid","code_information":[{"code":"95723","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":408.6,"maximum":408.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":408.6}]}]},{"description":"Eeg phy/qhp>60<84 hr w/veeg","code_information":[{"code":"95724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":513.66,"maximum":513.66,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":513.66}]}]},{"description":"Eeg phy/qhp>84 hr w/o vid","code_information":[{"code":"95725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":468.18,"maximum":468.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":468.18}]}]},{"description":"Eeg phy/qhp>84 hr w/veeg","code_information":[{"code":"95726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":652.59,"maximum":652.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":652.59}]}]},{"description":"Polysom <6 yrs 4/> paramtrs","code_information":[{"code":"95782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1384.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Echo transthoracic","code_information":[{"code":"93303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":252.1,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":252.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Echo transthoracic","code_information":[{"code":"93304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":189.75,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":189.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Tte w/doppler complete","code_information":[{"code":"93306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":205.46,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Tte w/o doppler complete","code_information":[{"code":"93307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.17,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Tte f-up or lmtd","code_information":[{"code":"93308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.71,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":208.72,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":208.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.09,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":219.55,"maximum":219.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.55}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.13,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"3d echo img cgen car anomal","code_information":[{"code":"93319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.78,"maximum":37.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.78}]}]},{"description":"Doppler echo exam heart","code_information":[{"code":"93320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.11,"maximum":53.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.11}]}]},{"description":"Doppler echo exam heart","code_information":[{"code":"93321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.75,"maximum":28.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.75}]}]},{"description":"Doppler color flow add-on","code_information":[{"code":"93325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.99,"maximum":31.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.99}]}]},{"description":"Stress tte only","code_information":[{"code":"93350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":187.04,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Stress tte complete","code_information":[{"code":"93351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.77,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Admin ecg contrast agent","code_information":[{"code":"93352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.06,"maximum":57.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.06}]}]},{"description":"Echo transesophageal (tee)","code_information":[{"code":"93355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.46,"maximum":361.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.46}]}]},{"description":"Myocrd strain img spckl trck","code_information":[{"code":"93356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.14,"maximum":19.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.14}]}]},{"description":"Right heart cath","code_information":[{"code":"93451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1120.82,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1120.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"Left hrt cath w/ventrclgrphy","code_information":[{"code":"93452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1017.78,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1017.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt cath w/ventriclgrphy","code_information":[{"code":"93453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1276.42,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1276.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"Coronary artery angio s&i","code_information":[{"code":"93454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1023.73,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1023.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"Coronary art/grft angio s&i","code_information":[{"code":"93455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1123.51,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1123.51},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"R hrt coronary artery angio","code_information":[{"code":"93456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1252.04,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1252.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"R hrt art/grft angio","code_information":[{"code":"93457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1350.16,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1350.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"L hrt artery/ventricle angio","code_information":[{"code":"93458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1148.98,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1148.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"L hrt art/grft angio","code_information":[{"code":"93459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1210.27,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1210.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt art/ventricle angio","code_information":[{"code":"93460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.61,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1336.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt art/ventricle angio","code_information":[{"code":"93461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1473.79,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1473.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"L hrt cath trnsptl puncture","code_information":[{"code":"93462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":330.14,"maximum":330.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":330.14}]}]},{"description":"Drug admin & hemodynmic meas","code_information":[{"code":"93463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.12,"maximum":157.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.12}]}]},{"description":"Exercise w/hemodynamic meas","code_information":[{"code":"93464","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.58,"maximum":206.58,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":206.58}]}]},{"description":"Insert/place heart catheter","code_information":[{"code":"93503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":141.37,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of heart lining","code_information":[{"code":"93505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":645.27,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":645.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Inject congenital card cath","code_information":[{"code":"93563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":82.43,"maximum":82.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82.43}]}]},{"description":"Inject hrt congntl art/grft","code_information":[{"code":"93564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.28,"maximum":88.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.28}]}]},{"description":"Inject l ventr/atrial angio","code_information":[{"code":"93565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.53,"maximum":43.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.53}]}]},{"description":"Inject r ventr/atrial angio","code_information":[{"code":"93566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.49,"maximum":41.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.49}]}]},{"description":"Inject suprvlv aortography","code_information":[{"code":"93567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.93,"maximum":59.93,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.93}]}]},{"description":"Inject pulm art hrt cath","code_information":[{"code":"93568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.69,"maximum":74.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.69}]}]},{"description":"Njx cth slct p-art angrp uni","code_information":[{"code":"93569","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.27,"maximum":60.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.27}]}]},{"description":"Njx cath slct p-art angrp bi","code_information":[{"code":"93573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.25,"maximum":100.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.25}]}]},{"description":"Njx cath slct pulm vn angrph","code_information":[{"code":"93574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.73,"maximum":111.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.73}]}]},{"description":"Njx cath slct p angrph mapca","code_information":[{"code":"93575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.43,"maximum":148.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.43}]}]},{"description":"Transcath closure of asd","code_information":[{"code":"93580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1555.55,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1555.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Transcath closure of vsd","code_information":[{"code":"93581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2113.0,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Perq transcath closure pda","code_information":[{"code":"93582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1054.72,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1054.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Perq transcath septal reduxn","code_information":[{"code":"93583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1182.77,"maximum":1182.77,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1182.77}]}]},{"description":"Vngrph chd anom/persist svc","code_information":[{"code":"93584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.69,"maximum":94.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.69}]}]},{"description":"Vngrph chd azygs/hemiazygs","code_information":[{"code":"93585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":89.21,"maximum":89.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89.21}]}]},{"description":"Vngrph chd coronary sinus","code_information":[{"code":"93586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.28,"maximum":113.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.28}]}]},{"description":"Vngrph chd vnvn cltrl at/abv","code_information":[{"code":"93587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":165.88,"maximum":165.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.88}]}]},{"description":"Vngrph chd vnvn cltrl below","code_information":[{"code":"93588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.04,"maximum":168.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":168.04}]}]},{"description":"Perq transcath cls mitral","code_information":[{"code":"93590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1715.64,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1715.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Perq transcath cls aortic","code_information":[{"code":"93591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1422.02,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1422.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Perq transcath closure each","code_information":[{"code":"93592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":618.96,"maximum":618.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":618.96}]}]},{"description":"Electrophys map 3d add-on","code_information":[{"code":"93613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":463.6,"maximum":463.6,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":463.6}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.79,"maximum":6351.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1357.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2036.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1384.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5654.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6351.12,"additional_payer_notes":"APC"}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.78,"maximum":80.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.78}]}]},{"description":"Ablate heart dysrhythm focus","code_information":[{"code":"93650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":928.68,"maximum":40685.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13047.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":928.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36220.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40685.85,"additional_payer_notes":"APC"}]}]},{"description":"Ep & ablate supravent arrhyt","code_information":[{"code":"93653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1332.42,"maximum":136344.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29149.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43723.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1332.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29731.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121379.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136344.48,"additional_payer_notes":"APC"}]}]},{"description":"Ep & ablate ventric tachy","code_information":[{"code":"93654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1605.87,"maximum":136344.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29149.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43723.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1605.87},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29731.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121379.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136344.48,"additional_payer_notes":"APC"}]}]},{"description":"Ablate arrhythmia add on","code_information":[{"code":"93655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":489.14,"maximum":489.14,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":489.14}]}]},{"description":"Tx atrial fib pulm vein isol","code_information":[{"code":"93656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1510.06,"maximum":136344.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29149.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43723.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1510.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29731.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121379.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136344.48,"additional_payer_notes":"APC"}]}]},{"description":"Tx l/r atrial fib addl","code_information":[{"code":"93657","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":489.69,"maximum":489.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":489.69}]}]},{"description":"Tilt table evaluation","code_information":[{"code":"93660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.39,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Bioimpedance cv analysis","code_information":[{"code":"93701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.82,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.82},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Bis xtracell fluid analysis","code_information":[{"code":"93702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Analyze pacemaker system","code_information":[{"code":"93724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.36,"maximum":1602.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1426.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1602.14,"additional_payer_notes":"APC"}]}]},{"description":"Interrogation vad in person","code_information":[{"code":"93750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.48,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Measure venous pressure","code_information":[{"code":"93770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.59,"maximum":12.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.59}]}]},{"description":"Ambulatory BP monitoring","code_information":[{"code":"93784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.12,"maximum":75.12,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.12}]}]},{"description":"Ambulatory BP recording","code_information":[{"code":"93786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.85,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Ambulatory BP analysis","code_information":[{"code":"93788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.19,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Review/report BP recording","code_information":[{"code":"93790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.08,"maximum":29.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.08}]}]},{"description":"Pt/caregiver trainj home inr","code_information":[{"code":"93792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.64,"maximum":111.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.64}]}]},{"description":"Anticoag mgmt pt warfarin","code_information":[{"code":"93793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.57,"maximum":18.57,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.57}]}]},{"description":"Cardiac rehab","code_information":[{"code":"93797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.71,"maximum":672.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":598.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":672.43,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac rehab/monitor","code_information":[{"code":"93798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.9,"maximum":672.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":598.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":672.43,"additional_payer_notes":"APC"}]}]},{"description":"Extracranial bilat study","code_information":[{"code":"93880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.95,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Extracranial uni/ltd study","code_information":[{"code":"93882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Intracranial complete study","code_information":[{"code":"93886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Intracranial limited study","code_information":[{"code":"93888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Tcd emboli detect w/o inj","code_information":[{"code":"93892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Tcd emboli detect w/inj","code_information":[{"code":"93893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Vsrctv std tcd icr art compl","code_information":[{"code":"93896","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":224.46,"maximum":224.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":224.46}]}]},{"description":"Emboli detcj wo iv mbubb njx","code_information":[{"code":"93897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":305.24,"maximum":305.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.24}]}]},{"description":"Ven-artl shunt det mbubb njx","code_information":[{"code":"93898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":312.31,"maximum":312.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":312.31}]}]},{"description":"Upr/l xtremity art 2 levels","code_information":[{"code":"93922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.83,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Upr/lxtr art stdy 3+ lvls","code_information":[{"code":"93923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.71,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Lwr xtr vasc stdy bilat","code_information":[{"code":"93924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":220.65,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Lower extremity study","code_information":[{"code":"93925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":324.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv infus each addl seq","code_information":[{"code":"96417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.30,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Chemo ia push tecnique","code_information":[{"code":"96420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.4,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemo ia infusion up to 1 hr","code_information":[{"code":"96422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.83,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemo ia infuse each addl hr","code_information":[{"code":"96423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.22,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy infusion method","code_information":[{"code":"96425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.23,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy intracavitary","code_information":[{"code":"96440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":221.24,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":221.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemotx admn prtl cavity","code_information":[{"code":"96446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.14,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy into cns","code_information":[{"code":"96450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.25,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Refill/maint portable pump","code_information":[{"code":"96521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.47,"maximum":1109.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":355.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":191.47},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":987.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.54,"additional_payer_notes":"APC"}]}]},{"description":"Refill/maint pump/resvr syst","code_information":[{"code":"96522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":181.73,"maximum":1109.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":355.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":987.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.54,"additional_payer_notes":"APC"}]}]},{"description":"Irrig drug delivery device","code_information":[{"code":"96523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.06,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy injection","code_information":[{"code":"96542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.27,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Photodynamic tx skin","code_information":[{"code":"96567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.18,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Photodynmc tx 30 min add-on","code_information":[{"code":"96570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.95,"maximum":87.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87.95}]}]},{"description":"Photodynamic tx addl 15 min","code_information":[{"code":"96571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.54,"maximum":40.54,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.54}]}]},{"description":"Pdt dstr prmlg les phys/qhp","code_information":[{"code":"96573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":357.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Dbrdmt prmlg les w/pdt","code_information":[{"code":"96574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Ultraviolet light therapy","code_information":[{"code":"96900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Trichogram","code_information":[{"code":"96902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.33,"maximum":32.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.33}]}]},{"description":"Photochemotherapy with UV-B","code_information":[{"code":"96910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy with UV-A","code_information":[{"code":"96912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy uv-a or b","code_information":[{"code":"96913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":245.03,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Laser tx skin < 250 sq cm","code_information":[{"code":"96920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.1,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Laser tx skin 250-500 sq cm","code_information":[{"code":"96921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.55,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Laser tx skin >500 sq cm","code_information":[{"code":"96922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":151.72,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Rcm celulr subcelulr img skn","code_information":[{"code":"96931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":271.78,"maximum":271.78,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.78}]}]},{"description":"Rcm celulr subcelulr img skn","code_information":[{"code":"96932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.16,"maximum":201.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.16}]}]},{"description":"Rcm celulr subcelulr img skn","code_information":[{"code":"96933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.62,"maximum":70.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.62}]}]},{"description":"Rcm celulr subcelulr img skn","code_information":[{"code":"96934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.07,"maximum":192.07,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.07}]}]},{"description":"Rcm celulr subcelulr img skn","code_information":[{"code":"96935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.65,"maximum":123.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":123.65}]}]},{"description":"Rcm celulr subcelulr img skn","code_information":[{"code":"96936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.43,"maximum":68.43,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.43}]}]},{"description":"Hot or cold packs therapy","code_information":[{"code":"97010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.88,"maximum":10.88,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.88}]}]},{"description":"Mechanical traction therapy","code_information":[{"code":"97012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.3,"maximum":66.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.89,"additional_payer_notes":"APC"}]}]},{"description":"Electric stimulation therapy","code_information":[{"code":"97014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.75,"maximum":20.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.75}]}]},{"description":"Vasopneumatic device therapy","code_information":[{"code":"97016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.95,"maximum":55.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55.9,"additional_payer_notes":"APC"}]}]},{"description":"Paraffin bath therapy","code_information":[{"code":"97018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.94,"maximum":27.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27.78,"additional_payer_notes":"APC"}]}]},{"description":"Whirlpool therapy","code_information":[{"code":"97022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.58,"maximum":72.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.58,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.37,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.88,"additional_payer_notes":"APC"}]}]},{"description":"Diathermy eg microwave","code_information":[{"code":"97024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.26,"maximum":33.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33.96,"additional_payer_notes":"APC"}]}]},{"description":"Infrared therapy","code_information":[{"code":"97026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.6,"maximum":30.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.87,"additional_payer_notes":"APC"}]}]},{"description":"Ultraviolet therapy","code_information":[{"code":"97028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.27,"maximum":38.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38.68,"additional_payer_notes":"APC"}]}]},{"description":"Electrical stimulation","code_information":[{"code":"97032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.63,"maximum":68.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.43,"additional_payer_notes":"APC"}]}]},{"description":"Electric current therapy","code_information":[{"code":"97033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.93,"maximum":88.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88.55,"additional_payer_notes":"APC"}]}]},{"description":"Contrast bath therapy","code_information":[{"code":"97034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.95,"maximum":65.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65.25,"additional_payer_notes":"APC"}]}]},{"description":"Ultrasound therapy","code_information":[{"code":"97035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.28,"maximum":66.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.79,"additional_payer_notes":"APC"}]}]},{"description":"Hydrotherapy","code_information":[{"code":"97036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.45,"maximum":161.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161.14,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic exercises","code_information":[{"code":"97110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.94,"maximum":135.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":120.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135.37,"additional_payer_notes":"APC"}]}]},{"description":"Neuromuscular reeducation","code_information":[{"code":"97112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.59,"maximum":152.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":135.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152.44,"additional_payer_notes":"APC"}]}]},{"description":"Aquatic therapy/exercises","code_information":[{"code":"97113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.87,"maximum":172.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":153.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172.46,"additional_payer_notes":"APC"}]}]},{"description":"Gait training therapy","code_information":[{"code":"97116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.94,"maximum":135.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":120.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135.37,"additional_payer_notes":"APC"}]}]},{"description":"Massage therapy","code_information":[{"code":"97124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.54,"maximum":138.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.54,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":123.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138.17,"additional_payer_notes":"APC"}]}]},{"description":"Ther ivntj 1st 15 min","code_information":[{"code":"97129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.72,"maximum":92.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":82.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92.24,"additional_payer_notes":"APC"}]}]},{"description":"Ther ivntj ea addl 15 min","code_information":[{"code":"97130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.42,"maximum":86.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.13},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.16,"additional_payer_notes":"APC"}]}]},{"description":"Manual therapy 1/> regions","code_information":[{"code":"97140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.6,"maximum":129.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":114.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129.1,"additional_payer_notes":"APC"}]}]},{"description":"Group therapeutic procedures","code_information":[{"code":"97150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.95,"maximum":83.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.96,"additional_payer_notes":"APC"}]}]},{"description":"Pt eval low complex 20 min","code_information":[{"code":"97161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.53,"maximum":456.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":146.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":406.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":456.2,"additional_payer_notes":"APC"}]}]},{"description":"Pt eval mod complex 30 min","code_information":[{"code":"97162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.53,"maximum":456.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":146.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":406.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":456.2,"additional_payer_notes":"APC"}]}]},{"description":"Pt eval high complex 45 min","code_information":[{"code":"97163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.53,"maximum":456.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":146.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.66},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":406.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":456.2,"additional_payer_notes":"APC"}]}]},{"description":"Pt re-eval est plan care","code_information":[{"code":"97164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.18,"maximum":314.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":279.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":314.23,"additional_payer_notes":"APC"}]}]},{"description":"Ot eval low complex 30 min","code_information":[{"code":"97165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.17,"maximum":468.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":150.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":417.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":468.55,"additional_payer_notes":"APC"}]}]},{"description":"Ot eval mod complex 45 min","code_information":[{"code":"97166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.17,"maximum":468.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":150.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":417.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":468.55,"additional_payer_notes":"APC"}]}]},{"description":"Ot eval high complex 60 min","code_information":[{"code":"97167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.17,"maximum":468.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":150.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":417.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":468.55,"additional_payer_notes":"APC"}]}]},{"description":"Ot re-eval est plan care","code_information":[{"code":"97168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.17,"maximum":318.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":102.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":283.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":318.87,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic activities","code_information":[{"code":"97530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.87,"maximum":163.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163.1,"additional_payer_notes":"APC"}]}]},{"description":"Sensory Integration","code_information":[{"code":"97533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.3,"maximum":282.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.83},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":251.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":282.05,"additional_payer_notes":"APC"}]}]},{"description":"Self care mngment training","code_information":[{"code":"97535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.24,"maximum":150.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.36,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.8,"additional_payer_notes":"APC"}]}]},{"description":"Community/work reintegration","code_information":[{"code":"97537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.92,"maximum":149.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":132.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149.31,"additional_payer_notes":"APC"}]}]},{"description":"Wheelchair mngment training","code_information":[{"code":"97542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.93,"maximum":144.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":128.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144.68,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl devital tis 20 cm/<","code_information":[{"code":"97597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.55,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.55},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl devital tis addl 20cm/<","code_information":[{"code":"97598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.39,"maximum":39.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.39}]}]},{"description":"Neg press wound tx <=50 cm","code_information":[{"code":"97605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.08,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wound tx >50 cm","code_information":[{"code":"97606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.39,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Physical performance test","code_information":[{"code":"97750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.56,"maximum":156.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.56,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156.98,"additional_payer_notes":"APC"}]}]},{"description":"Assistive technology assess","code_information":[{"code":"97755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.61,"maximum":175.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":156.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":175.92,"additional_payer_notes":"APC"}]}]},{"description":"Orthotic mgmt and training","code_information":[{"code":"97760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.79,"maximum":214.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":190.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214.18,"additional_payer_notes":"APC"}]}]},{"description":"Prosthetic training","code_information":[{"code":"97761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.18,"maximum":187.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.22},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":167.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":187.94,"additional_payer_notes":"APC"}]}]},{"description":"Orthc/prostc mgmt sbsq enc","code_information":[{"code":"97763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.74,"maximum":232.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":207.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":232.66,"additional_payer_notes":"APC"}]}]},{"description":"Synch audio-video new sf 15","code_information":[{"code":"98000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.95,"maximum":73.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.95}]}]},{"description":"Synch audio-video new low 30","code_information":[{"code":"98001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.61,"maximum":127.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.61}]}]},{"description":"Synch audio-video new mod 45","code_information":[{"code":"98002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.03,"maximum":207.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.03}]}]},{"description":"Synch audio-video new hi 60","code_information":[{"code":"98003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.25,"maximum":278.25,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.25}]}]},{"description":"Synch audio-video est sf 10","code_information":[{"code":"98004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.34,"maximum":55.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.34}]}]},{"description":"Synch audio-video est low 20","code_information":[{"code":"98005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.99,"maximum":102.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.99}]}]},{"description":"Synch audio-video est mod 30","code_information":[{"code":"98006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.33,"maximum":153.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.33}]}]},{"description":"Synch audio-video est hi 40","code_information":[{"code":"98007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.03,"maximum":207.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.03}]}]},{"description":"Synch audio-only new sf 15","code_information":[{"code":"98008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.69,"maximum":70.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.69}]}]},{"description":"Synch audio-only new low 30","code_information":[{"code":"98009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.73,"maximum":122.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.73}]}]},{"description":"Synch audio-only new mod 45","code_information":[{"code":"98010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.3,"maximum":193.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.3}]}]},{"description":"Synch audio-only new high 60","code_information":[{"code":"98011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.17,"maximum":254.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.17}]}]},{"description":"Synch audio-only est sf 10","code_information":[{"code":"98012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.03,"maximum":52.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.03}]}]},{"description":"Synch audio-only est low 20","code_information":[{"code":"98013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.8,"maximum":94.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.8}]}]},{"description":"Polysom <6 yrs cpap/bilvl","code_information":[{"code":"95783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1461.32},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Slp stdy unattended","code_information":[{"code":"95800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.38,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.38},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Multiple sleep latency test","code_information":[{"code":"95805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.25,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":622.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Sleep study unatt&resp efft","code_information":[{"code":"95806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.17,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Sleep study attended","code_information":[{"code":"95807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":579.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Polysom any age 1-3> param","code_information":[{"code":"95808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":667.19,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":667.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Polysom 6/> yrs 4/> param","code_information":[{"code":"95810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":831.48,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":831.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Polysom 6/>yrs cpap 4/> parm","code_information":[{"code":"95811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.63,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":871.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Eeg 41-60 minutes","code_information":[{"code":"95812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":474.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Eeg over 1 hour","code_information":[{"code":"95813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":584.48},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Eeg awake and drowsy","code_information":[{"code":"95816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":540.03},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Eeg awake and asleep","code_information":[{"code":"95819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":643.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Eeg coma or sleep only","code_information":[{"code":"95822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":588.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Surgery electrocorticogram","code_information":[{"code":"95829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2304.48,"maximum":2304.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2304.48}]}]},{"description":"Ecog impltd brn npgt <=30 d","code_information":[{"code":"95836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":172.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Range of motion measurements","code_information":[{"code":"95852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.98,"maximum":23.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.29,"additional_payer_notes":"APC"}]}]},{"description":"Cholinesterase challenge","code_information":[{"code":"95857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.96,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test one limb","code_information":[{"code":"95860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.68,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 2 limbs","code_information":[{"code":"95861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.99,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 3 limbs","code_information":[{"code":"95863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 4 limbs","code_information":[{"code":"95864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test larynx","code_information":[{"code":"95865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.73,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test hemidiaphragm","code_information":[{"code":"95866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.26,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test cran nerv unilat","code_information":[{"code":"95867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.92,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test cran nerve bilat","code_information":[{"code":"95868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.19,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test thor paraspinal","code_information":[{"code":"95869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.02,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.02},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test nonparaspinal","code_information":[{"code":"95870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.68,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Guide nerv destr elec stim","code_information":[{"code":"95873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.72,"maximum":79.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.72}]}]},{"description":"Guide nerv destr needle emg","code_information":[{"code":"95874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.38,"maximum":88.38,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.38}]}]},{"description":"Limb exercise test","code_information":[{"code":"95875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.92,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Musc tst done w/nerv tst lim","code_information":[{"code":"95885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.79,"maximum":67.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.79}]}]},{"description":"Musc test done w/n test comp","code_information":[{"code":"95886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.72,"maximum":79.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.72}]}]},{"description":"Musc tst done w/n tst nonext","code_information":[{"code":"95887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.21,"maximum":73.21,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.21}]}]},{"description":"Motor &/ sens nrve cndj test","code_information":[{"code":"95905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Nvr cndj tst 1-2 studies","code_information":[{"code":"95907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.62,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj tst 3-4 studies","code_information":[{"code":"95908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.27,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj tst 5-6 studies","code_information":[{"code":"95909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":89.45,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 7-8 studies","code_information":[{"code":"95910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.85,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.85},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 9-10 studies","code_information":[{"code":"95911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.49,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 11-12 studies","code_information":[{"code":"95912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.12,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.12},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 13/> studies","code_information":[{"code":"95913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.72,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.72},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Quan puplmtry phy/qhp uni/bi","code_information":[{"code":"95919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.28,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv parasym inervj","code_information":[{"code":"95921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.93,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv adrenrg inervj","code_information":[{"code":"95922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.53,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv syst funj test","code_information":[{"code":"95923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.37,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Ans parasymp & symp w/tilt","code_information":[{"code":"95924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.9,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":205.46,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.94,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"C motor evoked uppr limbs","code_information":[{"code":"95928","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":258.62,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"C motor evoked lwr limbs","code_information":[{"code":"95929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.24,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Visual evoked potential test","code_information":[{"code":"95930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.07,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Blink reflex test","code_information":[{"code":"95933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Neuromuscular junction test","code_information":[{"code":"95937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.06,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.06},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":533.53,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":533.53},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"C motor evoked upr&lwr limbs","code_information":[{"code":"95939","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.11,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.11},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Ionm in operatng room 15 min","code_information":[{"code":"95940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.53,"maximum":52.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.53}]}]},{"description":"EEG digital analysis","code_information":[{"code":"95957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.63,"maximum":310.63,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.63}]}]},{"description":"Electrode stimulation brain","code_information":[{"code":"95961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.97,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.97},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Electrode stim brain add-on","code_information":[{"code":"95962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":181.09,"maximum":181.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.09}]}]},{"description":"Analyze neurostim no prog","code_information":[{"code":"95970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.08,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Analyze neurostim simple","code_information":[{"code":"95971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.96,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Analyze neurostim complex","code_information":[{"code":"95972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.58,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Alys smpl cn npgt prgrmg","code_information":[{"code":"95976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.75},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Alys cplx cn npgt prgrmg","code_information":[{"code":"95977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.52,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Io anal gast n-stim init","code_information":[{"code":"95980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.0,"maximum":73.0,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.0}]}]},{"description":"Io anal gast n-stim subsq","code_information":[{"code":"95981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.9,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Io ga n-stim subsq w/reprog","code_information":[{"code":"95982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Alys brn npgt prgrmg 15 min","code_information":[{"code":"95983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.29,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.29},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Alys brn npgt prgrmg addl 15","code_information":[{"code":"95984","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.98,"maximum":69.98,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.98}]}]},{"description":"Spin/brain pump refil & main","code_information":[{"code":"95990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":141.44,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141.44},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Spin/brain pump refil & main","code_information":[{"code":"95991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.96,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Canalith repositioning proc","code_information":[{"code":"95992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.73,"maximum":139.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":123.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139.06,"additional_payer_notes":"APC"}]}]},{"description":"Genetic counseling svc ea 30","code_information":[{"code":"96041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.97,"maximum":83.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.97}]}]},{"description":"Developmental screen w/score","code_information":[{"code":"96110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.97,"maximum":18.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.97}]}]},{"description":"Cognitive test by hc pro","code_information":[{"code":"96125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.49,"maximum":479.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":153.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":168.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":426.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":479.4,"additional_payer_notes":"APC"}]}]},{"description":"Brief emotional/behav assmt","code_information":[{"code":"96127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.57,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.57},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Psycl tst eval phys/qhp 1st","code_information":[{"code":"96130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.93,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.93},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Psycl tst eval phys/qhp ea","code_information":[{"code":"96131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.2,"maximum":123.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":123.2}]}]},{"description":"Nrpsyc tst eval phys/qhp 1st","code_information":[{"code":"96132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.59,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Nrpsyc tst eval phys/qhp ea","code_information":[{"code":"96133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.75,"maximum":123.75,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":123.75}]}]},{"description":"Psycl/nrpsyc tst phy/qhp 1st","code_information":[{"code":"96136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.4,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.4},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Psycl/nrpsyc tst phy/qhp ea","code_information":[{"code":"96137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.16,"maximum":29.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.16}]}]},{"description":"Psycl/nrpsyc tst auto result","code_information":[{"code":"96146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.78,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Hlth bhv assmt/reassessment","code_information":[{"code":"96156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.29,"maximum":529.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.29,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":169.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":471.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":529.93,"additional_payer_notes":"APC"}]}]},{"description":"Hlth bhv ivntj indiv 1st 30","code_information":[{"code":"96158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.16,"maximum":925.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.16},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":925.88,"additional_payer_notes":"APC"}]}]},{"description":"Hlth bhv ivntj indiv ea addl","code_information":[{"code":"96159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.65,"maximum":34.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.65}]}]},{"description":"Pt-focused hlth risk assmt","code_information":[{"code":"96160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.88,"maximum":195.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":174.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.45,"additional_payer_notes":"APC"}]}]},{"description":"Caregiver health risk assmt","code_information":[{"code":"96161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.88,"maximum":195.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.88},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":174.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.45,"additional_payer_notes":"APC"}]}]},{"description":"Hlth bhv ivntj grp 1st 30","code_information":[{"code":"96164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.92,"maximum":195.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":174.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.45,"additional_payer_notes":"APC"}]}]},{"description":"Hlth bhv ivntj grp ea addl","code_information":[{"code":"96165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.16,"maximum":7.16,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.16}]}]},{"description":"Hlth bhv ivntj fam 1st 30","code_information":[{"code":"96167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.78,"maximum":195.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":174.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.45,"additional_payer_notes":"APC"}]}]},{"description":"Hlth bhv ivntj fam ea addl","code_information":[{"code":"96168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.46,"maximum":38.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.46}]}]},{"description":"Hlth bhv ivntj fam wo pt 1st","code_information":[{"code":"96170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.87,"maximum":118.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.87}]}]},{"description":"Hlth bhv ivntj fam w/o pt ea","code_information":[{"code":"96171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.72,"maximum":42.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.72}]}]},{"description":"Hydration iv infusion init","code_information":[{"code":"96360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.56,"maximum":1109.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":355.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":987.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.54,"additional_payer_notes":"APC"}]}]},{"description":"Hydrate iv infusion add-on","code_information":[{"code":"96361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.59,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.59},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag iv inf init","code_information":[{"code":"96365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.18,"maximum":1109.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":355.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":987.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.54,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag iv inf addon","code_information":[{"code":"96366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.68,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.68},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Tx/proph/dg addl seq iv inf","code_information":[{"code":"96367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.61,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Ther/diag concurrent inf","code_information":[{"code":"96368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.04,"maximum":31.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.04}]}]},{"description":"Sc ther infusion up to 1 hr","code_information":[{"code":"96369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.19,"maximum":1109.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":355.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":987.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.54,"additional_payer_notes":"APC"}]}]},{"description":"Sc ther infusion addl hr","code_information":[{"code":"96370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.71,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.71},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Sc ther infusion reset pump","code_information":[{"code":"96371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.30,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj sc/im","code_information":[{"code":"96372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.45,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.45},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj iv push","code_information":[{"code":"96374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.05,"maximum":1109.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":355.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":987.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.54,"additional_payer_notes":"APC"}]}]},{"description":"Tx/pro/dx inj new drug addon","code_information":[{"code":"96375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.94,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.94},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Admn rsv monoc antb im cnsl","code_information":[{"code":"96380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.61,"maximum":37.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.61}]}]},{"description":"1 admn rsv monoc antb im njx","code_information":[{"code":"96381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.13,"maximum":32.13,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.13}]}]},{"description":"Chemo anti-neopl sq/im","code_information":[{"code":"96401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.30,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Chemo hormon antineopl sq/im","code_information":[{"code":"96402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.7,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Chemo intralesional up to 7","code_information":[{"code":"96405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.04,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Chemo intralesional over 7","code_information":[{"code":"96406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.24,"maximum":1109.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":355.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.24},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":987.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.54,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv push sngl drug","code_information":[{"code":"96409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.19,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv push addl drug","code_information":[{"code":"96411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.30,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv infusion 1 hr","code_information":[{"code":"96413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.21,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200.21},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv infusion addl hr","code_information":[{"code":"96415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.99,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.99},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Chemo prolong infuse w/pump","code_information":[{"code":"96416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.92,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Behav chng smoking > 10 min","code_information":[{"code":"99407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.49,"maximum":195.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":174.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.45,"additional_payer_notes":"APC"}]}]},{"description":"Audit/dast 15-30 min","code_information":[{"code":"99408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.03,"maximum":52.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.03}]}]},{"description":"Audit/dast over 30 min","code_information":[{"code":"99409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.99,"maximum":102.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.99}]}]},{"description":"Prolong clincl staff svc","code_information":[{"code":"99415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.59,"maximum":33.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.59}]}]},{"description":"Prolong clincl staff svc add","code_information":[{"code":"99416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.69,"maximum":15.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.69}]}]},{"description":"Prolng ip/obs e/m ea 15 min","code_information":[{"code":"99418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.1,"maximum":64.1,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.1}]}]},{"description":"Chrnc care mgmt svc ea addl","code_information":[{"code":"99439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.87,"maximum":55.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.87}]}]},{"description":"Rem physiol mntr 20 min mo","code_information":[{"code":"99457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.73,"maximum":48.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.73}]}]},{"description":"Rem physiol mntr ea addl 20","code_information":[{"code":"99458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.73,"maximum":48.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.73}]}]},{"description":"Pelvic examination","code_information":[{"code":"99459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.71,"maximum":34.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.71}]}]},{"description":"Init nb em per day hosp","code_information":[{"code":"99460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Init nb em per day non-fac","code_information":[{"code":"99461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.59,"maximum":98.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.59}]}]},{"description":"Sbsq nb em per day hosp","code_information":[{"code":"99462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.2,"maximum":65.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.2}]}]},{"description":"Same day nb discharge","code_information":[{"code":"99463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.67},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Attendance at delivery","code_information":[{"code":"99464","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.2,"maximum":117.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.2}]}]},{"description":"Nb resuscitation","code_information":[{"code":"99465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.46,"maximum":3447.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1105.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.46},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":751.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3069.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3447.72,"additional_payer_notes":"APC"}]}]},{"description":"Ped crit care transport","code_information":[{"code":"99466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.61,"maximum":374.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.61}]}]},{"description":"Ped crit care transport addl","code_information":[{"code":"99467","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":187.87,"maximum":187.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.87}]}]},{"description":"Neonate crit care initial","code_information":[{"code":"99468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1444.2,"maximum":1444.2,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1444.2}]}]},{"description":"Neonate crit care subsq","code_information":[{"code":"99469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":624.89,"maximum":624.89,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":624.89}]}]},{"description":"Ped critical care initial","code_information":[{"code":"99471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1250.3,"maximum":1250.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1250.3}]}]},{"description":"Ped critical care subsq","code_information":[{"code":"99472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":648.69,"maximum":648.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":648.69}]}]},{"description":"Self-meas bp pt educaj/train","code_information":[{"code":"99473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.28,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.28},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Self-meas bp 2 readg bid 30d","code_information":[{"code":"99474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.24,"maximum":14.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.24}]}]},{"description":"Ped crit care age 2-5 init","code_information":[{"code":"99475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":907.97,"maximum":907.97,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":907.97}]}]},{"description":"Ped crit care age 2-5 subsq","code_information":[{"code":"99476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":550.46,"maximum":550.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":550.46}]}]},{"description":"Init day hosp neonate care","code_information":[{"code":"99477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.18,"maximum":548.18,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":548.18}]}]},{"description":"Ic lbw inf < 1500 gm subsq","code_information":[{"code":"99478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.72,"maximum":214.72,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.72}]}]},{"description":"Ic lbw inf 1500-2500 g subsq","code_information":[{"code":"99479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.99,"maximum":194.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.99}]}]},{"description":"Ic inf pbw 2501-5000 g subsq","code_information":[{"code":"99480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":187.87,"maximum":187.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.87}]}]},{"description":"Suprv interfacilty transport","code_information":[{"code":"99485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.87,"maximum":118.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.87}]}]},{"description":"Suprv interfac trnsport addl","code_information":[{"code":"99486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.99,"maximum":102.99,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.99}]}]},{"description":"Chron care mgmt srvc 20 min","code_information":[{"code":"99490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.05,"maximum":529.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.29,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":169.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.05},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":471.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":529.93,"additional_payer_notes":"APC"}]}]},{"description":"Colorectal scrn; hi risk ind","code_information":[{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.2,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Colon ca scrn not hi rsk ind","code_information":[{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.7,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Iv cipaglucosidase alfa-atga","code_information":[{"code":"G0138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":288.6,"maximum":3321.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":710.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1065.09,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":724.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2956.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3321.3,"additional_payer_notes":"APC"}]}]},{"description":"Provide INR test mater/equip","code_information":[{"code":"G0249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.92,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"MD INR test revie inter mgmt","code_information":[{"code":"G0250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.24,"maximum":14.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.24}]}]},{"description":"Synch audio-only est mod 30","code_information":[{"code":"98014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.17,"maximum":140.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.17}]}]},{"description":"Synch audio-only est high 40","code_information":[{"code":"98015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.03,"maximum":207.03,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.03}]}]},{"description":"Osteopath manj 1-2 regions","code_information":[{"code":"98925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":112.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.63,"additional_payer_notes":"APC"}]}]},{"description":"Osteopath manj 3-4 regions","code_information":[{"code":"98926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":112.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.63,"additional_payer_notes":"APC"}]}]},{"description":"Osteopath manj 5-6 regions","code_information":[{"code":"98927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":112.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.63,"additional_payer_notes":"APC"}]}]},{"description":"Osteopath manj 7-8 regions","code_information":[{"code":"98928","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":112.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.8},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.63,"additional_payer_notes":"APC"}]}]},{"description":"Osteopath manj 9-10 regions","code_information":[{"code":"98929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":112.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.9},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.63,"additional_payer_notes":"APC"}]}]},{"description":"Chiropract manj 1-2 regions","code_information":[{"code":"98940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":112.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.63,"additional_payer_notes":"APC"}]}]},{"description":"Chiropract manj 3-4 regions","code_information":[{"code":"98941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":112.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.63,"additional_payer_notes":"APC"}]}]},{"description":"Chiropractic manj 5 regions","code_information":[{"code":"98942","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":112.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.63,"additional_payer_notes":"APC"}]}]},{"description":"Chiropract manj xtrspinl 1/>","code_information":[{"code":"98943","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.7,"maximum":36.7,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.7}]}]},{"description":"Self-mgmt educ & train 1 pt","code_information":[{"code":"98960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.92,"maximum":50.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.92}]}]},{"description":"Hc pro phone call 5-10 min","code_information":[{"code":"98966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.34,"maximum":48.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.37,"additional_payer_notes":"APC"}]}]},{"description":"Hc pro phone call 11-20 min","code_information":[{"code":"98967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.02,"maximum":93.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.64,"additional_payer_notes":"APC"}]}]},{"description":"Hc pro phone call 21-30 min","code_information":[{"code":"98968","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.08,"maximum":136.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.17},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136.02,"additional_payer_notes":"APC"}]}]},{"description":"Rem ther mntr 1st setup&edu","code_information":[{"code":"98975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.04,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Rem ther mntr dev sply resp","code_information":[{"code":"98976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem ther mntr dv sply mscskl","code_information":[{"code":"98977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem ther mntr 1st 20 min","code_information":[{"code":"98980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.67,"maximum":120.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.84},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":106.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120.07,"additional_payer_notes":"APC"}]}]},{"description":"Rem ther mntr ea addl 20 min","code_information":[{"code":"98981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.34,"maximum":118.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.01,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.73},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":105.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118.53,"additional_payer_notes":"APC"}]}]},{"description":"Mod sed same phys/qhp <5 yrs","code_information":[{"code":"99151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.9,"maximum":38.9,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.9}]}]},{"description":"Mod sed same phys/qhp 5/>yrs","code_information":[{"code":"99152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.69,"maximum":19.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.69}]}]},{"description":"Mod sed same phys/qhp ea","code_information":[{"code":"99153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.47,"maximum":19.47,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.47}]}]},{"description":"Mod sed oth phys/qhp <5 yrs","code_information":[{"code":"99155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.68,"maximum":134.68,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.68}]}]},{"description":"Mod sed oth phys/qhp 5/>yrs","code_information":[{"code":"99156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.46,"maximum":120.46,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.46}]}]},{"description":"Mod sed other phys/qhp ea","code_information":[{"code":"99157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.59,"maximum":93.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.59}]}]},{"description":"Anogenital exam child w imag","code_information":[{"code":"99170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.43,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Visual acuity screen","code_information":[{"code":"99173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.4,"maximum":5.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.4}]}]},{"description":"Ocular instrumnt screen bil","code_information":[{"code":"99174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.28,"maximum":10.28,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.28}]}]},{"description":"Induction of vomiting","code_information":[{"code":"99175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.79,"maximum":48.79,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.79}]}]},{"description":"Ocular instrumnt screen bil","code_information":[{"code":"99177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.11,"maximum":8.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.11}]}]},{"description":"Hyperbaric oxygen therapy","code_information":[{"code":"99183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":172.69,"maximum":172.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":172.69}]}]},{"description":"Hypothermia ill neonate","code_information":[{"code":"99184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":347.31,"maximum":347.31,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":347.31}]}]},{"description":"Phlebotomy","code_information":[{"code":"99195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":145.77,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.77},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Office/outpatient visit new","code_information":[{"code":"99202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.62,"maximum":76.62,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.62}]}]},{"description":"Office/outpatient visit new","code_information":[{"code":"99203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.96,"maximum":133.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.96}]}]},{"description":"Office/outpatient visit new","code_information":[{"code":"99204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.24,"maximum":218.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.24}]}]},{"description":"Office/outpatient visit new","code_information":[{"code":"99205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.92,"maximum":296.92,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.92}]}]},{"description":"Office/outpatient visit est","code_information":[{"code":"99211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.24,"maximum":14.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.24}]}]},{"description":"Office/outpatient visit est","code_information":[{"code":"99212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.48,"maximum":57.48,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.48}]}]},{"description":"Office/outpatient visit est","code_information":[{"code":"99213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.8,"maximum":107.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.8}]}]},{"description":"Office/outpatient visit est","code_information":[{"code":"99214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.69,"maximum":158.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158.69}]}]},{"description":"Office/outpatient visit est","code_information":[{"code":"99215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.74,"maximum":234.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.74}]}]},{"description":"Initial hospital care","code_information":[{"code":"99221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.53,"maximum":134.53,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.53}]}]},{"description":"Initial hospital care","code_information":[{"code":"99222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":212.3,"maximum":212.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":212.3}]}]},{"description":"Initial hospital care","code_information":[{"code":"99223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.96,"maximum":282.96,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.96}]}]},{"description":"Subsequent hospital care","code_information":[{"code":"99231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.91,"maximum":79.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.91}]}]},{"description":"Subsequent hospital care","code_information":[{"code":"99232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.15,"maximum":129.15,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.15}]}]},{"description":"Subsequent hospital care","code_information":[{"code":"99233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.71,"maximum":192.71,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.71}]}]},{"description":"Observ/hosp same date","code_information":[{"code":"99234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.74,"maximum":158.74,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158.74}]}]},{"description":"Observ/hosp same date","code_information":[{"code":"99235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":258.4,"maximum":258.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.4}]}]},{"description":"Observ/hosp same date","code_information":[{"code":"99236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":337.81,"maximum":337.81,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":337.81}]}]},{"description":"Hospital discharge day","code_information":[{"code":"99238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.34,"maximum":132.34,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.34}]}]},{"description":"Hospital discharge day","code_information":[{"code":"99239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":187.09,"maximum":187.09,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.09}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.61,"maximum":439.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":141.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.61},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":391.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":439.86,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.41,"maximum":800.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":256.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.41},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":713.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":800.94,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.52,"maximum":1423.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":304.43,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":456.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.52},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1267.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1423.95,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.09,"maximum":2176.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":465.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":698.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.09},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":474.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1937.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2176.59,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.78,"maximum":3106.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":664.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":996.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":285.78},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":677.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2765.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3106.5,"additional_payer_notes":"APC"}]}]},{"description":"Critical care first hour","code_information":[{"code":"99291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":348.04,"maximum":4308.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":921.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1381.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":348.04},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":939.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3835.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4308.86,"additional_payer_notes":"APC"}]}]},{"description":"Critical care addl 30 min","code_information":[{"code":"99292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.04,"maximum":174.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.04}]}]},{"description":"Nursing facility care init","code_information":[{"code":"99304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.27,"maximum":131.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.27}]}]},{"description":"Nursing facility care init","code_information":[{"code":"99305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.24,"maximum":217.24,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.24}]}]},{"description":"Nursing facility care init","code_information":[{"code":"99306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":296.65,"maximum":296.65,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":296.65}]}]},{"description":"Nursing fac care subseq","code_information":[{"code":"99307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.08,"maximum":65.08,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.08}]}]},{"description":"Nursing fac care subseq","code_information":[{"code":"99308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.4,"maximum":121.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.4}]}]},{"description":"Nursing fac care subseq","code_information":[{"code":"99309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.11,"maximum":176.11,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.11}]}]},{"description":"Nursing fac care subseq","code_information":[{"code":"99310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.04,"maximum":251.04,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.04}]}]},{"description":"Home visit new patient","code_information":[{"code":"99341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.55,"maximum":80.55,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.55}]}]},{"description":"Home visit new patient","code_information":[{"code":"99342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.27,"maximum":128.27,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.27}]}]},{"description":"Home visit new patient","code_information":[{"code":"99344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.69,"maximum":231.69,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.69}]}]},{"description":"Home visit new patient","code_information":[{"code":"99345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.84,"maximum":327.84,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":327.84}]}]},{"description":"Home visit est patient","code_information":[{"code":"99347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.95,"maximum":73.95,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.95}]}]},{"description":"Home visit est patient","code_information":[{"code":"99348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.39,"maximum":125.39,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.39}]}]},{"description":"Home visit est patient","code_information":[{"code":"99349","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.42,"maximum":207.42,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.42}]}]},{"description":"Home visit est patient","code_information":[{"code":"99350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.06,"maximum":301.06,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.06}]}]},{"description":"Physician standby services","code_information":[{"code":"99360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.8,"maximum":94.8,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.8}]}]},{"description":"Init pm e/m new pat infant","code_information":[{"code":"99381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.87,"maximum":118.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.87}]}]},{"description":"Init pm e/m new pat 1-4 yrs","code_information":[{"code":"99382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.61,"maximum":127.61,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.61}]}]},{"description":"Prev visit new age 5-11","code_information":[{"code":"99383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.29,"maximum":135.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.29}]}]},{"description":"Prev visit new age 12-17","code_information":[{"code":"99384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.91,"maximum":159.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.91}]}]},{"description":"Prev visit new age 18-39","code_information":[{"code":"99385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.33,"maximum":153.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.33}]}]},{"description":"Prev visit new age 40-64","code_information":[{"code":"99386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.64,"maximum":185.64,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.64}]}]},{"description":"Init pm e/m new pat 65+ yrs","code_information":[{"code":"99387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":199.33,"maximum":199.33,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.33}]}]},{"description":"Per pm reeval est pat infant","code_information":[{"code":"99391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.49,"maximum":108.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.49}]}]},{"description":"Prev visit est age 1-4","code_information":[{"code":"99392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.87,"maximum":118.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.87}]}]},{"description":"Prev visit est age 5-11","code_information":[{"code":"99393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.87,"maximum":118.87,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.87}]}]},{"description":"Prev visit est age 12-17","code_information":[{"code":"99394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.29,"maximum":135.29,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.29}]}]},{"description":"Prev visit est age 18-39","code_information":[{"code":"99395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.17,"maximum":140.17,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.17}]}]},{"description":"Prev visit est age 40-64","code_information":[{"code":"99396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":152.22,"maximum":152.22,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.22}]}]},{"description":"Per pm reeval est pat 65+ yr","code_information":[{"code":"99397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.91,"maximum":159.91,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.91}]}]},{"description":"Behav chng smoking 3-10 min","code_information":[{"code":"99406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.14,"maximum":195.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":174.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.45,"additional_payer_notes":"APC"}]}]},{"description":"Tomosynthesis, mammo","code_information":[{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.49,"maximum":25.49,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.49}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":12.54,"maximum":58.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.54,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.66,"additional_payer_notes":"APC"}]}]},{"description":"Visit to determ ldct elig","code_information":[{"code":"G0296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.08,"maximum":529.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.29,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":169.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.08},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":471.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":529.93,"additional_payer_notes":"APC"}]}]},{"description":"Prostate biopsy, any mthd","code_information":[{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":314.43,"maximum":1869.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":599.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":314.43},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1664.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.78,"additional_payer_notes":"APC"}]}]},{"description":"Behavior counsel obesity 15m","code_information":[{"code":"G0447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.27,"maximum":529.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.29,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":169.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":471.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":529.93,"additional_payer_notes":"APC"}]}]},{"description":"Molecular pathology interpr","code_information":[{"code":"G0452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.4,"maximum":5.4,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.4}]}]},{"description":"Unrelat prac follow up visit","code_information":[{"code":"G0559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.73,"maximum":14.73,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.73}]}]},{"description":"Visit esketamine 56m or less","code_information":[{"code":"G2082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.89,"maximum":5363.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1146.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1720.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1169.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4774.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5363.61,"additional_payer_notes":"APC"}]}]},{"description":"Visit esketamine, > 56m","code_information":[{"code":"G2083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.89,"maximum":8427.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1801.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2702.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1837.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7502.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8427.08,"additional_payer_notes":"APC"}]}]},{"description":"Complex e/m visit add on","code_information":[{"code":"G2211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.3,"maximum":26.3,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.3}]}]},{"description":"Initiat med assist tx in er","code_information":[{"code":"G2213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.59,"maximum":93.59,"payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.59}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11953.38,"maximum":30211.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11953.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30211.14},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11953.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30211.14},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11953.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11953.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11953.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":236722.42,"10th_percentile":236722.42,"90th_percentile":236722.42},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":27697.31,"10th_percentile":27697.31,"90th_percentile":27697.31},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":44554.53,"10th_percentile":44554.53,"90th_percentile":44554.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9524.28,"10th_percentile":9524.28,"90th_percentile":9524.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12367.68,"10th_percentile":12367.68,"90th_percentile":22460.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":30399.03,"10th_percentile":30399.03,"90th_percentile":30399.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9343.58,"maximum":24850.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9530.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24850.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24850.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9530.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":55512.57,"10th_percentile":55512.57,"90th_percentile":55512.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7734.55,"10th_percentile":7734.55,"90th_percentile":7734.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17610.23,"maximum":44810.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17962.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44810.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44810.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17962.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9859.5,"maximum":25928.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9859.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25928.98},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9859.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25928.98},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9859.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9859.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10056.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9859.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6655.11,"maximum":18578.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6788.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18578.5},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18578.5},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6788.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18837.83,"maximum":46463.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18837.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19214.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46463.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18837.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46463.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18837.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18837.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19214.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18837.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20452.38,"maximum":50273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20452.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20861.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50273.22},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20452.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50273.22},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20452.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20452.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20861.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20452.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6613.86,"10th_percentile":1971.39,"90th_percentile":17049.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29449.01,"10th_percentile":29449.01,"90th_percentile":29449.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":57825.63,"10th_percentile":57825.63,"90th_percentile":57825.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":43369.75,"10th_percentile":43369.75,"90th_percentile":43369.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":701.04,"10th_percentile":701.04,"90th_percentile":701.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":17372.43,"10th_percentile":17372.43,"90th_percentile":17754.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7542.43,"maximum":17802.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17802.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17802.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":6754.84,"10th_percentile":6754.84,"90th_percentile":6754.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10228.15,"maximum":23939.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10228.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10432.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23939.63},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10228.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23939.63},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10228.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10228.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10432.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10228.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":4400.0,"10th_percentile":4400.0,"90th_percentile":4400.0},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9130.02,"10th_percentile":9130.02,"90th_percentile":9166.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":25226.16,"10th_percentile":25226.16,"90th_percentile":37468.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38335.87,"10th_percentile":21514.81,"90th_percentile":44455.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":977.96,"10th_percentile":977.96,"90th_percentile":977.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23239.63,"10th_percentile":22293.03,"90th_percentile":25068.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":21436.5,"10th_percentile":21436.5,"90th_percentile":21436.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9653.54,"10th_percentile":9653.54,"90th_percentile":9653.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":41499.11,"10th_percentile":41499.11,"90th_percentile":41499.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":8497.49,"10th_percentile":6414.72,"90th_percentile":10999.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17108.03,"maximum":40629.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17108.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17450.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40629.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17108.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40629.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17108.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17108.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17450.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17108.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":46924.28,"10th_percentile":46924.28,"90th_percentile":46924.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11469.66,"10th_percentile":11469.66,"90th_percentile":16941.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":37676.41,"10th_percentile":23119.7,"90th_percentile":120480.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17572.89,"10th_percentile":17572.89,"90th_percentile":17572.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20128.72,"10th_percentile":20128.72,"90th_percentile":59957.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":29515.28,"10th_percentile":29515.28,"90th_percentile":29515.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":84315.03,"10th_percentile":84315.03,"90th_percentile":84315.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13954.24,"10th_percentile":13954.24,"90th_percentile":13954.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":14533.84,"10th_percentile":14533.84,"90th_percentile":16723.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":132706.88,"10th_percentile":132706.88,"90th_percentile":132706.88},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18256.75,"10th_percentile":18256.75,"90th_percentile":18256.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7299.1,"maximum":24748.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24748.86},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24748.86},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10037.88,"maximum":27513.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27513.72},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27513.72},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8595.92,"10th_percentile":8595.92,"90th_percentile":8595.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24073.77,"10th_percentile":24073.77,"90th_percentile":24073.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":9068.52,"10th_percentile":9068.52,"90th_percentile":9068.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15450.49,"maximum":42450.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15450.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42450.7},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15450.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42450.7},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15450.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15450.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15450.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":49402.04,"10th_percentile":49402.04,"90th_percentile":49402.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":16661.12,"10th_percentile":16661.12,"90th_percentile":16661.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13206.1,"10th_percentile":13206.1,"90th_percentile":13206.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13675.86,"maximum":35403.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13949.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35403.68},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35403.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13949.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":23850.06,"10th_percentile":23850.06,"90th_percentile":23850.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":29405.67,"10th_percentile":29405.67,"90th_percentile":29405.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22161.14,"maximum":46496.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22161.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22604.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46496.83},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22161.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46496.83},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22161.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22161.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22604.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22161.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":58697.2,"10th_percentile":58697.2,"90th_percentile":58697.2},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35944.8,"10th_percentile":35944.8,"90th_percentile":35944.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41071.89,"maximum":94376.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41071.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41893.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":94376.09},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41071.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94376.09},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41071.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41071.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41893.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41071.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85530.47,"10th_percentile":85530.47,"90th_percentile":85530.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13191.96,"maximum":34358.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13455.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34358.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34358.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13455.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13191.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16278.35,"maximum":41203.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16278.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41203.14},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16278.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41203.14},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16278.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16278.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16278.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":54406.21,"10th_percentile":54406.21,"90th_percentile":54406.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":14755.41,"10th_percentile":14755.41,"90th_percentile":14755.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27434.71,"maximum":69256.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27434.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27983.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69256.34},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27434.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69256.34},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27434.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27434.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27983.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27434.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11571.01,"maximum":28963.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11571.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11802.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28963.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11571.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28963.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11571.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11571.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11802.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11571.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14833.95,"maximum":47575.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15130.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47575.8},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47575.8},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15130.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14833.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23683.3,"maximum":80990.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23683.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24156.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80990.13},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23683.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80990.13},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23683.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23683.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24156.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23683.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8852.36,"maximum":25558.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25558.08},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25558.08},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9029.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12860.82,"maximum":34290.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12860.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34290.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12860.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34290.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12860.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12860.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13118.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12860.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":12748.35,"10th_percentile":12748.35,"90th_percentile":12748.35},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21887.63,"maximum":85339.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21887.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22325.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85339.73},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21887.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85339.73},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21887.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21887.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22325.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21887.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11739.33,"maximum":32605.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11739.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32605.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11739.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32605.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11739.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11739.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11739.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34849.23,"10th_percentile":34849.23,"90th_percentile":34849.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14652.82,"maximum":38404.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14652.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14945.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38404.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14652.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38404.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14652.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14652.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14945.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14652.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25563.12,"maximum":55027.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55027.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55027.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25563.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17186.7,"maximum":48924.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17530.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48924.51},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48924.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17530.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":53779.86,"10th_percentile":53779.86,"90th_percentile":53779.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15811.29,"10th_percentile":15811.29,"90th_percentile":16495.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":16760.01,"10th_percentile":16760.01,"90th_percentile":16760.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24631.9,"maximum":70605.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24631.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25124.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70605.05},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24631.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70605.05},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24631.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24631.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25124.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24631.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":116262.42,"10th_percentile":116262.42,"90th_percentile":116262.42},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14789.99,"10th_percentile":14789.99,"90th_percentile":14789.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":22838.57,"10th_percentile":22838.57,"90th_percentile":22838.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32797.92,"maximum":101153.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33453.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":101153.37},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101153.37},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33453.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32797.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14559.52,"maximum":50239.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14850.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50239.51},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50239.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14850.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20853.04,"maximum":61400.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20853.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21270.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61400.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20853.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61400.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20853.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20853.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21270.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20853.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13803.36,"10th_percentile":13803.36,"90th_percentile":13803.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42623.32,"maximum":161541.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42623.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43475.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":161541.93},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42623.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161541.93},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42623.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42623.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43475.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42623.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17422.71,"maximum":57826.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17771.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57826.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57826.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17771.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17422.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20381.03,"maximum":65614.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20788.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":65614.82},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65614.82},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20788.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30094.82,"maximum":90768.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30094.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30696.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90768.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30094.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90768.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30094.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30094.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30696.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30094.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13552.37,"maximum":49834.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13552.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49834.89},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13552.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49834.89},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13552.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13552.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13552.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26963.61,"maximum":66727.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26963.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27502.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66727.51},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26963.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66727.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26963.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26963.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27502.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26963.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18216.67,"10th_percentile":18216.67,"90th_percentile":18216.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45910.04,"maximum":107526.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45910.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46828.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":107526.03},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45910.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107526.03},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45910.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45910.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46828.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45910.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39205.79,"maximum":97983.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39205.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39989.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":97983.9},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39205.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97983.9},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39205.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39205.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39989.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39205.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54571.86,"maximum":125632.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54571.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55663.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":125632.49},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54571.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125632.49},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54571.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54571.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55663.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54571.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50858.87,"maximum":127722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50858.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51876.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":127722.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50858.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127722.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50858.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50858.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51876.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50858.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70823.42,"maximum":163834.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70823.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72239.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":163834.74},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70823.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163834.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70823.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70823.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72239.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70823.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41475.71,"10th_percentile":41475.71,"90th_percentile":41475.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":132642.25,"10th_percentile":132642.25,"90th_percentile":132642.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56346.49,"maximum":155911.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56346.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57473.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":155911.06},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56346.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":155911.06},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56346.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56346.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57473.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56346.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":78001.51,"maximum":223144.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78001.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79561.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":223144.33},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78001.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":223144.33},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78001.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78001.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79561.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78001.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29698.73,"maximum":92049.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29698.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30292.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":92049.57},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29698.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92049.57},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29698.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29698.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30292.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29698.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46145.13,"maximum":163531.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46145.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47068.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":163531.28},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46145.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163531.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46145.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46145.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47068.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46145.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46994.02,"maximum":100310.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46994.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47933.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100310.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46994.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100310.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46994.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46994.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47933.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46994.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49670.6,"maximum":124924.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49670.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50664.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":124924.41},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49670.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124924.41},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49670.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49670.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50664.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49670.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":103083.4,"10th_percentile":103083.4,"90th_percentile":103083.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":71126.2,"maximum":160968.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71126.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72548.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160968.73},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71126.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160968.73},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71126.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71126.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72548.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71126.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61036.44,"maximum":134601.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61036.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62257.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134601.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61036.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134601.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61036.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61036.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62257.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61036.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61036.44,"maximum":148965.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61036.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62257.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":148965.2},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61036.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148965.2},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61036.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61036.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62257.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61036.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":90377.24,"maximum":228640.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90377.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92184.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":228640.33},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90377.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":228640.33},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90377.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90377.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92184.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90377.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":91970.75,"maximum":188313.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91970.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93810.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":188313.86},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91970.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188313.86},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91970.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91970.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93810.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91970.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":100359.97,"maximum":363174.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100359.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102367.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":363174.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100359.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":363174.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100359.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100359.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102367.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100359.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26032.39,"maximum":66794.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26032.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26553.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66794.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26032.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66794.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26032.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26032.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26553.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26032.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65973.03,"10th_percentile":65973.03,"90th_percentile":65973.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":71971.96,"10th_percentile":71971.96,"90th_percentile":71971.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":19431.29,"10th_percentile":19431.29,"90th_percentile":19431.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59750.3,"maximum":192090.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59750.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60945.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":192090.25},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59750.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":192090.25},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59750.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59750.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60945.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59750.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":89791.71,"10th_percentile":89791.71,"90th_percentile":89791.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9497.26,"maximum":20938.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9497.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20938.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9497.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20938.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9497.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9497.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9497.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24577.69,"10th_percentile":24577.69,"90th_percentile":24577.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17637.67,"maximum":37426.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17637.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17990.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37426.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17637.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37426.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17637.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17637.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17990.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17637.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":56356.44,"10th_percentile":56356.44,"90th_percentile":56356.44},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10376.2,"10th_percentile":10376.2,"90th_percentile":11920.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":13639.49,"10th_percentile":13639.49,"90th_percentile":13639.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15931.38,"10th_percentile":15931.38,"90th_percentile":15931.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24502.18,"10th_percentile":24502.18,"90th_percentile":24502.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":17089.7,"10th_percentile":17089.7,"90th_percentile":17089.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":9378.01,"10th_percentile":9378.01,"90th_percentile":9378.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8274.23,"maximum":19117.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8274.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8439.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19117.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8274.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19117.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8274.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8274.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8439.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8274.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7017.36,"maximum":13621.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7157.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13621.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13621.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7157.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":12222.38,"10th_percentile":12222.38,"90th_percentile":12222.38},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13284.81,"10th_percentile":13284.81,"90th_percentile":13284.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":16487.2,"10th_percentile":16487.2,"90th_percentile":16487.2},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9772.6,"maximum":21680.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9772.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9968.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21680.54},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9772.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21680.54},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9772.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9772.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9968.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9772.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13837.91,"10th_percentile":13837.91,"90th_percentile":21480.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9383.62,"90th_percentile":11133.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7429.91,"maximum":14397.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7429.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7578.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14397.5},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7429.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14397.5},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7429.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7429.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7578.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7429.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":11511.25,"10th_percentile":11511.25,"90th_percentile":11511.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10944.4,"maximum":23771.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11163.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23771.04},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23771.04},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11163.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17025.7,"maximum":34324.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17025.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17366.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34324.71},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17025.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34324.71},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17025.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17025.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17366.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17025.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7439.97,"maximum":23400.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7439.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7588.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23400.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7439.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23400.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7439.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7439.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7588.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7439.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9570.44,"maximum":29907.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29907.68},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29907.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":714.3,"10th_percentile":714.3,"90th_percentile":714.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8755.5,"10th_percentile":8755.5,"90th_percentile":8755.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18151.77,"maximum":50037.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18151.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18514.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50037.2},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18151.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50037.2},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18151.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18151.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18514.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18151.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":52319.53,"10th_percentile":52319.53,"90th_percentile":52319.53},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":57831.39,"10th_percentile":57831.39,"90th_percentile":57831.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14300.3,"10th_percentile":14300.3,"90th_percentile":14300.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6637.73,"maximum":15341.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15341.59},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15341.59},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8260.51,"maximum":20500.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8260.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20500.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8260.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20500.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8260.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8260.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8425.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8260.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20195.42,"10th_percentile":20195.42,"90th_percentile":20195.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12912.04,"maximum":28997.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12912.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13170.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28997.3},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12912.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28997.3},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12912.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12912.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13170.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12912.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28997.3,"10th_percentile":28997.3,"90th_percentile":28997.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":17555.33,"10th_percentile":17555.33,"90th_percentile":17555.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6761.22,"maximum":17499.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17499.53},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17499.53},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8599.88,"maximum":21950.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21950.28},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21950.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9000.17,"10th_percentile":9000.17,"90th_percentile":9000.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11021.24,"maximum":24951.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11021.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11241.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24951.16},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11021.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24951.16},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11021.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11021.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11241.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11021.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12189.39,"maximum":29941.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12189.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12433.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29941.4},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12189.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29941.4},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12189.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12189.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12433.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12189.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7449.12,"maximum":19691.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7449.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7598.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19691.19},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7449.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19691.19},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7449.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7449.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7598.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7449.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9936.34,"maximum":26097.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26097.57},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26097.57},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10135.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15144.96,"maximum":35572.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15144.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15447.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35572.27},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15144.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35572.27},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15144.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15144.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15447.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15144.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8083.05,"maximum":19724.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19724.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19724.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10622.41,"maximum":25659.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10622.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25659.24},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10622.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25659.24},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10622.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10622.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10834.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10622.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14883.34,"maximum":36145.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14883.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15181.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36145.47},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14883.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36145.47},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14883.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14883.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15181.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14883.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7783.92,"maximum":26030.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7939.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26030.13},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26030.13},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7939.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10685.53,"maximum":30548.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10685.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30548.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10685.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30548.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10685.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10685.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10685.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1065.28,"10th_percentile":1065.28,"90th_percentile":2854.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23538.35,"10th_percentile":22425.75,"90th_percentile":31952.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":14758.78,"10th_percentile":14758.78,"90th_percentile":14758.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7454.7,"10th_percentile":7454.7,"90th_percentile":7454.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":7922.62,"10th_percentile":7107.94,"90th_percentile":10491.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17043.08,"maximum":45282.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17043.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17383.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45282.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17043.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45282.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17043.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17043.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17383.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17043.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10401.5,"10th_percentile":6986.65,"90th_percentile":15534.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":36282.85,"10th_percentile":9556.96,"90th_percentile":50599.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":143949.37,"10th_percentile":143949.37,"90th_percentile":143949.37},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25902.62,"10th_percentile":25902.62,"90th_percentile":25902.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15264.52,"10th_percentile":8544.99,"90th_percentile":15892.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45549.55,"10th_percentile":29564.96,"90th_percentile":70461.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":50485.31,"10th_percentile":50485.31,"90th_percentile":50485.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":30977.88,"10th_percentile":30977.88,"90th_percentile":30977.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15039.88,"10th_percentile":12355.74,"90th_percentile":18613.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"11","median_amount":12065.57,"10th_percentile":1574.64,"90th_percentile":15211.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":38966.66,"10th_percentile":38966.66,"90th_percentile":38966.66},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7794.9,"maximum":19050.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7794.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7950.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19050.55},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7794.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19050.55},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7794.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7794.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7950.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7794.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12342.71,"10th_percentile":12342.71,"90th_percentile":12342.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9816.51,"maximum":25153.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10012.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25153.47},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25153.47},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10012.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9816.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":19860.82,"10th_percentile":19860.82,"90th_percentile":19860.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":14681.39,"10th_percentile":14681.39,"90th_percentile":14681.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15183.38,"maximum":36516.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15183.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15487.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36516.37},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15183.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36516.37},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15183.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15183.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15487.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15183.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11031.68,"10th_percentile":11031.68,"90th_percentile":11031.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57159.53,"10th_percentile":57159.53,"90th_percentile":57159.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":47962.4,"10th_percentile":47962.4,"90th_percentile":47962.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":15250.2,"10th_percentile":15250.2,"90th_percentile":15250.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8252.28,"maximum":20669.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20669.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20669.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":15827.46,"10th_percentile":15827.46,"90th_percentile":15827.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20669.0,"10th_percentile":20669.0,"90th_percentile":20669.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13453.58,"maximum":33582.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13453.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13722.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33582.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13453.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33582.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13453.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13453.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13722.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13453.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28115.29,"maximum":89419.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28115.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28677.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89419.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28115.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89419.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28115.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28115.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28677.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28115.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13387.72,"maximum":35133.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35133.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35133.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13387.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":55170.39,"10th_percentile":55170.39,"90th_percentile":55170.39},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17385.2,"maximum":46260.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17385.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17732.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46260.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17385.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46260.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17385.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17385.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17732.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17385.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":70753.59,"10th_percentile":70753.59,"90th_percentile":70753.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":64285.93,"10th_percentile":64285.93,"90th_percentile":64285.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":16425.67,"10th_percentile":16425.67,"90th_percentile":16425.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35079.33,"maximum":89992.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35079.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35780.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89992.78},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35079.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89992.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35079.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35079.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35780.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35079.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34497.14,"10th_percentile":34497.14,"90th_percentile":34497.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":267694.55,"10th_percentile":267694.55,"90th_percentile":267694.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18398.75,"maximum":48823.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18766.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48823.36},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48823.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18766.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18398.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49690.35,"10th_percentile":49690.35,"90th_percentile":49690.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23976.93,"maximum":65446.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23976.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":65446.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23976.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65446.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23976.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23976.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23976.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":96963.98,"10th_percentile":96963.98,"90th_percentile":96963.98},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20550.48,"10th_percentile":20550.48,"90th_percentile":20550.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":21961.67,"10th_percentile":21961.67,"90th_percentile":21961.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41886.03,"maximum":111167.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41886.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42723.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111167.55},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41886.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111167.55},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41886.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41886.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42723.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41886.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38281.78,"10th_percentile":38281.78,"90th_percentile":38281.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":114712.12,"10th_percentile":114712.12,"90th_percentile":114712.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7369.54,"maximum":17533.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7516.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17533.25},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17533.25},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7516.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":9758.21,"10th_percentile":9758.21,"90th_percentile":9758.21},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":3662.02,"10th_percentile":3662.02,"90th_percentile":3662.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7049.32,"10th_percentile":5423.9,"90th_percentile":7892.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":10029.94,"10th_percentile":10029.94,"90th_percentile":10029.94},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":3646.13,"10th_percentile":3646.13,"90th_percentile":3646.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":3160.13,"10th_percentile":3160.13,"90th_percentile":3235.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9210.94,"maximum":20702.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20702.72},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20702.72},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":23871.01,"10th_percentile":23871.01,"90th_percentile":23871.01},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9586.63,"10th_percentile":9586.63,"90th_percentile":9586.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16593.02,"maximum":46732.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16924.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46732.86},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46732.86},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16924.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16593.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10107.5,"10th_percentile":10107.5,"90th_percentile":10107.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35269.01,"10th_percentile":33228.89,"90th_percentile":53948.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":59203.2,"10th_percentile":59203.2,"90th_percentile":59203.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7481.46,"10th_percentile":7481.46,"90th_percentile":7481.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":11882.2,"10th_percentile":11882.2,"90th_percentile":18857.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7210.37,"maximum":16353.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7210.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7354.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16353.13},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7210.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16353.13},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7210.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7210.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7354.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7210.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":4285.13,"10th_percentile":4285.13,"90th_percentile":4285.13},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5057.67,"10th_percentile":5057.67,"90th_percentile":5057.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7651.12,"10th_percentile":7651.12,"90th_percentile":7651.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5423.9,"10th_percentile":5057.67,"90th_percentile":13837.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":3646.13,"10th_percentile":3646.13,"90th_percentile":3646.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":3235.43,"10th_percentile":3235.43,"90th_percentile":3235.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":12546.03,"10th_percentile":12546.03,"90th_percentile":12546.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9272.23,"maximum":19994.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9272.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9457.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19994.65},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9272.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19994.65},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9272.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9272.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9457.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9272.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":631.58,"10th_percentile":631.58,"90th_percentile":631.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8527.26,"10th_percentile":8527.26,"90th_percentile":8527.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15190.7,"maximum":50644.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15494.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50644.12},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50644.12},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15494.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1276.94,"10th_percentile":1276.94,"90th_percentile":1276.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19803.18,"10th_percentile":19803.18,"90th_percentile":19803.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":31081.96,"10th_percentile":31081.96,"90th_percentile":31081.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7641.22,"maximum":12947.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7641.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7794.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12947.63},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7641.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12947.63},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7641.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7641.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7794.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7641.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":5205.82,"10th_percentile":5205.82,"90th_percentile":5205.82},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49840.54,"10th_percentile":49840.54,"90th_percentile":49840.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":9032.71,"10th_percentile":9032.71,"90th_percentile":9032.71},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11702.74,"maximum":26299.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11702.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26299.88},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11702.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26299.88},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11702.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11702.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11702.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21680.54,"10th_percentile":21680.54,"90th_percentile":21680.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7602.8,"maximum":19354.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19354.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19354.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7754.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13068.47,"maximum":44979.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13068.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13329.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44979.53},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13068.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44979.53},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13068.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13068.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13329.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13068.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7763.8,"maximum":19421.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7763.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19421.45},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7763.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19421.45},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7763.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7763.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7763.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8180.01,"maximum":28457.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8343.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28457.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28457.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8343.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12519.61,"maximum":40629.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12519.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40629.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12519.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40629.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12519.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12519.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12770.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12519.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20257.53,"maximum":69323.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20257.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69323.78},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20257.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69323.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20257.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20257.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20257.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":37673.08,"10th_percentile":37673.08,"90th_percentile":37673.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10437.53,"10th_percentile":10437.53,"90th_percentile":10437.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7826.78,"10th_percentile":7826.78,"90th_percentile":7826.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":24013.76,"10th_percentile":24013.76,"90th_percentile":24013.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11886.6,"maximum":28963.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12124.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28963.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28963.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12124.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16740.3,"maximum":40124.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16740.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17075.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40124.17},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16740.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40124.17},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16740.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16740.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17075.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16740.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35160.74,"maximum":81799.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35863.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81799.36},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81799.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35863.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15491.66,"maximum":52127.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15491.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15801.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52127.7},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15491.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52127.7},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15491.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15491.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15801.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15491.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20840.23,"maximum":60692.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20840.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21257.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60692.02},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20840.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60692.02},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20840.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20840.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21257.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20840.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39905.58,"maximum":132274.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39905.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40703.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":132274.89},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39905.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132274.89},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39905.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39905.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40703.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39905.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12192.13,"maximum":40865.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12435.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40865.96},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40865.96},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12435.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8995.06,"maximum":20601.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8995.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20601.57},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8995.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20601.57},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8995.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8995.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8995.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14547.63,"maximum":26906.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14838.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26906.8},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26906.8},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14838.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10176.01,"maximum":37831.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10379.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37831.36},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37831.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10379.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20738.7,"maximum":83653.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20738.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83653.84},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20738.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83653.84},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20738.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20738.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20738.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7911.99,"maximum":19488.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7911.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8070.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19488.88},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7911.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19488.88},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7911.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7911.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8070.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7911.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":15668.55,"10th_percentile":15668.55,"90th_percentile":15668.55},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7627.51,"10th_percentile":7627.51,"90th_percentile":7627.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":17115.55,"10th_percentile":17115.55,"90th_percentile":17115.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13455.45,"10th_percentile":13455.45,"90th_percentile":16756.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":22150.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":7553.11,"10th_percentile":7553.11,"90th_percentile":7553.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12991.63,"maximum":45788.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12991.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45788.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12991.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45788.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12991.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12991.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13251.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12991.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":22359.19,"10th_percentile":22359.19,"90th_percentile":22359.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":58336.01,"10th_percentile":58336.01,"90th_percentile":58336.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8193.73,"maximum":24074.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8357.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24074.5},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24074.5},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8357.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8076.64,"maximum":23130.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8076.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23130.4},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8076.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23130.4},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8076.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8076.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8238.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8076.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11529.85,"maximum":40360.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11760.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40360.19},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40360.19},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11760.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11529.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10812.68,"maximum":37325.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10812.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11028.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37325.59},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10812.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37325.59},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10812.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10812.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11028.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10812.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17428.19,"maximum":62411.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62411.63},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62411.63},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17776.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17428.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14929.08,"maximum":51217.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15227.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51217.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51217.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15227.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13265.14,"maximum":43462.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13265.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43462.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13265.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43462.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13265.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13265.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13265.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22395.32,"maximum":79641.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22395.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22843.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":79641.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22395.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79641.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22395.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22395.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22843.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22395.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8538.59,"maximum":21613.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8538.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8709.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21613.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8538.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21613.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8538.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8538.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8709.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8538.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":38864.0,"10th_percentile":38864.0,"90th_percentile":38864.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20613.11,"10th_percentile":20613.11,"90th_percentile":20613.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11141.99,"maximum":31424.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11141.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11364.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31424.98},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11141.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31424.98},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11141.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11141.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11364.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11141.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9145.08,"maximum":18342.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18342.48},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18342.48},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21336.25,"10th_percentile":21336.25,"90th_percentile":21336.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18605.48,"maximum":41472.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18605.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18977.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41472.88},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18605.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41472.88},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18605.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18605.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18977.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18605.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1205.04,"10th_percentile":1205.04,"90th_percentile":1205.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13351.13,"maximum":31728.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13618.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31728.44},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31728.44},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13618.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21881.23,"maximum":56578.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21881.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22318.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56578.45},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21881.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56578.45},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21881.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21881.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22318.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21881.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33927.65,"maximum":111437.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34606.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111437.3},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111437.3},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34606.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24481.88,"maximum":67570.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24971.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67570.45},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67570.45},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24971.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24481.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24481.88,"maximum":75460.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24971.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75460.41},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75460.41},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24971.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24481.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33082.41,"maximum":91274.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33082.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33744.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91274.06},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33082.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91274.06},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33082.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33082.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33744.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33082.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8172.69,"maximum":22961.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8336.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22961.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22961.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8336.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8172.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6760.32,"10th_percentile":6760.32,"90th_percentile":6760.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":42310.21,"10th_percentile":42310.21,"90th_percentile":42310.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10246.44,"maximum":30109.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30109.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30109.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":14189.62,"10th_percentile":14189.62,"90th_percentile":14189.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":741.38,"10th_percentile":741.38,"90th_percentile":741.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16953.44,"maximum":43664.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17292.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43664.54},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43664.54},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17292.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16953.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":15451.38,"10th_percentile":15451.38,"90th_percentile":15451.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":42853.19,"10th_percentile":42853.19,"90th_percentile":42853.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17780.01,"10th_percentile":17780.01,"90th_percentile":17780.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8418.76,"maximum":19691.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19691.19},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19691.19},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8587.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10938.0,"maximum":24175.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11156.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24175.66},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24175.66},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11156.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13254.16,"maximum":46699.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13254.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13519.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46699.14},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13254.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46699.14},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13254.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13254.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13519.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13254.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9255.76,"maximum":19084.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9255.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9440.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19084.27},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9255.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19084.27},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9255.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9255.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9440.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9255.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12805.02,"maximum":29233.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12805.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13061.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29233.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12805.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29233.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12805.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12805.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13061.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12805.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21670.83,"maximum":48519.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21670.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22104.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48519.9},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21670.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48519.9},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21670.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21670.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22104.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21670.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9631.73,"maximum":23467.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9824.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23467.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23467.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9824.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9631.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13656.65,"maximum":37157.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37157.0},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37157.0},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21796.15,"maximum":61366.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21796.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22232.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61366.38},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21796.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61366.38},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21796.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21796.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22232.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21796.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9081.04,"maximum":23467.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9262.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23467.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23467.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9262.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17445.57,"maximum":71414.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17445.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17794.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71414.28},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17445.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71414.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17445.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17445.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17794.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17445.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16426.26,"10th_percentile":16426.26,"90th_percentile":16426.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12659.66,"10th_percentile":12659.66,"90th_percentile":12659.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24850.01,"maximum":24850.01,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24850.01},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24850.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33582.92,"maximum":33582.92,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33582.92},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33582.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51621.94,"maximum":51621.94,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51621.94},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51621.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8437.06,"maximum":21478.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8605.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21478.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21478.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8605.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18428.94,"maximum":32031.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18428.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18797.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32031.9},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18428.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32031.9},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18428.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18428.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18797.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18428.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":33623.75,"10th_percentile":33623.75,"90th_percentile":33623.75},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10317.8,"maximum":26468.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10317.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26468.47},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10317.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26468.47},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10317.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10317.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10317.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2957.8,"10th_percentile":2957.8,"90th_percentile":2957.8},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9314.84,"10th_percentile":9314.84,"90th_percentile":9314.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":55550.65,"10th_percentile":55550.65,"90th_percentile":55550.65},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":21284.64,"10th_percentile":21284.64,"90th_percentile":21284.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7096.92,"10th_percentile":7096.92,"90th_percentile":9900.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17775.96,"10th_percentile":17775.96,"90th_percentile":17775.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":12908.34,"10th_percentile":9383.62,"90th_percentile":52701.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":6233.58,"10th_percentile":6233.58,"90th_percentile":10114.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15563.92,"maximum":39820.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15563.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15875.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39820.71},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15563.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39820.71},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15563.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15563.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15875.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15563.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19029.72,"10th_percentile":19029.72,"90th_percentile":19029.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":63860.28,"10th_percentile":63860.28,"90th_percentile":63860.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101329.64,"10th_percentile":101329.64,"90th_percentile":101329.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12945.95,"10th_percentile":12945.95,"90th_percentile":12945.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38558.39,"10th_percentile":38558.39,"90th_percentile":38558.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11156.34,"10th_percentile":11156.34,"90th_percentile":18013.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":11827.0,"10th_percentile":10351.82,"90th_percentile":17956.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":29213.19,"10th_percentile":29213.19,"90th_percentile":29213.19},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7805.88,"maximum":21478.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7805.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7962.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21478.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7805.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21478.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7805.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7805.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7962.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7805.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":16581.62,"10th_percentile":16581.62,"90th_percentile":16581.62},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10273.89,"maximum":28626.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10273.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10479.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28626.4},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10273.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28626.4},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10273.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10273.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10479.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10273.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16117.35,"maximum":49531.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16117.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16439.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49531.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16117.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49531.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16117.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16117.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16439.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16117.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8195.56,"maximum":23535.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8195.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8359.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23535.02},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8195.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23535.02},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8195.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8195.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8359.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8195.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8795.64,"maximum":24681.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8795.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24681.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8795.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24681.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8795.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8795.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8795.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14323.51,"maximum":47879.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14323.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47879.26},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14323.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47879.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14323.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14323.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14323.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7149.08,"maximum":23332.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7149.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7292.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23332.71},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7149.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23332.71},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7149.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7149.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7292.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7149.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10130.27,"maximum":29637.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10332.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29637.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29637.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10332.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28912.94,"10th_percentile":28912.94,"90th_percentile":28912.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24747.89,"10th_percentile":24747.89,"90th_percentile":24747.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19284.23,"maximum":47474.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19284.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47474.65},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19284.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47474.65},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19284.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19284.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19284.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13729.84,"maximum":55061.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14004.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55061.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55061.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14004.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":27669.62,"10th_percentile":27669.62,"90th_percentile":27669.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16962.58,"maximum":58264.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16962.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17301.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58264.34},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16962.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58264.34},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16962.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16962.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17301.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16962.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26109.23,"maximum":80518.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26109.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26631.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80518.08},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26109.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80518.08},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26109.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26109.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26631.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26109.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9302.42,"maximum":25794.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9302.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25794.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9302.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25794.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9302.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9302.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9302.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8245.65,"10th_percentile":8245.65,"90th_percentile":8245.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12239.7,"maximum":29031.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12239.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12484.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29031.02},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12239.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29031.02},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12239.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12239.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12484.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12239.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":92999.27,"10th_percentile":92999.27,"90th_percentile":92999.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16526.24,"maximum":52700.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16856.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52700.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52700.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16856.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12740.07,"maximum":36786.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36786.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36786.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12994.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34462.46,"10th_percentile":34462.46,"90th_percentile":34462.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22139.19,"maximum":59107.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22139.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22581.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59107.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22139.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59107.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22139.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22139.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22581.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22139.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8400.66,"10th_percentile":8400.66,"90th_percentile":8400.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":12470.8,"10th_percentile":12470.8,"90th_percentile":12470.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11252.49,"10th_percentile":11252.49,"90th_percentile":11252.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":94022.93,"10th_percentile":94022.93,"90th_percentile":94022.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10215.34,"maximum":25456.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10215.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10419.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25456.93},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10215.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25456.93},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10215.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10215.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10419.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10215.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":36267.55,"10th_percentile":36267.55,"90th_percentile":36267.55},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":10289.01,"10th_percentile":10289.01,"90th_percentile":10289.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16051.55,"10th_percentile":16051.55,"90th_percentile":16051.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7293.13,"10th_percentile":7293.13,"90th_percentile":7293.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14855.9,"maximum":29300.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15153.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29300.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29300.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15153.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":66383.46,"10th_percentile":66383.46,"90th_percentile":66383.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8999.11,"10th_percentile":8999.11,"90th_percentile":8999.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33402.2,"10th_percentile":33402.2,"90th_percentile":33402.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":43124.87,"10th_percentile":43124.87,"90th_percentile":43124.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":18645.16,"10th_percentile":13687.12,"90th_percentile":22446.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9845.78,"maximum":34358.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10042.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34358.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34358.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10042.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17457.47,"maximum":62951.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17806.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62951.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62951.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17806.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36237.5,"10th_percentile":36237.5,"90th_percentile":36237.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16692.73,"maximum":36347.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16692.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17026.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36347.78},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16692.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36347.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16692.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16692.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17026.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16692.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29854.96,"10th_percentile":29854.96,"90th_percentile":29854.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21001.23,"maximum":59208.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21001.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21421.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59208.44},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21001.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59208.44},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21001.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21001.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21421.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21001.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1931.67,"10th_percentile":1931.67,"90th_percentile":1931.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13837.91,"10th_percentile":13837.91,"90th_percentile":13837.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":26736.62,"10th_percentile":26736.62,"90th_percentile":26736.62},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":121352.29,"10th_percentile":121352.29,"90th_percentile":121352.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17473.14,"10th_percentile":17473.14,"90th_percentile":17473.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36209.05,"maximum":86553.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36209.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36933.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86553.57},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36209.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86553.57},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36209.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36209.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36933.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36209.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51153.23,"10th_percentile":51153.23,"90th_percentile":51153.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11641.45,"maximum":34459.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11874.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34459.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34459.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11874.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15731.32,"maximum":50239.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16045.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50239.51},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50239.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16045.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15731.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":74755.69,"10th_percentile":74755.69,"90th_percentile":74755.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31003.17,"maximum":89857.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31623.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89857.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89857.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31003.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31623.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31003.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18660.37,"maximum":45114.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18660.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19033.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45114.4},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18660.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45114.4},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18660.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18660.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19033.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18660.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22755.73,"maximum":62344.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22755.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62344.19},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22755.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62344.19},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22755.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22755.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22755.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36295.95,"maximum":132544.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37021.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":132544.63},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132544.63},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36295.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37021.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36295.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16099.97,"maximum":42315.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16099.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16421.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42315.83},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16099.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42315.83},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16099.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16099.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16421.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16099.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20381.94,"maximum":49565.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20789.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49565.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49565.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20789.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20381.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41874.13,"maximum":76775.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41874.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42711.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76775.41},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41874.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76775.41},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41874.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41874.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42711.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41874.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20969.21,"maximum":44541.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20969.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21388.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44541.2},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20969.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44541.2},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20969.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20969.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21388.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20969.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":50523.12,"10th_percentile":50523.12,"90th_percentile":50523.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32096.31,"maximum":80214.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32096.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32738.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80214.62},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32096.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80214.62},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32096.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32096.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32738.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32096.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55849.78,"maximum":135073.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55849.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56966.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":135073.47},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55849.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135073.47},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55849.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55849.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56966.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55849.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23966.87,"maximum":61568.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24446.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61568.68},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61568.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24446.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29330.08,"maximum":73235.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29330.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29916.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":73235.04},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29330.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73235.04},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29330.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29330.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29916.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29330.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":69000.31,"10th_percentile":69000.31,"90th_percentile":69000.31},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42479.7,"maximum":104558.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42479.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43329.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":104558.87},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42479.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104558.87},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42479.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42479.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43329.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42479.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":118761.86,"10th_percentile":118761.86,"90th_percentile":118761.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":252955.18,"10th_percentile":252955.18,"90th_percentile":252955.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":108397.15,"10th_percentile":104727.31,"90th_percentile":108696.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":194488.64,"10th_percentile":194488.64,"90th_percentile":194488.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":23909.54,"10th_percentile":23909.54,"90th_percentile":23909.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36672.83,"maximum":102569.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36672.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37406.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":102569.52},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36672.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102569.52},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36672.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36672.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37406.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36672.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53306.75,"maximum":144919.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53306.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54372.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":144919.06},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53306.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144919.06},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53306.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53306.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54372.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53306.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":94304.82,"10th_percentile":94304.82,"90th_percentile":94304.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29953.95,"maximum":144042.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30553.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":144042.4},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144042.4},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29953.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30553.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29953.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49313.84,"maximum":193405.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49313.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50300.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":193405.24},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49313.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":193405.24},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49313.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49313.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50300.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49313.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72868.81,"maximum":257502.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72868.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74326.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":257502.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72868.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":257502.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72868.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72868.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74326.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72868.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66152.67,"maximum":251163.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66152.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67475.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":251163.82},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66152.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":251163.82},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66152.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66152.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67475.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66152.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":395905.75,"maximum":1241016.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":395905.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403823.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1241016.98},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":395905.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1241016.98},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":395905.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":395905.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403823.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":395905.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50580.78,"maximum":83384.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50580.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51592.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83384.09},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50580.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83384.09},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50580.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50580.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51592.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50580.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55130.78,"maximum":106177.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55130.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56233.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":106177.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55130.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106177.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55130.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55130.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56233.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55130.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":110822.95,"maximum":316239.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110822.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":316239.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110822.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":316239.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110822.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110822.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113039.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110822.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27249.93,"maximum":67873.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27249.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27794.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67873.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27249.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67873.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27249.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27249.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27794.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27249.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39454.6,"maximum":113426.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39454.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40243.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":113426.65},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39454.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113426.65},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39454.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39454.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40243.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39454.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50780.2,"maximum":139085.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50780.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51795.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":139085.88},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50780.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139085.88},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50780.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50780.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51795.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50780.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66528.64,"maximum":147683.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66528.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67859.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":147683.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66528.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147683.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66528.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66528.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67859.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66528.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10799.87,"maximum":25659.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25659.24},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25659.24},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10799.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11998.78,"10th_percentile":11998.78,"90th_percentile":11998.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8212.03,"maximum":19927.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19927.21},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19927.21},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8212.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13518.53,"maximum":46159.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13518.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46159.65},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13518.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46159.65},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13518.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13518.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13788.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13518.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8707.82,"maximum":21478.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8881.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21478.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21478.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8881.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15362.67,"maximum":35875.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15362.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35875.73},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15362.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35875.73},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15362.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15362.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15362.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9819.25,"maximum":24613.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10015.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24613.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24613.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10015.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25798.31,"10th_percentile":25798.31,"90th_percentile":25798.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7120.72,"maximum":18005.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18005.3},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18005.3},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14397.61,"maximum":30784.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14685.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30784.34},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30784.34},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14685.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8113.23,"maximum":17364.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8113.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8275.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17364.66},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8113.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17364.66},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8113.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8113.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8275.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8113.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22489.77,"10th_percentile":22489.77,"90th_percentile":22489.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5864.76,"maximum":13655.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13655.7},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13655.7},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12031.61,"10th_percentile":12031.61,"90th_percentile":12031.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":46497.36,"10th_percentile":46497.36,"90th_percentile":46497.36},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12490.34,"maximum":29401.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29401.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29401.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":37318.02,"10th_percentile":37318.02,"90th_percentile":37318.02},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11595.2,"10th_percentile":8602.23,"90th_percentile":15694.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":163038.27,"10th_percentile":163038.27,"90th_percentile":163038.27},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":74454.18,"10th_percentile":47038.46,"90th_percentile":179690.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32289.61,"10th_percentile":32289.61,"90th_percentile":32289.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3095.94,"10th_percentile":3095.94,"90th_percentile":3095.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29201.92,"10th_percentile":19053.19,"90th_percentile":33747.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9656.21,"10th_percentile":9656.21,"90th_percentile":9656.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":13721.21,"10th_percentile":13191.09,"90th_percentile":25017.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15565.94,"10th_percentile":15565.94,"90th_percentile":15565.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":40891.24,"10th_percentile":40891.24,"90th_percentile":40891.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":12556.5,"10th_percentile":9386.12,"90th_percentile":12622.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":13082.69,"10th_percentile":13082.69,"90th_percentile":13082.69},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16583.43,"10th_percentile":16583.43,"90th_percentile":16583.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8019.93,"maximum":17364.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17364.66},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17364.66},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8180.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":30866.0,"10th_percentile":20409.28,"90th_percentile":32640.07},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7301.99,"10th_percentile":844.57,"90th_percentile":9557.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":48837.5,"10th_percentile":48837.5,"90th_percentile":48837.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":28946.15,"10th_percentile":28946.15,"90th_percentile":28946.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11351.74,"10th_percentile":11351.74,"90th_percentile":11351.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8991.27,"10th_percentile":8991.27,"90th_percentile":8991.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6524.37,"10th_percentile":6524.37,"90th_percentile":17326.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":36774.49,"10th_percentile":36774.49,"90th_percentile":36774.49},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":5674.26,"10th_percentile":5674.26,"90th_percentile":7251.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15518.18,"maximum":40865.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15518.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15828.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40865.96},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15518.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40865.96},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15518.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15518.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15828.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15518.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2068.23,"10th_percentile":2068.23,"90th_percentile":2068.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13809.15,"10th_percentile":13809.15,"90th_percentile":13809.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":936.73,"10th_percentile":936.73,"90th_percentile":936.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9447.86,"maximum":22489.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22489.77},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22489.77},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9415.86,"10th_percentile":9415.86,"90th_percentile":13006.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5009.41,"10th_percentile":5009.41,"90th_percentile":5009.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6825.26,"maximum":18511.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6825.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6961.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18511.07},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6825.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18511.07},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6825.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6825.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6961.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6825.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22795.98,"maximum":45316.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22795.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23251.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45316.71},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22795.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45316.71},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22795.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22795.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23251.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22795.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14734.24,"maximum":41574.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14734.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15028.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41574.04},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14734.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41574.04},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14734.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14734.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15028.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14734.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11359.7,"maximum":29705.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11586.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29705.37},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29705.37},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11586.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50930.22,"maximum":145593.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50930.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51948.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145593.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50930.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145593.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50930.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50930.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51948.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50930.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":145218.97,"10th_percentile":145218.97,"90th_percentile":145218.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":160482.19,"10th_percentile":160482.19,"90th_percentile":160482.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":49350.79,"10th_percentile":49350.79,"90th_percentile":49350.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27418.24,"maximum":76370.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27418.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27966.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76370.79},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27418.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76370.79},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27418.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27418.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27966.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27418.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25665.39,"10th_percentile":25665.39,"90th_percentile":25665.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19743.62,"10th_percentile":19743.62,"90th_percentile":19743.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66417.83,"10th_percentile":66417.83,"90th_percentile":66417.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23064.15,"10th_percentile":23064.15,"90th_percentile":23064.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21192.41,"maximum":57050.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21192.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21616.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57050.5},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21192.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57050.5},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21192.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21192.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21616.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21192.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19284.16,"10th_percentile":19284.16,"90th_percentile":19284.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33505.03,"maximum":113595.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33505.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34175.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":113595.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33505.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113595.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33505.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33505.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34175.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33505.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24514.81,"maximum":92218.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24514.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25005.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":92218.16},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24514.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92218.16},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24514.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24514.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25005.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24514.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14929.99,"maximum":38472.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15228.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38472.0},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38472.0},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15228.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20177.95,"maximum":50239.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20177.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20581.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50239.51},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20177.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50239.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20177.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20177.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20581.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20177.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60250.5,"10th_percentile":60250.5,"90th_percentile":60250.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":65667.5,"10th_percentile":65667.5,"90th_percentile":65667.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33553.51,"maximum":76741.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34224.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76741.69},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76741.69},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34224.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33553.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15871.28,"maximum":42248.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15871.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16188.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42248.39},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15871.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42248.39},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15871.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15871.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16188.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15871.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22313.91,"maximum":70571.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22313.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22760.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70571.33},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22313.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70571.33},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22313.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22313.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22760.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22313.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34009.06,"maximum":130015.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34009.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34689.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":130015.8},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34009.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130015.8},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34009.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34009.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34689.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34009.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16282.92,"maximum":44440.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16282.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16608.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44440.05},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16282.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44440.05},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16282.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16282.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16608.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16282.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":100538.5,"10th_percentile":100538.5,"90th_percentile":100538.5},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":67787.02,"10th_percentile":59348.07,"90th_percentile":73023.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49265.28,"10th_percentile":45125.87,"90th_percentile":60133.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":96173.43,"10th_percentile":96173.43,"90th_percentile":96173.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22817.02,"maximum":59680.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22817.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23273.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59680.49},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22817.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59680.49},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22817.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22817.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23273.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22817.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":96120.22,"10th_percentile":96120.22,"90th_percentile":96120.22},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62327.72,"10th_percentile":61684.8,"90th_percentile":66430.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":123026.57,"10th_percentile":123026.57,"90th_percentile":123026.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":72175.55,"10th_percentile":72175.55,"90th_percentile":72175.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":16195.36,"10th_percentile":16195.36,"90th_percentile":16195.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42935.25,"maximum":97882.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42935.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43793.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":97882.74},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42935.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97882.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42935.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42935.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43793.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42935.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":175886.96,"10th_percentile":175886.96,"90th_percentile":175886.96},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5032.64,"10th_percentile":5032.64,"90th_percentile":5032.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":463898.43,"10th_percentile":463898.43,"90th_percentile":463898.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":97882.75,"10th_percentile":97882.75,"90th_percentile":100687.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":169719.14,"10th_percentile":169719.14,"90th_percentile":169719.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46294.09,"10th_percentile":46294.09,"90th_percentile":46294.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15545.63,"maximum":41101.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15545.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15856.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41101.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15545.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41101.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15545.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15545.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15856.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15545.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":44116.3,"10th_percentile":44116.3,"90th_percentile":44116.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":50763.37,"10th_percentile":50763.37,"90th_percentile":50763.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23246.96,"maximum":66255.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23246.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23711.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66255.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23246.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66255.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23246.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23246.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23711.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23246.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21766.26,"10th_percentile":21766.26,"90th_percentile":21766.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46511.03,"maximum":124587.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46511.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47441.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":124587.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46511.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124587.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46511.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46511.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47441.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46511.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51067.68,"10th_percentile":51067.68,"90th_percentile":51067.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":125514.37,"10th_percentile":125514.37,"90th_percentile":125514.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":444766.83,"10th_percentile":444766.83,"90th_percentile":444766.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30255.82,"maximum":89149.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30255.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30860.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89149.84},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30255.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89149.84},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30255.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30255.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30860.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30255.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29712.45,"maximum":101355.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29712.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30306.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":101355.68},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29712.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101355.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29712.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29712.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30306.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29712.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40473.64,"maximum":139591.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40473.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41283.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":139591.65},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40473.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139591.65},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40473.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40473.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41283.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40473.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17015.64,"maximum":61265.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17015.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17355.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61265.22},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17015.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61265.22},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17015.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17015.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17355.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17015.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25777.17,"maximum":82170.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25777.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26292.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":82170.25},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25777.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82170.25},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25777.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25777.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26292.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25777.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24960.48,"10th_percentile":24960.48,"90th_percentile":24960.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":42976.0,"10th_percentile":42976.0,"90th_percentile":42976.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82170.26,"10th_percentile":82170.26,"90th_percentile":82170.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22891.12,"maximum":78596.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22891.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23348.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78596.17},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22891.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78596.17},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22891.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22891.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23348.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22891.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41713.14,"maximum":145795.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41713.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42547.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145795.72},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41713.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145795.72},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41713.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41713.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42547.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41713.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7128.04,"maximum":22725.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22725.79},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22725.79},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13284.81,"10th_percentile":13284.81,"90th_percentile":13837.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9700.33,"maximum":25187.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9894.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25187.19},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25187.19},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9894.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":17629.98,"10th_percentile":17629.98,"90th_percentile":17629.98},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19962.98,"maximum":48621.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19962.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20362.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48621.05},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19962.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48621.05},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19962.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19962.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20362.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19962.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7474.73,"maximum":15982.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7474.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15982.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7474.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15982.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7474.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7474.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7474.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24859.55,"10th_percentile":24859.55,"90th_percentile":24859.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8861.5,"maximum":21984.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8861.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9038.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21984.0},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8861.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21984.0},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8861.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8861.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9038.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8861.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13284.81,"10th_percentile":13284.81,"90th_percentile":13284.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7309.16,"maximum":17128.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7309.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17128.64},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7309.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17128.64},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7309.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7309.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7309.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6066.92,"maximum":13217.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6188.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13217.37},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13217.37},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6188.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7618.35,"maximum":16791.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7618.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7770.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16791.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7618.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16791.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7618.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7618.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7770.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7618.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6651.23,"10th_percentile":6651.23,"90th_percentile":6651.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":11916.9,"10th_percentile":11916.9,"90th_percentile":11916.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11902.15,"maximum":26704.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12140.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26704.49},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26704.49},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12140.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"90th_percentile":200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":10134.87,"10th_percentile":10134.87,"90th_percentile":10134.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9242.04,"maximum":31087.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9426.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31087.8},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31087.8},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9426.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15303.22,"maximum":51318.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15609.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51318.48},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51318.48},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15609.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15303.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11920.06,"10th_percentile":11920.06,"90th_percentile":11920.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7795.81,"maximum":19320.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7951.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19320.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19320.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7951.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":50799.63,"10th_percentile":50799.63,"90th_percentile":50799.63},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10205.94,"10th_percentile":10205.94,"90th_percentile":10205.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":101.88,"10th_percentile":101.88,"90th_percentile":101.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6222.68,"10th_percentile":6222.68,"90th_percentile":7019.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17584.65,"10th_percentile":17584.65,"90th_percentile":17584.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":22974.81,"10th_percentile":22974.81,"90th_percentile":22974.81},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":20490.04,"10th_percentile":20490.04,"90th_percentile":20490.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6340.78,"10th_percentile":6340.78,"90th_percentile":6340.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8403.7,"10th_percentile":8403.7,"90th_percentile":8403.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11774.09,"maximum":27243.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11774.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27243.97},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11774.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27243.97},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11774.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11774.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11774.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":26199.3,"10th_percentile":26199.3,"90th_percentile":26199.3},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9444.72,"10th_percentile":9444.72,"90th_percentile":9444.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29654.64,"10th_percentile":29654.64,"90th_percentile":29654.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11535.53,"10th_percentile":11535.53,"90th_percentile":11535.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":11442.21,"10th_percentile":11442.21,"90th_percentile":11442.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7046.63,"maximum":16690.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7046.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7187.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16690.31},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7046.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16690.31},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7046.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7046.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7187.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7046.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11834.46,"maximum":38539.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11834.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38539.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11834.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38539.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11834.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11834.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12071.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11834.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7471.99,"maximum":17769.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7471.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17769.28},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7471.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17769.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7471.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7471.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7471.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":19679.95,"10th_percentile":19679.95,"90th_percentile":19679.95},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10653.51,"maximum":23400.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10653.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10866.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23400.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10653.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23400.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10653.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10653.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10866.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10653.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":25780.36,"10th_percentile":25780.36,"90th_percentile":25780.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":25674.58,"10th_percentile":25674.58,"90th_percentile":25674.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":751.93,"10th_percentile":751.93,"90th_percentile":751.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9374.76,"10th_percentile":9374.76,"90th_percentile":9374.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":27648.58,"10th_percentile":27648.58,"90th_percentile":27648.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":9688.77,"10th_percentile":9688.77,"90th_percentile":9688.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":18657.1,"10th_percentile":18657.1,"90th_percentile":18657.1}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15823.71,"maximum":29536.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16140.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29536.78},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29536.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16140.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15823.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11469.66,"10th_percentile":11469.66,"90th_percentile":11469.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7440.23,"10th_percentile":7440.23,"90th_percentile":7440.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":13436.3,"10th_percentile":13436.3,"90th_percentile":13436.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":21768.13,"10th_percentile":21768.13,"90th_percentile":21768.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5051.54,"maximum":15678.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5051.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5152.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15678.77},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5051.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15678.77},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5051.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5051.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5152.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5051.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6688.04,"maximum":23568.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6688.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6821.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23568.74},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6688.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23568.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6688.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6688.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6821.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6688.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15176.06,"maximum":51453.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15176.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51453.35},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15176.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51453.35},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15176.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15176.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15479.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15176.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28390.38,"maximum":28390.38,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28390.38},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28390.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38842.89,"maximum":38842.89,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38842.89},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38842.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6066.01,"maximum":17398.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6187.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17398.38},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17398.38},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6187.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8654.77,"maximum":19927.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8654.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8827.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19927.21},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8654.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19927.21},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8654.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8654.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8827.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8654.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":7398.59,"10th_percentile":7398.59,"90th_percentile":7398.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12632.13,"maximum":28896.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12884.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28896.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28896.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12884.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11640.33,"10th_percentile":11640.33,"90th_percentile":11640.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":19428.35,"10th_percentile":19428.35,"90th_percentile":19428.35},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9937.36,"10th_percentile":9937.36,"90th_percentile":9937.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26903.12,"10th_percentile":26903.12,"90th_percentile":26903.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1251.98,"10th_percentile":1251.98,"90th_percentile":1251.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28896.15,"10th_percentile":28896.15,"90th_percentile":31570.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10417.3,"10th_percentile":10417.3,"90th_percentile":10417.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9392.98,"maximum":34358.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34358.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34358.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9580.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16502.46,"maximum":35538.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16502.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16832.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35538.55},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16502.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35538.55},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16502.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16502.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16832.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16502.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25643.62,"maximum":64232.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25643.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26156.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64232.39},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25643.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64232.39},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25643.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25643.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26156.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25643.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10677.29,"maximum":28693.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10677.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28693.84},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10677.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28693.84},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10677.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10677.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10890.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10677.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":19926.02,"10th_percentile":19926.02,"90th_percentile":19926.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21130.21,"maximum":45721.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21130.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21552.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45721.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21130.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45721.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21130.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21130.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21552.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21130.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6366.96,"maximum":17094.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6366.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17094.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6366.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17094.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6366.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6366.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6366.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7220.43,"maximum":24850.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7220.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24850.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7220.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24850.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7220.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7220.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7220.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19007.98,"maximum":54150.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19007.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19388.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54150.77},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19007.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54150.77},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19007.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19007.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19388.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19007.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7503.09,"maximum":22995.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7653.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22995.53},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22995.53},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7653.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9296.01,"maximum":25220.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9481.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25220.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25220.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9481.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22946.92,"10th_percentile":22946.92,"90th_percentile":22946.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15562.09,"maximum":36988.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15562.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36988.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15562.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36988.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15562.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15562.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15562.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":23642.94,"10th_percentile":23642.94,"90th_percentile":23642.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33878.25,"maximum":107930.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33878.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34555.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":107930.65},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33878.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107930.65},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33878.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33878.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34555.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33878.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51805.64,"maximum":150381.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51805.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52841.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":150381.34},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51805.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150381.34},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51805.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51805.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52841.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51805.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43136.5,"maximum":138951.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43136.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43999.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":138951.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43136.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138951.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43136.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43136.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43999.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43136.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55834.23,"maximum":174186.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55834.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56950.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":174186.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55834.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174186.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55834.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55834.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56950.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55834.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66114.25,"maximum":211241.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66114.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67436.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":211241.95},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66114.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":211241.95},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66114.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66114.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67436.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66114.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30999.51,"maximum":86890.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30999.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31619.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86890.74},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30999.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86890.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30999.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30999.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31619.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30999.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30594.26,"10th_percentile":30594.26,"90th_percentile":30594.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":28223.98,"10th_percentile":28223.98,"90th_percentile":28454.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38626.75,"maximum":120136.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38626.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39399.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":120136.49},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38626.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120136.49},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38626.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38626.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39399.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38626.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27296.53,"10th_percentile":27296.53,"90th_percentile":27296.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24242.21,"maximum":72358.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24242.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24727.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":72358.38},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24242.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72358.38},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24242.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24242.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24727.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24242.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33419.96,"maximum":96904.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33419.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34088.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96904.93},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33419.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96904.93},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33419.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33419.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34088.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33419.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49153.76,"maximum":118585.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49153.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":118585.47},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49153.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118585.47},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49153.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49153.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50136.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49153.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39520.47,"maximum":96736.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39520.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40310.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96736.34},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39520.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96736.34},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39520.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39520.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40310.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39520.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63804.49,"maximum":185582.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63804.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65080.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":185582.72},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63804.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":185582.72},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63804.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63804.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65080.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63804.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44438.19,"maximum":137265.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44438.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":137265.12},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44438.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137265.12},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44438.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44438.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44438.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56948.4,"maximum":150381.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56948.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58087.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":150381.34},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56948.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150381.34},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56948.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56948.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58087.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56948.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33986.19,"maximum":116022.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33986.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34665.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":116022.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33986.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116022.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33986.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33986.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34665.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33986.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31446.83,"maximum":62782.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31446.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32075.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62782.52},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31446.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62782.52},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31446.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31446.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32075.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31446.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17279.64,"10th_percentile":17279.64,"90th_percentile":17279.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46920.71,"10th_percentile":46920.71,"90th_percentile":46920.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":58822.61,"10th_percentile":58822.61,"90th_percentile":58822.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28856.24,"maximum":90599.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28856.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29433.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90599.7},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28856.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90599.7},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28856.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28856.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29433.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28856.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15798.1,"maximum":44305.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15798.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16114.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44305.18},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15798.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44305.18},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15798.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15798.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16114.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15798.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18181.95,"maximum":51217.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18545.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51217.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51217.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18545.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30643.67,"maximum":91813.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30643.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31256.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91813.54},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30643.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91813.54},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30643.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30643.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31256.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30643.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19385.77,"maximum":65918.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19385.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":65918.28},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19385.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65918.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19385.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19385.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19773.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19385.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29631.04,"maximum":96230.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30223.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96230.57},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96230.57},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30223.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29631.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10879.46,"maximum":22894.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11097.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22894.38},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22894.38},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10879.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11097.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10879.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16420.13,"maximum":33920.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16748.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33920.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33920.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16748.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16420.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33875.38,"10th_percentile":33875.38,"90th_percentile":33875.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20805.47,"maximum":55634.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20805.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55634.35},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20805.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55634.35},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20805.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20805.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20805.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15412.07,"maximum":48688.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15412.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15720.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48688.49},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15412.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48688.49},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15412.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15412.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15720.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15412.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31105.63,"maximum":111471.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31105.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31727.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111471.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31105.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111471.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31105.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31105.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31727.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31105.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20121.24,"maximum":73605.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20121.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":73605.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20121.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73605.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20121.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20121.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20121.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16078.01,"maximum":53577.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16078.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16399.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53577.57},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16078.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53577.57},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16078.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16078.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16399.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16078.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33477.59,"maximum":100074.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33477.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34147.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100074.4},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33477.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100074.4},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33477.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33477.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34147.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33477.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19793.75,"maximum":49700.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19793.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20189.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49700.02},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19793.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49700.02},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19793.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19793.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20189.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19793.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13359.36,"maximum":38809.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13359.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38809.18},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13359.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38809.18},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13359.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13359.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13359.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22718.23,"maximum":52970.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22718.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23172.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52970.65},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22718.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52970.65},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22718.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22718.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23172.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22718.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16362.5,"maximum":42383.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16362.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16689.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42383.26},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16362.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42383.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16362.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16362.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16689.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16362.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2420.04,"10th_percentile":2420.04,"90th_percentile":2420.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":49646.77,"10th_percentile":49646.77,"90th_percentile":49646.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13382.23,"maximum":35504.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35504.83},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35504.83},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35504.84,"10th_percentile":35504.84,"90th_percentile":35504.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32055.14,"maximum":110594.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32055.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32696.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":110594.35},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32055.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110594.35},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32055.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32055.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32696.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32055.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16782.38,"maximum":57117.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16782.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17118.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57117.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16782.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57117.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16782.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16782.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17118.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16782.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13690.5,"maximum":47508.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13690.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13964.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47508.37},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13690.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47508.37},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13690.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13690.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13964.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13690.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38878.31,"maximum":120844.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38878.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39655.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":120844.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38878.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120844.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38878.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38878.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39655.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38878.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34821.28,"10th_percentile":34821.28,"90th_percentile":34821.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":154241.78,"10th_percentile":154241.78,"90th_percentile":154241.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":120844.57,"10th_percentile":120844.57,"90th_percentile":120844.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20902.44,"maximum":69863.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20902.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21320.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69863.26},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20902.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69863.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20902.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20902.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21320.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20902.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14612.57,"maximum":51992.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14612.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51992.83},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14612.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51992.83},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14612.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14612.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14612.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18892.72,"maximum":48991.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18892.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19270.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48991.95},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18892.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48991.95},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18892.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18892.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19270.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18892.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10550.14,"maximum":26670.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10761.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26670.77},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26670.77},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10761.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7406.13,"maximum":19354.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7554.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19354.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19354.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7554.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17689.81,"maximum":42956.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17689.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18043.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42956.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17689.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42956.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17689.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17689.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18043.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17689.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":65722.27,"10th_percentile":28647.42,"90th_percentile":236739.53},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":13253.39,"10th_percentile":7264.76,"90th_percentile":18637.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":22099.37,"10th_percentile":22099.37,"90th_percentile":22099.37},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43134.66,"10th_percentile":43134.66,"90th_percentile":43134.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11728.79,"10th_percentile":11728.79,"90th_percentile":11728.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44504.12,"10th_percentile":37120.92,"90th_percentile":52674.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":39637.22,"10th_percentile":39637.22,"90th_percentile":86278.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":15942.19,"10th_percentile":12736.96,"90th_percentile":17943.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11235.3,"maximum":28457.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11235.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28457.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11235.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28457.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11235.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11235.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11235.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":35731.42,"10th_percentile":35731.42,"90th_percentile":35731.42},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7513.97,"10th_percentile":7513.97,"90th_percentile":10234.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7573.06,"10th_percentile":7573.06,"90th_percentile":7573.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29136.09,"10th_percentile":29136.09,"90th_percentile":29136.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18500.87,"10th_percentile":18500.87,"90th_percentile":18500.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8694.1,"maximum":26873.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8867.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26873.08},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26873.08},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8867.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":27962.58,"10th_percentile":27962.58,"90th_percentile":27962.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15800.84,"maximum":47980.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16116.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47980.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47980.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16116.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8583.42,"maximum":21747.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8755.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21747.97},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21747.97},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8755.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19743.02,"10th_percentile":19743.02,"90th_percentile":19743.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6572.78,"maximum":15813.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6704.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15813.64},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15813.64},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6704.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17305.62,"maximum":50306.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17305.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50306.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17305.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50306.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17305.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17305.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17305.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16244.77,"10th_percentile":16244.77,"90th_percentile":16244.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":18660.13,"10th_percentile":9556.96,"90th_percentile":176865.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":83556.31,"10th_percentile":83556.31,"90th_percentile":83556.31},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10015.96,"10th_percentile":10015.96,"90th_percentile":10015.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26710.58,"10th_percentile":26710.58,"90th_percentile":30839.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":22644.18,"10th_percentile":22644.18,"90th_percentile":22644.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"16","median_amount":19689.97,"10th_percentile":9383.62,"90th_percentile":196515.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":13508.14,"10th_percentile":11694.18,"90th_percentile":14906.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15624.97,"10th_percentile":15624.97,"90th_percentile":16857.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9718.63,"maximum":25861.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9913.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25861.54},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25861.54},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9913.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":20372.11,"10th_percentile":20372.11,"90th_percentile":20372.11},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"15","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":19491.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6459.59,"10th_percentile":6459.59,"90th_percentile":6459.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":12419.37,"10th_percentile":9515.48,"90th_percentile":17095.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"15","median_amount":9653.07,"10th_percentile":9383.62,"90th_percentile":21238.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":120781.28,"10th_percentile":120781.28,"90th_percentile":120781.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":8684.19,"10th_percentile":8684.19,"90th_percentile":8684.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":22834.58,"10th_percentile":22834.58,"90th_percentile":22834.58},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10573.74,"10th_percentile":10573.74,"90th_percentile":10573.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7289.04,"maximum":21545.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7434.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21545.67},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21545.67},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7434.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":22855.29,"10th_percentile":22855.29,"90th_percentile":22855.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16173.15,"maximum":39719.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16173.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16496.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39719.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16173.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39719.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16173.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16173.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16496.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16173.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10899.58,"maximum":28019.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11117.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28019.48},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28019.48},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11117.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13624.3,"10th_percentile":13624.3,"90th_percentile":13624.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8456.27,"maximum":23703.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8456.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23703.61},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8456.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23703.61},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8456.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8456.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8456.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11960.4,"10th_percentile":11960.4,"90th_percentile":11960.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":190505.51,"maximum":190505.51,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":190505.51},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":190505.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":123069.93,"maximum":123069.93,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":123069.93},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123069.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":101321.96,"maximum":101321.96,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":101321.96},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101321.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":77759.1,"maximum":224223.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77759.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79314.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":224223.3},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77759.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":224223.3},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77759.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77759.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79314.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77759.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55436.31,"maximum":166194.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55436.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56545.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":166194.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55436.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":166194.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55436.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55436.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56545.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55436.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39057.6,"maximum":145391.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39838.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145391.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145391.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39838.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39057.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":131094.77,"maximum":131094.77,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":131094.77},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131094.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72796.71,"maximum":72796.71,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":72796.71},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72796.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51410.47,"maximum":218187.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51410.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52438.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":218187.82},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51410.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":218187.82},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51410.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51410.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52438.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51410.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25221.0,"maximum":63085.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25221.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25725.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63085.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25221.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63085.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25221.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25221.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25725.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25221.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53025.01,"maximum":120608.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53025.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54085.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":120608.53},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53025.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120608.53},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53025.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53025.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54085.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53025.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29380.4,"maximum":71313.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29380.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71313.13},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29380.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71313.13},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29380.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29380.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29968.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29380.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17570.9,"maximum":47036.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17922.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47036.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47036.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17922.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":39260.74,"10th_percentile":39260.74,"90th_percentile":39260.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48505.2,"maximum":101187.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48505.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49475.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":101187.09},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48505.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101187.09},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48505.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48505.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49475.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48505.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33148.28,"maximum":71380.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33148.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33811.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71380.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33148.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71380.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33148.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33148.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33811.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33148.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26025.99,"maximum":57455.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26546.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57455.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57455.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26546.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26025.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28634.87,"maximum":73302.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28634.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29207.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":73302.48},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28634.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73302.48},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28634.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28634.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29207.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28634.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18533.22,"maximum":40360.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18533.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18903.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40360.19},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18533.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40360.19},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18533.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18533.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18903.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18533.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45059.31,"maximum":101760.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45059.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45960.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":101760.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45059.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101760.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45059.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45059.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45960.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45059.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27838.12,"maximum":63895.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27838.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28394.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63895.21},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27838.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63895.21},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27838.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27838.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28394.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27838.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23220.43,"maximum":51756.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23220.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23684.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51756.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23220.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51756.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23220.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23220.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23684.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23220.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40158.05,"maximum":99197.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40158.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40961.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":99197.74},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40158.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99197.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40158.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40158.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40961.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40158.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21705.59,"maximum":53105.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21705.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53105.52},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21705.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53105.52},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21705.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21705.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21705.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11684.44,"maximum":39921.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11684.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11918.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39921.86},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11684.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39921.86},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11684.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11684.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11918.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11684.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32489.65,"maximum":84260.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32489.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33139.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":84260.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32489.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84260.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32489.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32489.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33139.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32489.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23384.17,"maximum":55330.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23384.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23851.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55330.89},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23384.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55330.89},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23384.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23384.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23851.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23384.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17892.89,"maximum":42248.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18250.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42248.39},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42248.39},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18250.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27528.93,"maximum":84260.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27528.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28079.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":84260.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27528.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84260.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27528.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27528.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28079.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27528.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20048.05,"maximum":59242.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59242.16},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59242.16},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15808.16,"maximum":42956.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15808.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42956.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15808.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42956.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15808.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15808.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15808.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26244.61,"maximum":49565.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26244.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26769.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49565.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26244.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49565.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26244.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26244.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26769.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26244.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30408.58,"maximum":111336.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30408.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31016.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111336.14},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30408.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111336.14},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30408.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30408.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31016.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30408.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20016.95,"maximum":46294.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20016.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20417.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46294.53},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20016.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46294.53},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20016.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20016.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20417.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20016.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15215.4,"maximum":35403.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15215.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15519.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35403.68},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15215.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35403.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15215.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15215.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15519.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15215.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17069.61,"maximum":60725.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17411.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60725.74},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60725.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17069.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17411.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17069.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":238.1,"10th_percentile":238.1,"90th_percentile":238.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11104.49,"maximum":36347.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36347.78},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36347.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34474.67,"maximum":77955.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34474.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35164.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77955.53},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34474.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77955.53},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34474.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34474.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35164.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34474.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24087.62,"maximum":62108.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24087.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24569.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62108.17},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24087.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62108.17},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24087.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24087.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24569.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24087.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19243.07,"maximum":44102.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19243.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44102.87},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19243.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44102.87},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19243.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19243.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19627.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19243.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44460.02,"10th_percentile":44460.02,"90th_percentile":44460.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":34185.31,"10th_percentile":34185.31,"90th_percentile":34185.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34054.8,"maximum":121215.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34054.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34735.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121215.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34054.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121215.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34054.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34054.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34735.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34054.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17389.77,"maximum":44945.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17389.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17737.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44945.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17389.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44945.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17389.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17389.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17737.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17389.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11941.49,"maximum":35808.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11941.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12180.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35808.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11941.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35808.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11941.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11941.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12180.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11941.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28484.85,"maximum":86755.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28484.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29054.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86755.87},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28484.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86755.87},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28484.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28484.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29054.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28484.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19318.99,"maximum":42889.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19705.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42889.03},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42889.03},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19705.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19318.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29838.69,"maximum":70166.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29838.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30435.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70166.72},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29838.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70166.72},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29838.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29838.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30435.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29838.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16879.34,"maximum":43293.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17216.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43293.64},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43293.64},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17216.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16879.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13200.19,"maximum":32470.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13200.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13464.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32470.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13200.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32470.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13200.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13200.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13464.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13200.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":20561.0,"10th_percentile":20561.0,"90th_percentile":20561.0},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26420.25,"maximum":88745.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26420.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26948.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":88745.22},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26420.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88745.22},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26420.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26420.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26948.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26420.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17987.11,"maximum":42147.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17987.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18346.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42147.24},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17987.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42147.24},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17987.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17987.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18346.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17987.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17288.24,"maximum":38370.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17288.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17634.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38370.85},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17288.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38370.85},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17288.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17288.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17634.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17288.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13230.38,"maximum":48553.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13494.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48553.62},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48553.62},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13494.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13230.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":33430.74,"10th_percentile":33430.74,"90th_percentile":33430.74},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17412.64,"maximum":68784.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17412.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17760.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68784.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17412.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68784.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17412.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17412.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17760.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17412.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14741.56,"maximum":48587.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14741.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15036.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48587.34},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14741.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48587.34},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14741.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14741.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15036.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14741.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49767.46,"maximum":49767.46,"payers_information":[{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49767.46},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49767.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52156.91,"maximum":181705.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52156.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53200.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":181705.17},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52156.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181705.17},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52156.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52156.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53200.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52156.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":119351.22,"maximum":404984.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119351.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121738.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404984.38},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119351.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":404984.38},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119351.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119351.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121738.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119351.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43305.73,"maximum":161980.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43305.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44171.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":161980.26},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43305.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161980.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43305.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43305.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44171.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43305.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":95204.41,"maximum":357610.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95204.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97108.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":357610.88},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95204.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":357610.88},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95204.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95204.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97108.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95204.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":127595.01,"maximum":336975.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127595.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130146.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":336975.59},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127595.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":336975.59},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127595.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127595.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130146.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127595.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":118405.93,"10th_percentile":118405.93,"90th_percentile":118405.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":106383.37,"10th_percentile":106383.37,"90th_percentile":106383.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":118676.39,"10th_percentile":118676.39,"90th_percentile":118676.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":337169.73,"10th_percentile":337169.73,"90th_percentile":337169.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":236982.46,"10th_percentile":236982.46,"90th_percentile":236982.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":132048.33,"10th_percentile":132048.33,"90th_percentile":132048.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":126806.7,"10th_percentile":126806.7,"90th_percentile":126806.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":195047.29,"maximum":507688.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195047.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198948.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":507688.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195047.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":507688.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195047.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195047.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198948.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195047.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":274343.53,"10th_percentile":274343.53,"90th_percentile":274343.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2416341.9,"10th_percentile":2416341.9,"90th_percentile":2416341.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":447522.63,"10th_percentile":447522.63,"90th_percentile":447522.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":484185.62,"10th_percentile":484185.62,"90th_percentile":484185.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":104546.81,"maximum":446895.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104546.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106637.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":446895.59},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104546.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":446895.59},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104546.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104546.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106637.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104546.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":257238.8,"maximum":672568.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257238.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262383.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":672568.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257238.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":672568.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257238.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257238.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262383.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257238.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10264.74,"maximum":22894.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10264.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10470.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22894.38},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10264.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22894.38},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10264.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10264.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10470.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10264.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":19646.83,"10th_percentile":19646.83,"90th_percentile":24911.3},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":6174.62,"10th_percentile":710.22,"90th_percentile":8079.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9250.04,"90th_percentile":15041.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9814.2,"10th_percentile":9814.2,"90th_percentile":9814.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18948.89,"10th_percentile":18948.89,"90th_percentile":18948.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7346.41,"10th_percentile":6643.68,"90th_percentile":9551.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13837.91,"10th_percentile":13835.23,"90th_percentile":59767.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":23246.53,"10th_percentile":23246.53,"90th_percentile":23246.53},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":17198.89,"10th_percentile":17198.89,"90th_percentile":17198.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":21777.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7596.41,"10th_percentile":7596.41,"90th_percentile":7596.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":13071.37,"10th_percentile":13071.37,"90th_percentile":13071.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":6665.63,"10th_percentile":1031.29,"90th_percentile":9885.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15393.21,"10th_percentile":15393.21,"90th_percentile":15393.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7916.56,"maximum":15645.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8074.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15645.05},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15645.05},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8074.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":18941.88,"10th_percentile":18941.88,"90th_percentile":22174.3},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":838.2,"10th_percentile":775.78,"90th_percentile":7379.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12559.81,"10th_percentile":12559.81,"90th_percentile":12559.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5254.76,"10th_percentile":5254.76,"90th_percentile":5254.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":13837.91,"10th_percentile":13284.81,"90th_percentile":19866.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":26881.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43894.83,"maximum":153078.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43894.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44772.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":153078.77},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43894.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153078.77},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43894.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43894.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44772.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43894.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34787.52,"maximum":119360.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34787.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35483.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":119360.98},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34787.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119360.98},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34787.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34787.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35483.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34787.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30430.54,"maximum":134028.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30430.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31039.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134028.22},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30430.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134028.22},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30430.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30430.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31039.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30430.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48422.87,"maximum":183627.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48422.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49391.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":183627.08},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48422.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183627.08},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48422.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48422.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49391.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48422.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26495.26,"maximum":73605.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26495.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27025.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":73605.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26495.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73605.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26495.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26495.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27025.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26495.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20250.22,"maximum":60793.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20250.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20655.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60793.18},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20250.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60793.18},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20250.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20250.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20655.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20250.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30012.49,"maximum":77921.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30012.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30612.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77921.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30012.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77921.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30012.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30012.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30612.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30012.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17628.53,"maximum":47912.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17628.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17981.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47912.98},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17628.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47912.98},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17628.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17628.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17981.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17628.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":41416.87,"10th_percentile":41416.87,"90th_percentile":41416.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43418.4,"10th_percentile":43418.4,"90th_percentile":43418.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14906.16,"10th_percentile":14906.16,"90th_percentile":14906.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15083.67,"maximum":40528.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15083.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40528.78},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15083.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40528.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15083.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15083.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15083.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41023.1,"10th_percentile":41023.1,"90th_percentile":41023.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42769.7,"10th_percentile":42769.7,"90th_percentile":42769.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24131.53,"maximum":52869.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24131.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24614.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52869.49},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24131.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52869.49},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24131.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24131.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24614.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24131.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12978.82,"maximum":29705.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12978.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13238.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29705.37},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12978.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29705.37},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12978.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12978.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13238.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12978.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34707.81,"10th_percentile":34707.81,"90th_percentile":34707.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10359.87,"maximum":24243.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10567.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24243.09},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24243.09},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10567.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10359.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20276.04,"10th_percentile":20276.04,"90th_percentile":20276.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28893.75,"maximum":101254.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28893.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29471.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":101254.52},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28893.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101254.52},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28893.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28893.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29471.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28893.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14794.61,"maximum":50880.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15090.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50880.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50880.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15090.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14794.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10465.07,"maximum":37359.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10465.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10674.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37359.31},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10465.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37359.31},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10465.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10465.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10674.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10465.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29439.85,"maximum":103547.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29439.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30028.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103547.33},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29439.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103547.33},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29439.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29439.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30028.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29439.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16890.32,"maximum":58196.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16890.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58196.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16890.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58196.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16890.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16890.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16890.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11007.52,"maximum":34392.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11007.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11227.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34392.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11007.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34392.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11007.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11007.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11227.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11007.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27599.37,"maximum":79776.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27599.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":79776.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27599.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79776.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27599.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27599.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27599.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15085.5,"maximum":32908.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32908.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32908.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15387.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9828.4,"maximum":25558.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25558.08},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25558.08},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17308.36,"maximum":59208.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17308.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17654.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59208.44},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17308.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59208.44},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17308.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17308.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17654.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17308.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10763.28,"maximum":34054.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10978.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34054.97},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34054.97},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10978.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10763.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39322.88,"maximum":76168.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39322.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40109.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76168.49},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39322.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76168.49},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39322.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39322.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40109.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39322.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34076.72,"10th_percentile":34076.72,"90th_percentile":34076.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61461.75,"10th_percentile":61461.75,"90th_percentile":61461.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28870.4,"10th_percentile":28870.4,"90th_percentile":28870.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44394.02,"10th_percentile":44394.02,"90th_percentile":44394.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":20219.47,"10th_percentile":20219.47,"90th_percentile":20219.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22280.97,"maximum":53948.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22280.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22726.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53948.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22280.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53948.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22280.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22280.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22726.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22280.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":96256.38,"10th_percentile":96256.38,"90th_percentile":96256.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":29899.57,"10th_percentile":29899.57,"90th_percentile":29899.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15903.3,"maximum":49396.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15903.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16221.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49396.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15903.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49396.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15903.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15903.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16221.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15903.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14436.03,"maximum":28188.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14436.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14724.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28188.07},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14436.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28188.07},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14436.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14436.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14724.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14436.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":7947.49,"10th_percentile":7947.49,"90th_percentile":7947.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8899.92,"maximum":15914.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8899.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9077.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15914.8},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8899.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15914.8},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8899.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8899.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9077.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8899.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30594.26,"10th_percentile":30594.26,"90th_percentile":30594.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":27337.53,"10th_percentile":27337.53,"90th_percentile":27337.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6379.77,"maximum":12273.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12273.28},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12273.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28120.9,"10th_percentile":28120.9,"90th_percentile":28120.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17387.94,"maximum":47879.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17387.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17735.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47879.26},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17387.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47879.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17387.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17387.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17735.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17387.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8586.31,"10th_percentile":8586.31,"90th_percentile":8586.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9287.0,"10th_percentile":9287.0,"90th_percentile":9287.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53439.36,"10th_percentile":53439.36,"90th_percentile":53439.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":43226.62,"10th_percentile":43226.62,"90th_percentile":43226.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10473.3,"maximum":26030.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10473.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10682.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26030.13},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10473.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26030.13},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10473.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10473.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10682.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10473.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19996.26,"10th_percentile":19996.26,"90th_percentile":19996.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8117.81,"maximum":19623.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8280.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19623.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19623.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8280.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11502.4,"maximum":31829.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31829.59},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31829.59},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8293.44,"maximum":16690.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8459.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16690.31},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16690.31},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8459.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12759.81,"10th_percentile":12759.81,"90th_percentile":12759.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18271.08,"10th_percentile":18271.08,"90th_percentile":18271.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13187.38,"maximum":46901.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13187.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46901.45},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13187.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46901.45},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13187.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13187.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13187.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8039.14,"maximum":15847.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15847.36},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15847.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13824.3,"10th_percentile":13824.3,"90th_percentile":13824.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11351.47,"maximum":39517.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11578.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39517.25},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39517.25},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11578.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7191.16,"maximum":16488.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7191.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7334.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16488.0},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7191.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16488.0},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7191.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7191.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7334.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7191.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":24771.46,"10th_percentile":24771.46,"90th_percentile":24771.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10747.73,"maximum":35471.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10747.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10962.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35471.12},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10747.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35471.12},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10747.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10747.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10962.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10747.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16022.21,"maximum":41472.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16022.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16342.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41472.88},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16022.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41472.88},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16022.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16022.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16342.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16022.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":29769.23,"10th_percentile":15250.0,"90th_percentile":70903.74},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":10092.33,"10th_percentile":6479.97,"90th_percentile":11581.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":40134.2,"10th_percentile":40134.2,"90th_percentile":40134.2},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9250.04,"10th_percentile":9250.04,"90th_percentile":9250.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13475.86,"10th_percentile":13475.86,"90th_percentile":13475.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11764.24,"10th_percentile":10920.86,"90th_percentile":12733.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41472.88,"10th_percentile":31446.24,"90th_percentile":91274.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":11502.04,"10th_percentile":11502.04,"90th_percentile":11502.04},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":13966.65,"10th_percentile":13966.65,"90th_percentile":13966.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":10229.04,"10th_percentile":10112.72,"90th_percentile":31603.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9560.23,"10th_percentile":2277.65,"90th_percentile":11881.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"23","median_amount":10996.45,"10th_percentile":6682.41,"90th_percentile":12972.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11976.68,"10th_percentile":11382.67,"90th_percentile":13627.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10173.26,"maximum":24007.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10173.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10376.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24007.07},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10173.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24007.07},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10173.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10173.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10376.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10173.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":18867.82,"10th_percentile":18867.82,"90th_percentile":18867.82},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7076.3,"10th_percentile":891.41,"90th_percentile":8111.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":20704.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82122.28,"10th_percentile":82122.28,"90th_percentile":82122.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6658.63,"10th_percentile":6392.2,"90th_percentile":6895.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21789.17,"10th_percentile":21789.17,"90th_percentile":22705.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":15872.38,"10th_percentile":15872.38,"90th_percentile":15872.38},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":27455.17,"10th_percentile":9653.07,"90th_percentile":55949.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11929.21,"10th_percentile":11929.21,"90th_percentile":11929.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"14","median_amount":8233.29,"10th_percentile":5674.95,"90th_percentile":13163.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":26277.98,"10th_percentile":26277.98,"90th_percentile":26277.98},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7199.39,"maximum":21309.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7343.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21309.64},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21309.64},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7343.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":3668.04,"10th_percentile":3668.04,"90th_percentile":3668.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7892.47,"10th_percentile":7892.47,"90th_percentile":7892.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6510.13,"10th_percentile":6510.13,"90th_percentile":6510.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":31140.65,"10th_percentile":31140.65,"90th_percentile":31140.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19186.35,"maximum":48991.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19570.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48991.95},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48991.95},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19570.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19186.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49633.78,"10th_percentile":49633.78,"90th_percentile":49633.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14922.68,"maximum":44541.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14922.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15221.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44541.2},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14922.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44541.2},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14922.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14922.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15221.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14922.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22175.78,"maximum":76337.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76337.08},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76337.08},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22175.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22619.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22175.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13706.05,"maximum":47440.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13706.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13980.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47440.93},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13706.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47440.93},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13706.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13706.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13980.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13706.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19950.18,"maximum":70975.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19950.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20349.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70975.95},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19950.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70975.95},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19950.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19950.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20349.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19950.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10948.06,"maximum":39416.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39416.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39416.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11167.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14640.93,"maximum":37393.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14640.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37393.03},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14640.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37393.03},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14640.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14640.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14640.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14445.83,"10th_percentile":14445.83,"90th_percentile":14445.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10561.12,"maximum":26906.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10561.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26906.8},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10561.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26906.8},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10561.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10561.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10561.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21354.33,"maximum":73369.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21354.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21781.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":73369.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21354.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73369.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21354.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21354.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21781.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21354.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14344.55,"maximum":46125.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14631.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46125.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46125.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14631.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18181.95,"maximum":38438.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18545.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38438.28},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38438.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18545.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":4180.44,"10th_percentile":4180.44,"90th_percentile":4180.44},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13174.58,"maximum":25895.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13438.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25895.26},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25895.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13438.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17442.83,"maximum":60422.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17442.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17791.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60422.28},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17442.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60422.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17442.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17442.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17791.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17442.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6218.52,"10th_percentile":6218.52,"90th_percentile":6218.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11143.89,"10th_percentile":11143.89,"90th_percentile":11143.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15273.85,"10th_percentile":15273.85,"90th_percentile":15273.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11341.41,"maximum":37730.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11568.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37730.21},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37730.21},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11568.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10344.75,"10th_percentile":10344.75,"90th_percentile":10344.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":41271.12,"10th_percentile":41271.12,"90th_percentile":41271.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":762.58,"10th_percentile":762.58,"90th_percentile":762.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6886.55,"maximum":25625.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25625.52},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25625.52},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11592.96,"maximum":42248.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11824.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42248.39},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42248.39},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11824.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7493.03,"maximum":25119.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25119.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25119.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14453.41,"maximum":51419.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14453.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14742.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51419.63},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14453.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51419.63},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14453.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14453.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14742.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14453.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1231.27,"10th_percentile":1231.27,"90th_percentile":1231.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8308.99,"maximum":18039.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18039.02},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18039.02},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10573.01,"maximum":34661.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10573.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10784.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34661.89},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10573.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34661.89},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10573.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10573.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10784.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10573.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7035.65,"maximum":20938.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7035.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7176.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20938.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7035.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20938.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7035.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7035.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7176.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7035.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5057.67,"10th_percentile":5057.67,"90th_percentile":5057.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":3646.13,"10th_percentile":3646.13,"90th_percentile":3646.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20372.79,"maximum":50003.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20372.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20780.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50003.48},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20372.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50003.48},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20372.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20372.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20780.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20372.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13196.53,"maximum":40427.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13196.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40427.63},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13196.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40427.63},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13196.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13196.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13196.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33586.44,"maximum":136961.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33586.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34258.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":136961.66},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33586.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136961.66},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33586.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33586.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34258.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33586.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19737.95,"maximum":50880.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19737.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20132.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50880.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19737.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50880.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19737.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19737.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20132.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19737.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14321.68,"maximum":37055.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14321.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14608.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37055.85},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14321.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37055.85},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14321.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14321.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14608.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14321.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33662.37,"maximum":125733.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33662.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34335.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":125733.64},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33662.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125733.64},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33662.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33662.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34335.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33662.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17441.91,"maximum":50070.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17441.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50070.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17441.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50070.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17441.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17441.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17441.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13933.83,"maximum":35133.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13933.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35133.94},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13933.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35133.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13933.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13933.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14212.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13933.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17672.43,"maximum":41574.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17672.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41574.04},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17672.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41574.04},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17672.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17672.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18025.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17672.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43191.22,"10th_percentile":43191.22,"90th_percentile":43191.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":69785.62,"10th_percentile":69785.62,"90th_percentile":69785.62},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":49968.2,"10th_percentile":49968.2,"90th_percentile":49968.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12237.87,"maximum":28963.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12237.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12482.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28963.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12237.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28963.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12237.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12237.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12482.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12237.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":137.63,"10th_percentile":137.63,"90th_percentile":137.63},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":56193.58,"10th_percentile":56193.58,"90th_percentile":56193.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":67458.3,"10th_percentile":67458.3,"90th_percentile":67458.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37423.89,"10th_percentile":37423.89,"90th_percentile":37423.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28505.2,"10th_percentile":28505.2,"90th_percentile":30213.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":31513.51,"10th_percentile":31513.51,"90th_percentile":31513.51},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19632.76,"maximum":31964.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19632.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20025.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31964.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19632.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31964.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19632.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19632.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20025.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19632.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11293.84,"maximum":19050.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11293.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11519.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19050.55},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11293.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19050.55},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11293.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11293.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11519.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11293.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":16378.16,"10th_percentile":16378.16,"90th_percentile":16378.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":18486.34,"10th_percentile":18486.34,"90th_percentile":18486.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16778.72,"maximum":35707.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17114.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35707.14},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35707.14},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17114.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16778.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9633.6,"10th_percentile":9633.6,"90th_percentile":9633.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8752.65,"maximum":24883.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8927.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24883.73},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24883.73},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8927.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13312.91,"10th_percentile":13312.91,"90th_percentile":13312.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13837.91,"10th_percentile":13837.91,"90th_percentile":13837.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":24870.67,"10th_percentile":24870.67,"90th_percentile":24870.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":15088.53,"10th_percentile":15088.53,"90th_percentile":15088.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13578.9,"maximum":45282.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13578.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13850.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45282.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13578.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45282.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13578.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13578.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13850.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13578.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24375.77,"maximum":53341.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24375.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53341.54},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24375.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53341.54},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24375.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24375.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24863.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24375.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14388.46,"maximum":46800.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14676.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46800.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46800.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14676.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17735.55,"maximum":44035.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17735.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18090.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44035.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17735.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44035.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17735.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17735.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18090.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17735.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":37962.65,"10th_percentile":37962.65,"90th_percentile":37962.65},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10850.47,"10th_percentile":10850.47,"90th_percentile":10850.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":116620.93,"10th_percentile":116620.93,"90th_percentile":116620.93},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52918.28,"10th_percentile":52918.28,"90th_percentile":52918.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":19158.26,"10th_percentile":18746.72,"90th_percentile":25208.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17149.55,"10th_percentile":17149.55,"90th_percentile":17149.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10839.21,"maximum":26266.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26266.16},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26266.16},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":36423.95,"10th_percentile":36423.95,"90th_percentile":36423.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21069.78,"10th_percentile":21069.78,"90th_percentile":21069.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26771.82,"10th_percentile":26771.82,"90th_percentile":26771.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":17731.64,"10th_percentile":17731.64,"90th_percentile":17731.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9674.72,"maximum":23298.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9868.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23298.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23298.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9868.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13986.88,"maximum":49396.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14266.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49396.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49396.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14266.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":63390.05,"10th_percentile":63390.05,"90th_percentile":63390.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9843.95,"maximum":20601.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9843.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10040.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20601.57},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9843.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20601.57},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9843.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9843.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10040.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9843.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":5226.86,"10th_percentile":5226.86,"90th_percentile":5226.86},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":11490.37,"10th_percentile":11490.37,"90th_percentile":11490.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6958.81,"maximum":16825.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16825.18},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16825.18},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6958.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10104.66,"maximum":20601.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10306.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20601.57},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20601.57},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10306.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7849.95,"10th_percentile":7849.95,"90th_percentile":7849.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9624.88,"10th_percentile":9624.88,"90th_percentile":9624.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23201.16,"10th_percentile":18730.63,"90th_percentile":48075.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":15342.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":30353.14,"10th_percentile":30353.14,"90th_percentile":30353.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6107.17,"maximum":15645.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6229.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15645.05},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15645.05},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6229.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10429.4,"10th_percentile":10429.4,"90th_percentile":10429.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13284.81,"10th_percentile":13178.95,"90th_percentile":13284.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10691.02,"maximum":17398.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10691.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17398.38},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10691.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17398.38},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10691.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10691.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10904.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10691.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":19122.66,"10th_percentile":19122.66,"90th_percentile":37266.35},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":26403.62,"10th_percentile":26403.62,"90th_percentile":26403.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":12014.21,"10th_percentile":12014.21,"90th_percentile":12014.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17398.38,"10th_percentile":12777.86,"90th_percentile":20768.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":20733.53,"10th_percentile":20733.53,"90th_percentile":20733.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16346.04,"maximum":37595.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16346.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16672.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37595.34},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16346.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37595.34},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16346.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16346.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16672.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16346.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37098.1,"10th_percentile":37098.1,"90th_percentile":37098.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":10385.3,"10th_percentile":10385.3,"90th_percentile":10385.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10060.75,"maximum":18477.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10261.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18477.35},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18477.35},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10261.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19656.49,"10th_percentile":19656.49,"90th_percentile":19656.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6877.4,"maximum":11767.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7014.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11767.51},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11767.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7014.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2190.52,"10th_percentile":2190.52,"90th_percentile":2190.52},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11435.4,"10th_percentile":11435.4,"90th_percentile":11435.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11767.51,"10th_percentile":11767.51,"90th_percentile":13328.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":6923.0,"10th_percentile":6923.0,"90th_percentile":6923.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8584.33,"maximum":12475.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12475.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12475.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12575.59,"10th_percentile":12575.59,"90th_percentile":12575.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23346.67,"maximum":27918.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23346.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23813.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27918.33},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23346.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27918.33},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23346.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23346.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23813.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23346.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":50072.03,"10th_percentile":50072.03,"90th_percentile":50072.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10585.82,"maximum":24276.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10585.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10797.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24276.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10585.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24276.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10585.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10585.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10797.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10585.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9650.02,"maximum":20298.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9650.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9843.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20298.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9650.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20298.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9650.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9650.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9843.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9650.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":29527.33,"10th_percentile":29527.33,"90th_percentile":29527.33},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":18645.74,"10th_percentile":18645.74,"90th_percentile":18645.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20713.39,"10th_percentile":20713.39,"90th_percentile":20713.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":20608.67,"10th_percentile":19558.46,"90th_percentile":21453.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":28384.21,"10th_percentile":28384.21,"90th_percentile":28384.21},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":187.26,"10th_percentile":159.74,"90th_percentile":19583.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":19335.24,"10th_percentile":19335.24,"90th_percentile":24599.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":32605.75,"10th_percentile":32605.75,"90th_percentile":32605.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15977.39,"maximum":27446.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15977.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16296.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27446.28},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15977.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27446.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15977.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15977.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16296.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15977.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":54803.84,"10th_percentile":54803.84,"90th_percentile":54803.84},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20382.93,"10th_percentile":20382.93,"90th_percentile":20382.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":43402.63,"10th_percentile":43402.63,"90th_percentile":43402.63},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11104.49,"maximum":24310.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24310.53},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24310.53},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":27194.31,"10th_percentile":27194.31,"90th_percentile":27194.31},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":15860.02,"10th_percentile":15860.02,"90th_percentile":15860.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15346.63,"10th_percentile":15346.63,"90th_percentile":15346.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21309.56,"10th_percentile":21309.56,"90th_percentile":21309.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":18839.69,"10th_percentile":18839.69,"90th_percentile":18839.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9659.17,"maximum":20399.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9852.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20399.26},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20399.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9659.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9852.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9659.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"14","median_amount":36841.73,"10th_percentile":27720.96,"90th_percentile":50461.41},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":35112.27,"10th_percentile":34637.4,"90th_percentile":37957.92},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"24","median_amount":15467.17,"10th_percentile":9692.8,"90th_percentile":22023.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20709.82,"10th_percentile":20702.06,"90th_percentile":20943.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"69","median_amount":20722.76,"10th_percentile":18415.66,"90th_percentile":21393.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":32054.61,"10th_percentile":27022.64,"90th_percentile":33478.35},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"11","median_amount":15073.75,"10th_percentile":12814.19,"90th_percentile":20751.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"29","median_amount":20037.28,"10th_percentile":12876.29,"90th_percentile":32685.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":32105.29,"10th_percentile":28525.77,"90th_percentile":37013.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17374.22,"maximum":37629.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17721.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37629.05},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37629.05},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17721.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55257.01,"maximum":210230.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55257.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56362.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":210230.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55257.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":210230.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55257.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55257.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56362.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55257.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":13792.68,"10th_percentile":13792.68,"90th_percentile":13792.68},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":23400.56,"10th_percentile":23400.56,"90th_percentile":23400.56},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":39675.04,"10th_percentile":3662.02,"90th_percentile":77868.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39636.21,"10th_percentile":39636.21,"90th_percentile":39636.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":80956.42,"10th_percentile":25615.4,"90th_percentile":226865.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":6894.18,"10th_percentile":3646.13,"90th_percentile":12449.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":33168.13,"10th_percentile":27773.48,"90th_percentile":53409.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":112020.35,"10th_percentile":112020.35,"90th_percentile":112020.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38018.44,"maximum":66154.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38018.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38778.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66154.3},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38018.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66154.3},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38018.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38018.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38778.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38018.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":19447.5,"10th_percentile":19447.5,"90th_percentile":19447.5},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":16665.19,"10th_percentile":16665.19,"90th_percentile":16665.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":5567.67,"10th_percentile":5567.67,"90th_percentile":57413.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66860.03,"10th_percentile":65954.31,"90th_percentile":89941.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":12244.21,"10th_percentile":12244.21,"90th_percentile":12244.21},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":14739.6,"10th_percentile":14739.6,"90th_percentile":14739.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":76329.22,"10th_percentile":9397.59,"90th_percentile":86341.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20871.31,"maximum":23758.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23292.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23758.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20871.31},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23292.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20871.31},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23292.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23292.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23758.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23292.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":6016.57,"10th_percentile":6016.57,"90th_percentile":6016.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":45341.78,"10th_percentile":34192.1,"90th_percentile":72655.64},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"11","median_amount":20335.14,"10th_percentile":3662.02,"90th_percentile":38411.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22217.14,"10th_percentile":22217.14,"90th_percentile":22217.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":22217.14,"10th_percentile":20671.32,"90th_percentile":51860.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":11718.51,"10th_percentile":11718.51,"90th_percentile":11718.51},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":3646.13,"10th_percentile":3646.13,"90th_percentile":30300.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"21","median_amount":3235.43,"10th_percentile":3160.13,"90th_percentile":28666.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":16969.55,"10th_percentile":16969.55,"90th_percentile":16969.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27277.69,"maximum":39810.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39030.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39810.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27277.69},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39030.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27277.69},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39030.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39030.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39810.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39030.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":68464.12,"10th_percentile":68464.12,"90th_percentile":68464.12},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":3662.02,"10th_percentile":3662.02,"90th_percentile":11925.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28857.95,"10th_percentile":28857.95,"90th_percentile":28857.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28857.95,"10th_percentile":27277.7,"90th_percentile":39636.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":4126.97,"10th_percentile":3646.13,"90th_percentile":37456.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":3235.43,"10th_percentile":3235.43,"90th_percentile":6490.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":24568.6,"10th_percentile":24568.6,"90th_percentile":24568.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7249.32,"maximum":14677.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14389.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14677.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7249.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14389.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7249.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14389.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14389.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14677.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14389.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":10025.15,"10th_percentile":5255.73,"90th_percentile":13040.05},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":19283.07,"10th_percentile":19283.07,"90th_percentile":19283.07},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"20","median_amount":3662.02,"10th_percentile":3662.02,"90th_percentile":6489.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5436.04,"10th_percentile":5436.04,"90th_percentile":5436.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":7249.32,"10th_percentile":7130.39,"90th_percentile":11578.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":20321.9,"10th_percentile":20321.9,"90th_percentile":20321.9},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":3646.13,"10th_percentile":3646.13,"90th_percentile":7949.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"26","median_amount":3160.13,"10th_percentile":3160.13,"90th_percentile":3235.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":6047.53,"10th_percentile":5548.01,"90th_percentile":19080.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2716.17,"maximum":5057.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2716.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2770.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5057.67},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2716.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5057.67},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2716.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2716.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2770.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2716.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"18","median_amount":7653.08,"10th_percentile":3310.62,"90th_percentile":10983.19},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2911.1,"10th_percentile":2101.25,"90th_percentile":6919.3},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"51","median_amount":3662.02,"10th_percentile":3662.02,"90th_percentile":3662.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":1078.31,"10th_percentile":1078.31,"90th_percentile":1078.31},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":5423.9,"10th_percentile":5057.67,"90th_percentile":5423.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"79","median_amount":5057.67,"10th_percentile":4147.32,"90th_percentile":5423.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":4110.93,"10th_percentile":3803.4,"90th_percentile":7123.08},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"23","median_amount":3646.13,"10th_percentile":3646.13,"90th_percentile":3646.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"52","median_amount":3235.43,"10th_percentile":3160.13,"90th_percentile":6470.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":4418.3,"10th_percentile":3703.37,"90th_percentile":9530.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11563.69,"maximum":38235.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11563.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11794.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38235.97},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11563.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38235.97},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11563.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11563.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11794.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11563.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10039.71,"maximum":26165.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26165.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26165.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26990.35,"10th_percentile":26990.35,"90th_percentile":26990.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9643.62,"maximum":21984.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21984.0},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21984.0},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":28084.24,"10th_percentile":28084.24,"90th_percentile":28084.24},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":10046.76,"10th_percentile":10046.76,"90th_percentile":10046.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22808.21,"10th_percentile":22808.21,"90th_percentile":22808.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":133.12,"10th_percentile":133.12,"90th_percentile":133.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":15279.76,"10th_percentile":14726.44,"90th_percentile":17349.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42316.88,"maximum":102636.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42316.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43163.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":102636.95},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42316.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102636.95},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42316.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42316.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43163.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42316.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26587.65,"maximum":77517.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26587.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27119.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77517.2},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26587.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77517.2},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26587.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26587.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27119.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26587.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28518.7,"maximum":93229.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28518.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29089.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":93229.69},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28518.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93229.69},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28518.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28518.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29089.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28518.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19909.93,"maximum":49497.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49497.72},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49497.72},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20308.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16031.36,"maximum":36111.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16031.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16351.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36111.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16031.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36111.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16031.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16031.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16351.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16031.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15289.49,"maximum":30919.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15595.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30919.21},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30919.21},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15595.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32339.12,"10th_percentile":32339.12,"90th_percentile":32339.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10240.04,"maximum":25119.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25119.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25119.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10240.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30040.85,"maximum":83754.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30040.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30641.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83754.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30040.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83754.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30040.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30040.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30641.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30040.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19898.03,"maximum":56072.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19898.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20295.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56072.68},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19898.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56072.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19898.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19898.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20295.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19898.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14945.55,"maximum":34796.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14945.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15244.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34796.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14945.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34796.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14945.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14945.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15244.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14945.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35075.67,"maximum":70133.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35777.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70133.0},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70133.0},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35777.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35075.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19185.44,"maximum":45451.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45451.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45451.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14554.03,"maximum":31188.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14845.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31188.96},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31188.96},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14845.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14554.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32987.27,"10th_percentile":32987.27,"90th_percentile":32987.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27143.82,"maximum":91476.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27143.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27686.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91476.36},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27143.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91476.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27143.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27143.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27686.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27143.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20260.28,"maximum":55094.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20260.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20665.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55094.87},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20260.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55094.87},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20260.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20260.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20665.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20260.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15229.12,"maximum":51554.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15533.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51554.5},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51554.5},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15533.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8262.34,"maximum":26873.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8427.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26873.08},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26873.08},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8427.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12615.66,"maximum":43158.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12615.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12867.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43158.77},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12615.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43158.77},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12615.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12615.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12867.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12615.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8276.06,"maximum":20669.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20669.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20669.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9618.01,"maximum":32537.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9618.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9810.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32537.67},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9618.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32537.67},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9618.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9618.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9810.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9618.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7477.48,"maximum":23905.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7627.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23905.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23905.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7627.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18906.44,"maximum":38505.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18906.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19284.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38505.72},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18906.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38505.72},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18906.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18906.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19284.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18906.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1055.21,"10th_percentile":1055.21,"90th_percentile":1055.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12746.47,"maximum":27378.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27378.85},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27378.85},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8091.28,"maximum":17566.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17566.97},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17566.97},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17047.66,"maximum":51857.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17388.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51857.96},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51857.96},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17388.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10292.18,"maximum":31897.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10292.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10498.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31897.03},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10292.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31897.03},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10292.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10292.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10498.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10292.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7791.24,"maximum":26030.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26030.13},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26030.13},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23589.99,"maximum":81799.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23589.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24061.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81799.36},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23589.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81799.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23589.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23589.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24061.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23589.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11439.29,"maximum":32335.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11439.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11668.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32335.36},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11439.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32335.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11439.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11439.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11668.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11439.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":473.84,"10th_percentile":473.84,"90th_percentile":473.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10013.36,"10th_percentile":10013.36,"90th_percentile":10013.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8537.68,"maximum":26434.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8537.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26434.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8537.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26434.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8537.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8537.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8537.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18551.51,"maximum":63254.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18551.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18922.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63254.57},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18551.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63254.57},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18551.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18551.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18922.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18551.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11931.42,"maximum":29098.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11931.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12170.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29098.45},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11931.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29098.45},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11931.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11931.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12170.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11931.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8884.37,"maximum":24883.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9062.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24883.73},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24883.73},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9062.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16220.72,"maximum":39719.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39719.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39719.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16220.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9682.04,"maximum":21242.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9875.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21242.21},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21242.21},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9875.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19996.72,"10th_percentile":19996.72,"90th_percentile":19996.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":13439.11,"10th_percentile":13439.11,"90th_percentile":13439.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12746.47,"maximum":44709.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44709.79},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44709.79},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12746.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8481.88,"maximum":20770.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8651.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20770.16},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20770.16},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8651.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8481.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12979.74,"maximum":46227.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13239.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46227.09},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46227.09},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13239.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8486.45,"maximum":22793.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8486.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8656.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22793.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8486.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22793.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8486.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8486.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8656.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8486.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11710.63,"10th_percentile":11710.63,"90th_percentile":11710.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14490.0,"maximum":30312.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30312.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30312.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14490.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9059.09,"maximum":15543.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9059.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9240.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15543.9},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9059.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15543.9},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9059.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9059.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9240.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9059.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17947.78,"maximum":48823.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18306.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48823.36},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48823.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18306.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11189.56,"maximum":27952.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27952.05},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27952.05},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8242.21,"maximum":23298.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8407.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23298.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23298.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8407.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13921.93,"maximum":36988.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13921.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14200.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36988.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13921.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36988.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13921.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13921.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14200.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13921.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9080.13,"maximum":20702.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9080.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9261.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20702.72},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9080.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20702.72},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9080.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9080.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9261.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9080.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15008.66,"maximum":47238.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15008.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15308.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47238.62},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15008.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47238.62},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15008.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15008.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15308.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15008.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43947.52,"10th_percentile":43947.52,"90th_percentile":43947.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9801.87,"maximum":24411.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9801.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9997.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24411.68},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9801.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24411.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9801.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9801.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9997.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9801.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7742.76,"maximum":21984.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7897.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21984.0},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21984.0},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7897.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":3646.13,"10th_percentile":3646.13,"90th_percentile":3646.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27792.38,"maximum":62209.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27792.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28348.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62209.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27792.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62209.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27792.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27792.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28348.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27792.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16343.29,"maximum":34358.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16343.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16670.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34358.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16343.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34358.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16343.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16343.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16670.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16343.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11374.34,"maximum":28221.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11601.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28221.79},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28221.79},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11601.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60817.82,"maximum":194045.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60817.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62034.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":194045.88},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60817.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194045.88},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60817.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60817.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62034.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60817.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32643.33,"maximum":107391.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32643.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33296.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":107391.16},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32643.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107391.16},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32643.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32643.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33296.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32643.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17326.66,"maximum":62108.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17326.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17673.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62108.17},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17326.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62108.17},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17326.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17326.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17673.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17326.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45722.51,"maximum":185414.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45722.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46636.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":185414.13},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45722.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":185414.13},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45722.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45722.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46636.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45722.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25135.93,"maximum":77483.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25135.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25638.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77483.48},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25135.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77483.48},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25135.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25135.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25638.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25135.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15583.13,"maximum":54083.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15583.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15894.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54083.34},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15583.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54083.34},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15583.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15583.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15894.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15583.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30512.86,"maximum":61737.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30512.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31123.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61737.27},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30512.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61737.27},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30512.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30512.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31123.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30512.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49684.02,"10th_percentile":49684.02,"90th_percentile":49684.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16695.47,"maximum":44473.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16695.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17029.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44473.77},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16695.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44473.77},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16695.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16695.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17029.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16695.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":70004.76,"10th_percentile":70004.76,"90th_percentile":70004.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14089.33,"maximum":35673.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14089.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14371.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35673.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14089.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35673.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14089.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14089.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14371.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14089.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13084.81,"10th_percentile":13084.81,"90th_percentile":13084.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18512.18,"maximum":67671.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18512.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67671.6},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18512.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67671.6},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18512.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18512.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18512.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16662.54,"maximum":60186.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16995.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60186.26},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60186.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16662.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16995.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16662.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20470.67,"maximum":78764.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20470.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20880.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78764.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20470.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78764.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20470.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20470.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20880.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20470.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18535.05,"maximum":67907.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18905.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67907.63},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67907.63},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18905.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18535.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18591.76,"maximum":36516.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18591.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36516.37},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18591.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36516.37},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18591.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18591.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18963.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18591.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11740.24,"maximum":22523.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11975.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22523.48},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22523.48},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11975.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11740.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8817.6,"maximum":15173.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8817.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8993.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15173.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8817.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15173.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8817.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8817.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8993.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8817.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20287.72,"maximum":71751.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20287.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20693.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71751.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20287.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71751.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20287.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20287.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20693.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20287.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2628.8,"10th_percentile":2628.8,"90th_percentile":2628.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15709.17,"10th_percentile":15709.17,"90th_percentile":15709.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18559.91,"10th_percentile":18559.91,"90th_percentile":18559.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":15659.85,"10th_percentile":15659.85,"90th_percentile":15659.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10790.72,"maximum":20466.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10790.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11006.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20466.7},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10790.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20466.7},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10790.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10790.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11006.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10790.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":15650.71,"10th_percentile":15650.71,"90th_percentile":15650.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16138.39,"maximum":54454.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16138.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16461.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54454.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16138.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54454.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16138.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16138.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16461.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16138.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":22909.14,"10th_percentile":22909.14,"90th_percentile":22909.14},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7684.96,"10th_percentile":7684.96,"90th_percentile":10376.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11517.75,"10th_percentile":11517.75,"90th_percentile":11517.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29300.76,"10th_percentile":21243.62,"90th_percentile":57202.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":63355.34,"10th_percentile":63355.34,"90th_percentile":89255.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":8354.89,"10th_percentile":8294.79,"90th_percentile":13682.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11237.12,"maximum":28086.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11237.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28086.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11237.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28086.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11237.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11237.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11237.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23016.82,"10th_percentile":23016.82,"90th_percentile":23016.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11418.54,"10th_percentile":11418.54,"90th_percentile":11418.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":9983.02,"10th_percentile":9983.02,"90th_percentile":9983.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7926.62,"maximum":23467.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7926.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8085.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23467.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7926.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23467.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7926.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7926.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8085.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7926.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10416.59,"maximum":23130.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23130.4},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23130.4},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6422.76,"maximum":11329.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6422.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6551.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11329.18},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6422.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11329.18},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6422.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6422.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6551.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6422.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13889.92,"maximum":35707.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13889.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14167.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35707.14},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13889.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35707.14},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13889.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13889.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14167.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13889.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8855.1,"maximum":16386.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8855.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16386.85},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8855.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16386.85},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8855.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8855.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8855.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14354.61,"maximum":49093.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14354.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49093.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14354.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49093.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14354.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14354.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14641.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14354.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":27753.67,"10th_percentile":27753.67,"90th_percentile":27753.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9267.66,"maximum":19084.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9267.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9453.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19084.27},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9267.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19084.27},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9267.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9267.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9453.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9267.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":37642.31,"10th_percentile":37642.31,"90th_percentile":37642.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14730.58,"maximum":45957.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14730.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15025.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45957.35},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14730.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45957.35},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14730.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14730.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15025.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14730.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":65287.63,"10th_percentile":65287.63,"90th_percentile":65287.63},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":61798.02,"10th_percentile":61798.02,"90th_percentile":61798.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11799.6,"10th_percentile":11799.6,"90th_percentile":11799.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":23953.45,"10th_percentile":23953.45,"90th_percentile":23953.45},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":77734.26,"10th_percentile":77734.26,"90th_percentile":77734.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":17688.45,"10th_percentile":17688.45,"90th_percentile":17688.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9179.84,"maximum":17432.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9363.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17432.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17432.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9363.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8048.08,"10th_percentile":8048.08,"90th_percentile":8048.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":28934.15,"10th_percentile":28934.15,"90th_percentile":28934.15},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":3662.02,"10th_percentile":3662.02,"90th_percentile":26051.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9440.2,"10th_percentile":9440.2,"90th_percentile":9440.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":13284.81,"10th_percentile":4578.07,"90th_percentile":51860.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":15464.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"12","median_amount":3160.13,"10th_percentile":3160.13,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":6575.7,"10th_percentile":6575.7,"90th_percentile":6575.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20938.11,"maximum":62546.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20938.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62546.5},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20938.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62546.5},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20938.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20938.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20938.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13688.67,"maximum":47002.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13688.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47002.6},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13688.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47002.6},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13688.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13688.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13688.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48101.43,"10th_percentile":48101.43,"90th_percentile":48101.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32789.69,"maximum":77078.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32789.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33445.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77078.87},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32789.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77078.87},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32789.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32789.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33445.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32789.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17997.17,"maximum":39247.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17997.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18357.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39247.51},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17997.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39247.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17997.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17997.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18357.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17997.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":39156.81,"10th_percentile":39156.81,"90th_percentile":39156.81},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":128579.77,"10th_percentile":128579.77,"90th_percentile":128579.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39775.29,"10th_percentile":39775.29,"90th_percentile":39775.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":23191.88,"10th_percentile":23191.88,"90th_percentile":23191.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13862.47,"maximum":24580.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14139.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24580.27},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24580.27},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14139.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13862.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27301.16,"maximum":67739.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27301.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27847.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67739.04},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27301.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67739.04},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27301.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27301.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27847.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27301.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":53853.27,"10th_percentile":53853.27,"90th_percentile":53853.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15527.33,"maximum":42956.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15837.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42956.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42956.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15837.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15527.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":85303.54,"10th_percentile":85303.54,"90th_percentile":85303.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14686.67,"maximum":34729.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14686.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14980.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34729.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14686.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34729.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14686.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14686.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14980.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14686.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":43930.17,"10th_percentile":43930.17,"90th_percentile":43930.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":41307.02,"10th_percentile":41307.02,"90th_percentile":41307.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":43375.07,"10th_percentile":43375.07,"90th_percentile":43375.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33446.49,"maximum":63794.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33446.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34115.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63794.06},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33446.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63794.06},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33446.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33446.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34115.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33446.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":50526.6,"10th_percentile":50526.6,"90th_percentile":50526.6},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14580.93,"10th_percentile":14580.93,"90th_percentile":14580.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17298.3,"maximum":38134.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17298.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17644.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38134.82},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17298.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38134.82},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17298.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17298.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17644.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17298.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12340.32,"maximum":27783.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27783.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27783.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12340.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12587.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12340.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28515.04,"maximum":97444.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28515.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29085.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":97444.41},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28515.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97444.41},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28515.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28515.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29085.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28515.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14604.34,"maximum":43664.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43664.54},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43664.54},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13039.19,"maximum":32436.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13299.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32436.51},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32436.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13299.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34979.62,"maximum":77045.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34979.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35679.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77045.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34979.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77045.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34979.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34979.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35679.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34979.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":86852.73,"10th_percentile":86852.73,"90th_percentile":86852.73},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":55719.87,"10th_percentile":55719.87,"90th_percentile":55719.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38592.15,"10th_percentile":38592.15,"90th_percentile":38592.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":165022.67,"10th_percentile":165022.67,"90th_percentile":165022.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18490.08,"10th_percentile":18490.08,"90th_percentile":18490.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":98179.65,"10th_percentile":98179.65,"90th_percentile":98179.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":110959.47,"10th_percentile":110959.47,"90th_percentile":110959.47},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":208891.5,"10th_percentile":208891.5,"90th_percentile":208891.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":18436.38,"10th_percentile":15220.2,"90th_percentile":18803.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20819.19,"maximum":44777.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21235.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44777.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44777.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20819.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21235.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20819.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":55794.01,"10th_percentile":55794.01,"90th_percentile":55794.01},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21152.0,"10th_percentile":21152.0,"90th_percentile":21152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":29108.84,"10th_percentile":29108.84,"90th_percentile":29108.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21084.28,"10th_percentile":21084.28,"90th_percentile":21352.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66790.5,"10th_percentile":52332.5,"90th_percentile":73583.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":45302.99,"10th_percentile":45302.99,"90th_percentile":45302.99},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":32067.93,"10th_percentile":32067.93,"90th_percentile":118244.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":15778.35,"10th_percentile":15778.35,"90th_percentile":30056.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14239.35,"maximum":29503.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14239.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29503.07},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14239.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29503.07},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14239.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14239.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14239.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":138481.49,"10th_percentile":138481.49,"90th_percentile":138481.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1937.27,"10th_percentile":1937.27,"90th_percentile":1937.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45001.65,"10th_percentile":45001.65,"90th_percentile":45001.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14119.57,"10th_percentile":14119.57,"90th_percentile":14119.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14030.79,"maximum":30109.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14030.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14311.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30109.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14030.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30109.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14030.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14030.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14311.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14030.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":18135.09,"10th_percentile":5048.04,"90th_percentile":34901.58},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"42","median_amount":9345.94,"10th_percentile":1345.64,"90th_percentile":15663.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":39302.25,"10th_percentile":39302.25,"90th_percentile":39302.25},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"13","median_amount":17060.04,"10th_percentile":9556.96,"90th_percentile":36774.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8294.03,"10th_percentile":8294.03,"90th_percentile":8294.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":56358.68,"10th_percentile":56358.68,"90th_percentile":56358.68},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28997.3,"10th_percentile":28997.3,"90th_percentile":28997.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":9768.35,"10th_percentile":5631.03,"90th_percentile":16641.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":26402.91,"10th_percentile":20500.42,"90th_percentile":33075.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":21818.35,"10th_percentile":21818.35,"90th_percentile":21818.35},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":27088.19,"10th_percentile":22625.59,"90th_percentile":34434.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"24","median_amount":16662.13,"10th_percentile":9383.62,"90th_percentile":28096.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11951.93,"10th_percentile":9701.04,"90th_percentile":19535.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19521.77,"10th_percentile":19521.77,"90th_percentile":19521.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":30340.0,"10th_percentile":27260.82,"90th_percentile":51161.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"19","median_amount":9047.55,"10th_percentile":6827.22,"90th_percentile":15233.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9808.29,"10th_percentile":968.61,"90th_percentile":28282.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9086.53,"maximum":18409.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9086.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9268.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18409.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9086.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18409.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9086.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9086.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9268.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9086.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":16517.68,"10th_percentile":3824.44,"90th_percentile":22094.82},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":7368.44,"10th_percentile":704.3,"90th_percentile":9625.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":17606.89,"10th_percentile":17606.89,"90th_percentile":17606.89},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"11","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":14526.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17894.91,"10th_percentile":17894.91,"90th_percentile":17894.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8351.53,"10th_percentile":7331.34,"90th_percentile":13483.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":18183.49,"10th_percentile":11240.3,"90th_percentile":56151.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":22501.7,"10th_percentile":22501.7,"90th_percentile":22501.7},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"14","median_amount":10795.34,"10th_percentile":9383.62,"90th_percentile":37262.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7929.14,"10th_percentile":5920.42,"90th_percentile":9517.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":13504.62,"10th_percentile":13504.62,"90th_percentile":13504.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"14","median_amount":9100.18,"10th_percentile":5434.42,"90th_percentile":13538.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9606.38,"10th_percentile":9606.38,"90th_percentile":9606.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6570.95,"maximum":14127.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6702.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14127.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14127.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6702.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":7897.67,"10th_percentile":7897.67,"90th_percentile":11723.1},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27944.81,"10th_percentile":27944.81,"90th_percentile":27944.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27716.08,"10th_percentile":27716.08,"90th_percentile":27716.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14557.12,"10th_percentile":14084.15,"90th_percentile":87297.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":8320.6,"10th_percentile":1196.35,"90th_percentile":27956.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13105.97,"maximum":32133.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13105.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13368.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32133.05},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13105.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32133.05},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13105.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13105.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13368.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13105.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":5045.8,"10th_percentile":5045.8,"90th_percentile":22140.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":8794.19,"10th_percentile":1276.94,"90th_percentile":13996.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":77892.49,"10th_percentile":77892.49,"90th_percentile":77892.49},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"51","median_amount":11900.24,"10th_percentile":9308.15,"90th_percentile":40259.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9814.85,"10th_percentile":7092.17,"90th_percentile":14994.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"35","median_amount":31810.92,"10th_percentile":11693.21,"90th_percentile":66594.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":12036.17,"10th_percentile":12036.17,"90th_percentile":12036.17},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"26","median_amount":16976.6,"10th_percentile":9515.48,"90th_percentile":69523.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"44","median_amount":10201.44,"10th_percentile":9383.62,"90th_percentile":38432.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11156.34,"10th_percentile":10713.26,"90th_percentile":24192.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":29738.53,"10th_percentile":3190.12,"90th_percentile":34387.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"22","median_amount":12686.96,"10th_percentile":6604.29,"90th_percentile":16217.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1161.72,"10th_percentile":1161.72,"90th_percentile":1161.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8007.12,"maximum":17701.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8167.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17701.84},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17701.84},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8167.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"18","median_amount":17698.17,"10th_percentile":2921.92,"90th_percentile":30424.96},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":6734.38,"10th_percentile":878.08,"90th_percentile":8093.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":11036.18,"10th_percentile":11036.18,"90th_percentile":11036.18},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"41","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":11189.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13130.7,"10th_percentile":13130.7,"90th_percentile":33423.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":7799.92,"10th_percentile":5385.72,"90th_percentile":9881.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"43","median_amount":13976.98,"10th_percentile":12344.8,"90th_percentile":22320.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":12110.85,"10th_percentile":12110.85,"90th_percentile":32649.53},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"14","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":13591.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"48","median_amount":9653.07,"10th_percentile":9383.62,"90th_percentile":21542.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7364.19,"10th_percentile":7364.19,"90th_percentile":7364.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"11","median_amount":23555.76,"10th_percentile":11763.35,"90th_percentile":45777.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"22","median_amount":7599.78,"10th_percentile":1303.99,"90th_percentile":15453.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12974.62,"10th_percentile":12974.62,"90th_percentile":12974.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13897.24,"maximum":25524.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13897.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14175.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25524.37},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13897.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25524.37},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13897.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13897.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14175.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13897.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":34790.03,"10th_percentile":13241.56,"90th_percentile":73894.63},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"39","median_amount":7408.09,"10th_percentile":704.3,"90th_percentile":12062.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"17","median_amount":14119.25,"10th_percentile":9556.96,"90th_percentile":31684.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28896.15,"10th_percentile":24134.55,"90th_percentile":87247.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":7139.96,"10th_percentile":5164.82,"90th_percentile":14930.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":21243.62,"10th_percentile":15388.07,"90th_percentile":32135.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":16267.94,"10th_percentile":10703.84,"90th_percentile":44138.05},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":21889.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"13","median_amount":24987.49,"10th_percentile":9653.07,"90th_percentile":63057.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9273.51,"10th_percentile":1276.94,"90th_percentile":20359.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26651.44,"10th_percentile":26651.44,"90th_percentile":26651.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":36529.06,"10th_percentile":18921.16,"90th_percentile":99086.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"27","median_amount":7419.19,"10th_percentile":1231.14,"90th_percentile":12686.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8962.85,"10th_percentile":7723.05,"90th_percentile":11737.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":25831.73,"10th_percentile":25831.73,"90th_percentile":25831.73}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15946.29,"maximum":39517.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16265.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39517.25},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39517.25},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16265.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15946.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":29990.57,"10th_percentile":29990.57,"90th_percentile":31099.55},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":10642.95,"10th_percentile":6719.74,"90th_percentile":18166.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":27086.01,"10th_percentile":27086.01,"90th_percentile":27086.01},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":10913.42,"10th_percentile":9556.96,"90th_percentile":38815.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7142.86,"10th_percentile":7142.86,"90th_percentile":7142.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23712.19,"10th_percentile":21377.08,"90th_percentile":30589.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":10596.91,"10th_percentile":7657.67,"90th_percentile":15485.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":36753.9,"10th_percentile":24870.91,"90th_percentile":42530.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":24886.86,"10th_percentile":24886.86,"90th_percentile":24886.86},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":15848.62,"10th_percentile":15848.62,"90th_percentile":15848.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"11","median_amount":22430.27,"10th_percentile":9383.62,"90th_percentile":35826.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9824.29,"10th_percentile":9824.29,"90th_percentile":10649.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11850.09,"10th_percentile":11850.09,"90th_percentile":11850.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":50652.7,"10th_percentile":50652.7,"90th_percentile":50652.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"24","median_amount":9476.01,"10th_percentile":7589.73,"90th_percentile":11953.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":36585.9,"10th_percentile":36585.9,"90th_percentile":36585.9},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15865.29,"10th_percentile":15865.29,"90th_percentile":15865.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18857.04,"maximum":46395.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18857.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19234.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46395.68},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18857.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46395.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18857.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18857.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19234.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18857.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36008.72,"maximum":92420.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36008.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36728.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":92420.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36008.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92420.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36008.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36008.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36728.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36008.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":67671.49,"10th_percentile":67671.49,"90th_percentile":67671.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19139.7,"maximum":47609.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47609.52},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47609.52},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19139.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19139.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12896.49,"maximum":32976.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12896.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13154.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32976.0},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12896.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32976.0},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12896.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12896.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13154.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12896.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38319.81,"10th_percentile":38319.81,"90th_percentile":38319.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15841.09,"maximum":51352.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16157.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51352.19},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51352.19},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16157.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8988.65,"maximum":20770.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8988.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20770.16},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8988.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20770.16},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8988.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8988.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8988.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16271.03,"maximum":34729.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16596.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34729.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34729.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16596.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16271.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6983.51,"maximum":15442.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15442.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15442.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15235.52,"maximum":33582.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15235.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15540.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33582.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15235.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33582.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15235.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15235.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15540.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15235.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8728.86,"maximum":16420.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8903.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16420.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16420.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8903.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17635.84,"maximum":38438.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17635.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38438.28},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17635.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38438.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17635.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17635.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17988.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17635.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10057.09,"maximum":23029.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10057.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10258.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23029.25},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10057.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23029.25},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10057.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10057.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10258.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10057.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7185.67,"maximum":16926.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16926.33},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16926.33},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6847.2,"10th_percentile":6847.2,"90th_percentile":6847.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16891.23,"maximum":47339.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16891.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17229.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47339.78},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16891.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47339.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16891.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16891.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17229.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16891.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10197.96,"maximum":17600.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17600.69},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17600.69},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":196193.47,"maximum":708747.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196193.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200117.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":708747.95},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196193.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":708747.95},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196193.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196193.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200117.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196193.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66501.2,"maximum":79641.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66501.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67831.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":79641.42},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66501.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79641.42},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66501.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66501.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67831.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66501.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30350.95,"maximum":38944.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30350.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30957.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38944.05},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30350.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38944.05},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30350.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30350.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30957.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30350.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36510.92,"maximum":97478.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36510.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37241.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":97478.13},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36510.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97478.13},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36510.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36510.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37241.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36510.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21110.09,"maximum":66626.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21532.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66626.35},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66626.35},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21532.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19732.46,"maximum":30582.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19732.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20127.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30582.04},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19732.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30582.04},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19732.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19732.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20127.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19732.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34080.41,"maximum":109043.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34762.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":109043.33},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109043.33},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34762.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34080.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":140130.49,"10th_percentile":140130.49,"90th_percentile":140130.49},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":39906.32,"10th_percentile":39906.32,"90th_percentile":65064.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10224.86,"10th_percentile":10224.86,"90th_percentile":10224.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":119351.65,"10th_percentile":119351.65,"90th_percentile":119351.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":27874.06,"10th_percentile":27874.06,"90th_percentile":49022.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":53043.97,"10th_percentile":53043.97,"90th_percentile":53043.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22265.42,"maximum":55533.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22265.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22710.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55533.2},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22265.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55533.2},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22265.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22265.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22710.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22265.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43005.74,"10th_percentile":43005.74,"90th_percentile":52987.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":11068.52,"10th_percentile":11068.52,"90th_percentile":11068.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":22212.46,"10th_percentile":12190.39,"90th_percentile":81973.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19437.0,"maximum":37763.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19437.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19825.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37763.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19437.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37763.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19437.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19437.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19825.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19437.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":19684.86,"10th_percentile":19684.86,"90th_percentile":30574.95},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":10882.51,"10th_percentile":9556.96,"90th_percentile":11060.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41487.57,"10th_percentile":41487.57,"90th_percentile":41487.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20431.13,"10th_percentile":20317.39,"90th_percentile":20455.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":32362.51,"10th_percentile":32362.51,"90th_percentile":32362.51},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":98747.39,"10th_percentile":98747.39,"90th_percentile":98747.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":18695.44,"10th_percentile":14329.61,"90th_percentile":20037.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":34772.48,"10th_percentile":34772.48,"90th_percentile":40735.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":15194.48,"10th_percentile":15194.48,"90th_percentile":15194.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15054.4,"maximum":50509.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15054.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15355.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50509.25},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15054.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50509.25},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15054.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15054.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15355.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15054.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11378.91,"maximum":35842.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35842.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35842.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12500.4,"maximum":29806.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12750.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29806.53},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29806.53},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12750.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8211.11,"maximum":20196.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20196.96},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20196.96},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11771.34,"maximum":34796.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12006.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34796.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34796.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12006.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6630.41,"maximum":22759.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22759.51},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22759.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5974.53,"maximum":10654.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6094.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10654.82},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10654.82},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6094.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"28","median_amount":8034.28,"10th_percentile":2661.66,"90th_percentile":28765.69},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9300.37,"10th_percentile":6023.23,"90th_percentile":19063.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4859.01,"10th_percentile":3293.93,"90th_percentile":8564.26},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"127","median_amount":3662.02,"10th_percentile":3544.42,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":708.98,"10th_percentile":708.98,"90th_percentile":708.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":35690.45,"10th_percentile":35690.45,"90th_percentile":35690.45},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":5057.67,"10th_percentile":3793.25,"90th_percentile":5423.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9412.15,"10th_percentile":7136.41,"90th_percentile":12372.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"203","median_amount":5057.67,"10th_percentile":3782.67,"90th_percentile":10249.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"11","median_amount":3876.72,"10th_percentile":3225.76,"90th_percentile":7543.5},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"54","median_amount":3646.13,"10th_percentile":3646.13,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"162","median_amount":3235.43,"10th_percentile":3160.13,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10755.21,"10th_percentile":10755.21,"90th_percentile":10755.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"18","median_amount":4684.15,"10th_percentile":2631.01,"90th_percentile":19059.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":9552.66,"10th_percentile":9552.66,"90th_percentile":12157.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10318.05,"10th_percentile":10318.05,"90th_percentile":10318.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":62461.63,"maximum":193101.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62461.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63710.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":193101.78},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62461.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":193101.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62461.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62461.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63710.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62461.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35310.76,"maximum":159788.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36016.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":159788.61},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159788.61},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36016.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35310.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70591.98,"maximum":193135.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70591.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72003.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":193135.5},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70591.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":193135.5},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70591.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70591.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72003.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70591.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39435.39,"maximum":111943.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39435.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40224.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111943.06},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39435.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111943.06},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39435.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39435.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40224.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39435.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27819.82,"maximum":87025.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28376.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":87025.62},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87025.62},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28376.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27819.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25896.09,"maximum":80484.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25896.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26414.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80484.36},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25896.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80484.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25896.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25896.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26414.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25896.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14908.04,"maximum":37190.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37190.72},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37190.72},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14908.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9491.77,"maximum":25591.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9491.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9681.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25591.8},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9491.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25591.8},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9491.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9491.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9681.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9491.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56883.45,"maximum":225942.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56883.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58021.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":225942.91},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56883.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":225942.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56883.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56883.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58021.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56883.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72902.69,"10th_percentile":72902.69,"90th_percentile":72902.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26783.97,"10th_percentile":26783.97,"90th_percentile":26783.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25014.27,"maximum":97545.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25014.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25514.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":97545.57},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25014.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97545.57},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25014.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25014.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25514.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25014.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27288.35,"maximum":93499.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27288.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27834.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":93499.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27288.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93499.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27288.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27288.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27834.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27288.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":52302.19,"10th_percentile":52302.19,"90th_percentile":52302.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":84154.09,"10th_percentile":84154.09,"90th_percentile":84154.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":26037.61,"10th_percentile":26037.61,"90th_percentile":26037.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12734.58,"maximum":44642.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12734.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44642.35},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12734.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44642.35},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12734.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12734.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12734.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":21215.31,"10th_percentile":21215.31,"90th_percentile":21215.31},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":19929.3,"10th_percentile":19929.3,"90th_percentile":19929.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9145.99,"maximum":29671.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9328.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29671.66},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29671.66},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9328.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12759.28,"maximum":45721.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13014.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45721.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45721.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13014.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12759.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10494.51,"10th_percentile":10494.51,"90th_percentile":12525.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13763.23,"10th_percentile":13763.23,"90th_percentile":13763.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13754.13,"10th_percentile":13754.13,"90th_percentile":13754.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":28401.38,"10th_percentile":28401.38,"90th_percentile":28401.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10147.82,"10th_percentile":10147.82,"90th_percentile":10147.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43807.01,"maximum":133050.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43807.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44683.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":133050.4},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43807.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133050.4},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43807.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43807.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44683.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43807.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"11","median_amount":69517.12,"10th_percentile":47947.65,"90th_percentile":167040.36},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"37","median_amount":25333.68,"10th_percentile":14107.28,"90th_percentile":51818.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":72366.26,"10th_percentile":72366.26,"90th_percentile":76689.54},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"22","median_amount":35803.27,"10th_percentile":18215.83,"90th_percentile":108820.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35250.53,"10th_percentile":35250.53,"90th_percentile":35250.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":68739.54,"10th_percentile":61265.23,"90th_percentile":170675.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":29675.38,"10th_percentile":16075.38,"90th_percentile":66821.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"60","median_amount":61265.23,"10th_percentile":24670.26,"90th_percentile":148809.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":62051.85,"10th_percentile":50536.74,"90th_percentile":183876.65},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"12","median_amount":63052.58,"10th_percentile":42777.0,"90th_percentile":122924.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"22","median_amount":70195.0,"10th_percentile":29495.81,"90th_percentile":148921.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25660.43,"10th_percentile":16531.21,"90th_percentile":69351.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28896.83,"10th_percentile":28896.83,"90th_percentile":28896.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":55297.81,"10th_percentile":41675.0,"90th_percentile":200825.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"37","median_amount":22899.8,"10th_percentile":15996.27,"90th_percentile":53470.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27340.05,"10th_percentile":27340.05,"90th_percentile":39014.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23377.77,"maximum":64367.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23377.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23845.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64367.26},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23377.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64367.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23377.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23377.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23845.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23377.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"11","median_amount":34836.44,"10th_percentile":11850.0,"90th_percentile":166251.46},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":20780.21,"10th_percentile":14719.89,"90th_percentile":44838.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":34791.66,"10th_percentile":34791.66,"90th_percentile":56538.96},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"20","median_amount":28565.09,"10th_percentile":16026.99,"90th_percentile":150860.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20546.52,"10th_percentile":20546.52,"90th_percentile":20546.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":250516.2,"10th_percentile":250516.2,"90th_percentile":250516.2},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30034.05,"10th_percentile":30034.05,"90th_percentile":95405.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":28469.88,"10th_percentile":16121.61,"90th_percentile":43870.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"43","median_amount":33021.73,"10th_percentile":20652.88,"90th_percentile":101637.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":86457.15,"10th_percentile":28358.6,"90th_percentile":169729.26},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"14","median_amount":19379.64,"10th_percentile":10394.48,"90th_percentile":46413.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"38","median_amount":35642.76,"10th_percentile":16950.3,"90th_percentile":73446.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34018.93,"10th_percentile":19009.7,"90th_percentile":34489.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":82528.66,"10th_percentile":31799.34,"90th_percentile":327211.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"25","median_amount":19417.72,"10th_percentile":11823.2,"90th_percentile":41604.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":62371.12,"10th_percentile":62371.12,"90th_percentile":62371.12},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4166.41,"10th_percentile":4166.41,"90th_percentile":4166.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16567.41,"maximum":39584.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16567.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16898.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39584.69},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16567.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39584.69},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16567.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16567.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16898.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16567.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":34888.65,"10th_percentile":26785.25,"90th_percentile":112293.77},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30040.72,"10th_percentile":30040.72,"90th_percentile":30040.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":42971.07,"10th_percentile":42971.07,"90th_percentile":47320.19},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"18","median_amount":17889.6,"10th_percentile":11368.18,"90th_percentile":34966.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":38620.97,"10th_percentile":38620.97,"90th_percentile":38620.97},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":22318.72,"10th_percentile":20344.78,"90th_percentile":97983.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20608.91,"10th_percentile":13468.34,"90th_percentile":45855.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"42","median_amount":21069.78,"10th_percentile":19503.55,"90th_percentile":44447.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":26111.43,"10th_percentile":26111.43,"90th_percentile":32955.43},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":18116.03,"10th_percentile":15169.61,"90th_percentile":19701.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"30","median_amount":22399.53,"10th_percentile":15674.79,"90th_percentile":49986.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":37096.68,"10th_percentile":24878.33,"90th_percentile":49700.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":16120.45,"10th_percentile":9725.33,"90th_percentile":46971.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32249.99,"maximum":86250.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32249.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32894.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86250.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32249.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86250.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32249.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32249.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32894.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32249.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":52610.99,"10th_percentile":52610.99,"90th_percentile":52610.99},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28675.52,"10th_percentile":28675.52,"90th_percentile":56247.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":43234.51,"10th_percentile":43234.51,"90th_percentile":48982.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14525.87,"10th_percentile":14525.87,"90th_percentile":28694.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42765.61,"10th_percentile":17836.3,"90th_percentile":54632.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":19411.94,"10th_percentile":19411.94,"90th_percentile":19411.94},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":59960.85,"10th_percentile":59960.85,"90th_percentile":59960.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":18052.64,"10th_percentile":9653.07,"90th_percentile":56978.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34510.33,"10th_percentile":34510.33,"90th_percentile":34510.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":15498.51,"10th_percentile":15498.51,"90th_percentile":27544.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15923.42,"maximum":40865.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16241.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40865.96},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40865.96},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16241.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":26771.88,"10th_percentile":17715.87,"90th_percentile":59971.39},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12398.81,"10th_percentile":7457.67,"90th_percentile":23803.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":14021.62,"10th_percentile":14021.62,"90th_percentile":14021.62},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":20037.06,"10th_percentile":9556.96,"90th_percentile":89561.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46045.79,"10th_percentile":16873.38,"90th_percentile":49484.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13220.91,"10th_percentile":11711.4,"90th_percentile":15263.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":30665.91,"10th_percentile":16001.72,"90th_percentile":57146.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":30537.28,"10th_percentile":30537.28,"90th_percentile":111710.86},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":47913.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":11188.94,"10th_percentile":9653.07,"90th_percentile":48058.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15948.83,"10th_percentile":15948.83,"90th_percentile":15948.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":24380.69,"10th_percentile":24380.69,"90th_percentile":26049.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":15312.28,"10th_percentile":15312.28,"90th_percentile":15651.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14006.56,"10th_percentile":14006.56,"90th_percentile":14006.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11858.24,"maximum":30649.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11858.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12095.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30649.47},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11858.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30649.47},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11858.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11858.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12095.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11858.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":22123.57,"10th_percentile":22123.57,"90th_percentile":22123.57},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41521.64,"10th_percentile":41521.64,"90th_percentile":41521.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9250.04,"90th_percentile":47851.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":19321.48,"10th_percentile":19321.48,"90th_percentile":19321.48},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":13837.91,"10th_percentile":13284.81,"90th_percentile":17398.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":12289.21,"10th_percentile":12289.21,"90th_percentile":13553.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":19600.37,"10th_percentile":19600.37,"90th_percentile":19600.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18350.27,"maximum":53813.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18350.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18717.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53813.59},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18350.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53813.59},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18350.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18350.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18717.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18350.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37333.28,"maximum":120203.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37333.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38079.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":120203.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37333.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120203.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37333.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37333.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38079.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37333.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":102791.92,"10th_percentile":102791.92,"90th_percentile":102791.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":68091.3,"10th_percentile":68091.3,"90th_percentile":116759.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":45296.94,"10th_percentile":45296.94,"90th_percentile":45296.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":126986.34,"10th_percentile":126986.34,"90th_percentile":126986.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":46254.73,"10th_percentile":46254.73,"90th_percentile":46254.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17892.89,"maximum":49733.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18250.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49733.74},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49733.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18250.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":150561.18,"10th_percentile":150561.18,"90th_percentile":150561.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33805.23,"10th_percentile":33805.23,"90th_percentile":33805.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":26823.35,"10th_percentile":26823.35,"90th_percentile":26823.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":103084.31,"10th_percentile":103084.31,"90th_percentile":103084.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":22954.2,"10th_percentile":22954.2,"90th_percentile":22954.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13292.58,"maximum":35369.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13292.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13558.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35369.96},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13292.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35369.96},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13292.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13292.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13558.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13292.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10760.54,"maximum":17297.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10760.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10975.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17297.23},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10760.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17297.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10760.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10760.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10975.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10760.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":17235.05,"10th_percentile":17235.05,"90th_percentile":21146.25},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14104.47,"10th_percentile":10474.09,"90th_percentile":17522.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7785.75,"maximum":15577.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7941.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15577.62},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15577.62},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7941.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":17026.94,"10th_percentile":17026.94,"90th_percentile":17026.94},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":11524.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15577.62,"10th_percentile":14577.62,"90th_percentile":22919.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":15023.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":19800.51,"10th_percentile":19800.51,"90th_percentile":19800.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7055.78,"maximum":13284.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7055.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7196.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13284.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7055.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13284.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7055.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7055.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7196.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7055.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"29","median_amount":18433.07,"10th_percentile":14320.26,"90th_percentile":22732.32},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":17044.05,"10th_percentile":11943.13,"90th_percentile":26912.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"86","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6013.99,"10th_percentile":6013.99,"90th_percentile":6013.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":15440.25,"10th_percentile":15440.25,"90th_percentile":20329.41},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13112.91,"10th_percentile":8375.43,"90th_percentile":15836.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"131","median_amount":13284.81,"10th_percentile":10389.28,"90th_percentile":13837.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"23","median_amount":16590.02,"10th_percentile":13663.21,"90th_percentile":23943.11},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"38","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9826.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"102","median_amount":9653.07,"10th_percentile":9383.62,"90th_percentile":10791.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6088.21,"10th_percentile":6088.21,"90th_percentile":6088.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"15","median_amount":18592.86,"10th_percentile":15956.94,"90th_percentile":21250.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21085.39,"maximum":54723.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21085.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21507.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54723.97},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21085.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54723.97},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21085.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21085.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21507.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21085.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":53366.3,"10th_percentile":53366.3,"90th_percentile":78814.47},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10917.94,"10th_percentile":10917.94,"90th_percentile":10917.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":36111.54,"10th_percentile":36111.54,"90th_percentile":72957.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":68784.3,"10th_percentile":68784.3,"90th_percentile":68784.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12061.62,"10th_percentile":12061.62,"90th_percentile":12061.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":14499.34,"10th_percentile":14489.29,"90th_percentile":17221.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12468.39,"maximum":29300.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12468.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12717.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29300.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12468.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29300.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12468.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12468.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12717.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12468.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9543.27,"10th_percentile":7681.76,"90th_percentile":11042.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9250.04,"10th_percentile":9250.04,"90th_percentile":9250.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12522.44,"10th_percentile":12522.44,"90th_percentile":12522.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16906.16,"10th_percentile":16906.16,"90th_percentile":16906.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":10040.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":81250.49,"10th_percentile":81250.49,"90th_percentile":99683.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":11120.22,"10th_percentile":11120.22,"90th_percentile":11120.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10462.33,"maximum":24816.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10671.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24816.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24816.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10671.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6308.06,"10th_percentile":6308.06,"90th_percentile":6308.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":119916.02,"10th_percentile":119916.02,"90th_percentile":119916.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13734.41,"maximum":34392.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14009.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34392.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34392.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14009.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"15","median_amount":39770.17,"10th_percentile":23642.87,"90th_percentile":76014.64},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":63344.07,"10th_percentile":63344.07,"90th_percentile":63344.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"71","median_amount":9999.66,"10th_percentile":1193.89,"90th_percentile":16203.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":27489.66,"10th_percentile":14468.69,"90th_percentile":54984.42},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"30","median_amount":11899.85,"10th_percentile":9556.96,"90th_percentile":49262.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":24834.73,"10th_percentile":24834.73,"90th_percentile":24834.73},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28188.07,"10th_percentile":28188.07,"90th_percentile":31148.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":11360.73,"10th_percentile":6309.53,"90th_percentile":16516.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"41","median_amount":28896.15,"10th_percentile":15095.89,"90th_percentile":49093.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":40844.92,"10th_percentile":40844.92,"90th_percentile":40844.92},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"14","median_amount":11679.63,"10th_percentile":9515.48,"90th_percentile":27164.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"50","median_amount":18118.97,"10th_percentile":9383.62,"90th_percentile":57241.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":11638.11,"10th_percentile":9934.26,"90th_percentile":13082.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16137.35,"10th_percentile":16137.35,"90th_percentile":16137.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":31444.68,"10th_percentile":25387.82,"90th_percentile":41282.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"47","median_amount":11827.0,"10th_percentile":6607.68,"90th_percentile":17079.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":40398.75,"10th_percentile":40398.75,"90th_percentile":40398.75},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":13703.74,"10th_percentile":10282.73,"90th_percentile":15701.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9287.78,"maximum":23737.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9473.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23737.32},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23737.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9473.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":29272.1,"10th_percentile":10165.54,"90th_percentile":43218.02},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":8331.86,"10th_percentile":1261.77,"90th_percentile":9647.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":16679.39,"10th_percentile":16679.39,"90th_percentile":16679.39},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"36","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":12357.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12225.41,"10th_percentile":12225.41,"90th_percentile":12225.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":41125.58,"10th_percentile":41125.58,"90th_percentile":41125.58},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17871.07,"10th_percentile":17576.84,"90th_percentile":25869.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":8374.85,"10th_percentile":4866.42,"90th_percentile":12760.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"28","median_amount":18741.54,"10th_percentile":12142.86,"90th_percentile":53741.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":26066.22,"10th_percentile":26066.22,"90th_percentile":43770.73},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"17","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":13682.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"43","median_amount":9653.07,"10th_percentile":9383.62,"90th_percentile":20822.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":871.12,"10th_percentile":866.95,"90th_percentile":8859.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":30809.44,"10th_percentile":2222.08,"90th_percentile":69626.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"14","median_amount":8424.48,"10th_percentile":1073.29,"90th_percentile":9901.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7953.33,"10th_percentile":677.82,"90th_percentile":10096.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14841.26,"maximum":44912.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15138.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44912.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44912.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15138.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14841.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":27893.02,"10th_percentile":20896.52,"90th_percentile":49220.12},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13302.57,"10th_percentile":1269.07,"90th_percentile":15854.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":34995.33,"10th_percentile":34995.33,"90th_percentile":34995.33},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"16","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":25781.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13112.91,"10th_percentile":13112.91,"90th_percentile":13112.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10642.94,"10th_percentile":9368.1,"90th_percentile":13962.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":14011.31,"10th_percentile":13197.38,"90th_percentile":41272.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":12531.67,"10th_percentile":10849.2,"90th_percentile":57282.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":8996.68,"10th_percentile":8021.3,"90th_percentile":35280.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19703.18,"10th_percentile":19703.18,"90th_percentile":19703.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20342.61,"maximum":45519.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20342.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20749.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45519.02},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20342.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45519.02},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20342.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20342.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20749.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20342.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13134.04,"10th_percentile":6057.16,"90th_percentile":17671.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"16","median_amount":12402.93,"10th_percentile":9556.96,"90th_percentile":35394.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6648.53,"10th_percentile":6648.53,"90th_percentile":6648.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30531.98,"10th_percentile":30531.98,"90th_percentile":30531.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8935.0,"10th_percentile":8935.0,"90th_percentile":8935.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":22469.13,"10th_percentile":15332.96,"90th_percentile":60918.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":14379.75,"10th_percentile":14379.75,"90th_percentile":14379.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"16","median_amount":14172.36,"10th_percentile":9653.07,"90th_percentile":48991.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":12299.97,"10th_percentile":10443.17,"90th_percentile":14906.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10164.12,"maximum":25423.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10164.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10367.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25423.21},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10164.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25423.21},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10164.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10164.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10367.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10164.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":21841.72,"10th_percentile":21841.72,"90th_percentile":55796.4},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":930.18,"10th_percentile":930.18,"90th_percentile":1473.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":25685.58,"10th_percentile":25685.58,"90th_percentile":25685.58},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"19","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":12341.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4536.89,"10th_percentile":4536.89,"90th_percentile":4536.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15442.75,"10th_percentile":15442.75,"90th_percentile":27277.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5334.41,"10th_percentile":1211.09,"90th_percentile":7981.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23338.35,"10th_percentile":16626.47,"90th_percentile":24659.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"19","median_amount":9653.07,"10th_percentile":9383.62,"90th_percentile":30975.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":11302.2,"10th_percentile":11302.2,"90th_percentile":11302.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":1037.35,"10th_percentile":1037.35,"90th_percentile":1037.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7492.96,"10th_percentile":7492.96,"90th_percentile":7492.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6669.75,"maximum":19387.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6803.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19387.73},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19387.73},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6803.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":796.22,"10th_percentile":796.22,"90th_percentile":796.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":3662.02,"10th_percentile":3662.02,"90th_percentile":3662.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26006.92,"10th_percentile":26006.92,"90th_percentile":26006.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":11511.04,"10th_percentile":11511.04,"90th_percentile":11511.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":12268.82,"10th_percentile":12268.82,"90th_percentile":12268.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21759.56,"maximum":39550.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21759.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22194.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39550.97},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21759.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39550.97},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21759.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21759.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22194.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21759.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11492.34,"maximum":25827.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11492.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11722.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25827.83},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11492.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25827.83},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11492.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11492.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11722.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11492.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8754.48,"maximum":18308.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8929.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18308.76},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18308.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8929.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18909.18,"10th_percentile":18909.18,"90th_percentile":18909.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":29585.34,"10th_percentile":29585.34,"90th_percentile":29585.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54537.1,"maximum":153179.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54537.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55627.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":153179.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54537.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153179.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54537.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54537.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55627.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54537.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":234841.45,"10th_percentile":234841.45,"90th_percentile":234841.45},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21366.22,"maximum":69087.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21793.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69087.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69087.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21793.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11902.15,"maximum":39584.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12140.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39584.69},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39584.69},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12140.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42828.22,"maximum":115618.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42828.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43684.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":115618.3},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42828.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115618.3},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42828.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42828.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43684.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42828.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14961.92,"10th_percentile":14961.92,"90th_percentile":14961.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":134018.49,"10th_percentile":134018.49,"90th_percentile":134018.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21613.2,"maximum":67098.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21613.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22045.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67098.4},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21613.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67098.4},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21613.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21613.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22045.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21613.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13232.21,"maximum":40967.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13496.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40967.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40967.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13496.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35370.1,"10th_percentile":35370.1,"90th_percentile":35370.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43678.95,"maximum":163497.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43678.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44552.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":163497.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43678.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163497.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43678.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43678.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44552.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43678.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":89322.73,"10th_percentile":89322.73,"90th_percentile":89322.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":20706.16,"10th_percentile":20706.16,"90th_percentile":20706.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22030.33,"maximum":71684.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22030.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22470.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71684.02},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22030.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71684.02},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22030.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22030.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22470.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22030.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16474.1,"maximum":46463.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16474.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16803.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46463.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16474.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46463.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16474.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16474.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16803.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16474.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":60592.32,"10th_percentile":60592.32,"90th_percentile":60592.32},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29794.78,"maximum":54285.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29794.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30390.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54285.64},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29794.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54285.64},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29794.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29794.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30390.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29794.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19826.71,"10th_percentile":19826.71,"90th_percentile":19826.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14655.57,"maximum":44912.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14948.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44912.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44912.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14948.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48218.57,"10th_percentile":48218.57,"90th_percentile":48218.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11888.43,"maximum":21377.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12126.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21377.08},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21377.08},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12126.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11888.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":10715.73,"10th_percentile":10715.73,"90th_percentile":10715.73},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7489.37,"maximum":13824.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7639.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13824.29},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13824.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7639.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5671.75,"maximum":9710.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5671.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5785.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9710.72},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5671.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9710.72},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5671.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5671.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5785.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5671.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":14333.23,"10th_percentile":14333.23,"90th_percentile":14333.23},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9418.8,"10th_percentile":7707.57,"90th_percentile":15508.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":9347.29,"10th_percentile":9347.29,"90th_percentile":9347.29},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":5942.28,"10th_percentile":5942.28,"90th_percentile":5942.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51107.68,"maximum":237373.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51107.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52129.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":237373.24},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51107.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237373.24},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51107.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51107.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52129.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51107.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28896.15,"10th_percentile":28896.15,"90th_percentile":28896.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":41521.11,"10th_percentile":41521.11,"90th_percentile":41521.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12240.47,"10th_percentile":12240.47,"90th_percentile":12240.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19968.47,"maximum":90498.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19968.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20367.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90498.55},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19968.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90498.55},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19968.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19968.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20367.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19968.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":3979.92,"10th_percentile":3979.92,"90th_percentile":3979.92},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9968.8,"10th_percentile":9968.8,"90th_percentile":9968.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12043.94,"maximum":56409.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12043.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12284.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56409.86},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12043.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56409.86},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12043.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12043.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12284.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12043.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44836.11,"maximum":103850.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44836.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45732.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103850.79},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44836.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103850.79},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44836.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44836.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45732.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44836.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19983.11,"maximum":36887.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19983.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20382.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36887.26},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19983.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36887.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19983.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19983.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20382.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19983.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14096.65,"maximum":28727.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14096.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14378.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28727.56},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14096.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28727.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14096.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14096.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14378.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14096.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30479.93,"maximum":109279.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30479.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31089.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":109279.36},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30479.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109279.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30479.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30479.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31089.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30479.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7829.81,"10th_percentile":1251.98,"90th_percentile":30081.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":33487.1,"10th_percentile":33487.1,"90th_percentile":33487.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48849.9,"10th_percentile":48849.9,"90th_percentile":48849.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9255.44,"10th_percentile":9255.44,"90th_percentile":9255.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20500.42,"10th_percentile":20500.42,"90th_percentile":20500.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13082.5,"10th_percentile":13082.5,"90th_percentile":13082.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":10451.47,"10th_percentile":10451.47,"90th_percentile":10451.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28320.59,"10th_percentile":28320.59,"90th_percentile":28320.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15811.82,"maximum":55229.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15811.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16128.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55229.74},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15811.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55229.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15811.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15811.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16128.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15811.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8591.82,"10th_percentile":8591.82,"90th_percentile":8591.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17364.67,"10th_percentile":17364.67,"90th_percentile":17364.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":47268.56,"10th_percentile":47268.56,"90th_percentile":47268.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5998.73,"10th_percentile":5998.73,"90th_percentile":5998.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":15916.08,"10th_percentile":15916.08,"90th_percentile":15916.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":25125.68,"10th_percentile":25125.68,"90th_percentile":25125.68},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10262.22,"10th_percentile":10262.22,"90th_percentile":10262.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10131.18,"maximum":37797.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10131.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10333.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37797.64},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10131.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37797.64},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10131.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10131.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10333.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10131.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":20444.58,"10th_percentile":20444.58,"90th_percentile":20444.58},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19136.04,"maximum":57994.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19136.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19518.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57994.6},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19136.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57994.6},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19136.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19136.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19518.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19136.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10781.34,"10th_percentile":10781.34,"90th_percentile":10781.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12024.73,"maximum":35369.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12265.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35369.96},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35369.96},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12265.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12024.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8678.55,"maximum":28929.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8678.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28929.86},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8678.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28929.86},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8678.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8678.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8852.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8678.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7232.6,"10th_percentile":7232.6,"90th_percentile":7232.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24603.54,"maximum":50441.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24603.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25095.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50441.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24603.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50441.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24603.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24603.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25095.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24603.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12855.33,"maximum":25288.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13112.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25288.34},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25288.34},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13112.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8658.43,"maximum":14667.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8831.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14667.24},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14667.24},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8831.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25673.8,"maximum":85069.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25673.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26187.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85069.98},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25673.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85069.98},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25673.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25673.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26187.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25673.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46064.63,"maximum":115517.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46064.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46985.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":115517.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46064.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115517.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46064.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46064.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46985.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46064.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":123922.05,"10th_percentile":55776.49,"90th_percentile":128436.02},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":42062.36,"10th_percentile":25338.87,"90th_percentile":76145.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":357685.36,"10th_percentile":357685.36,"90th_percentile":357685.36},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"16","median_amount":71442.25,"10th_percentile":27077.75,"90th_percentile":211284.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63422.97,"10th_percentile":63422.97,"90th_percentile":63422.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":118362.14,"10th_percentile":118362.14,"90th_percentile":118362.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":39342.43,"10th_percentile":23047.07,"90th_percentile":46011.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":115436.43,"10th_percentile":85018.37,"90th_percentile":159289.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":58606.43,"10th_percentile":58606.43,"90th_percentile":58606.43},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":58596.41,"10th_percentile":57943.13,"90th_percentile":134162.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"23","median_amount":87862.31,"10th_percentile":40134.55,"90th_percentile":306408.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30954.14,"10th_percentile":30954.14,"90th_percentile":30954.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":179668.6,"10th_percentile":179668.6,"90th_percentile":179668.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"20","median_amount":41237.51,"10th_percentile":25135.26,"90th_percentile":67911.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":243351.8,"10th_percentile":243351.8,"90th_percentile":243351.8},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48839.76,"10th_percentile":48839.76,"90th_percentile":48839.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19166.23,"maximum":47778.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19166.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47778.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19166.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47778.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19166.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19166.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19166.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16867.16,"10th_percentile":15854.76,"90th_percentile":21673.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":47762.34,"10th_percentile":47762.34,"90th_percentile":47762.34},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"15","median_amount":27304.64,"10th_percentile":16690.37,"90th_percentile":57061.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":77766.32,"10th_percentile":77766.32,"90th_percentile":77766.32},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47865.74,"10th_percentile":44940.27,"90th_percentile":89594.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17561.19,"10th_percentile":15255.3,"90th_percentile":42807.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":45381.37,"10th_percentile":22116.14,"90th_percentile":78837.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":53801.0,"10th_percentile":53801.0,"90th_percentile":53801.0},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":16593.28,"10th_percentile":16593.28,"90th_percentile":16593.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"13","median_amount":31464.02,"10th_percentile":9870.19,"90th_percentile":55411.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17778.53,"10th_percentile":17778.53,"90th_percentile":17778.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":132120.19,"10th_percentile":132120.19,"90th_percentile":132120.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"12","median_amount":17531.68,"10th_percentile":13184.03,"90th_percentile":33090.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14584.22,"maximum":37426.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14584.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14875.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37426.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14584.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37426.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14584.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14584.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14875.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14584.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42498.0,"maximum":93735.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43347.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":93735.46},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93735.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43347.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42498.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20477.99,"maximum":43361.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20887.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43361.08},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43361.08},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20477.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20887.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20477.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13630.13,"maximum":31559.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13630.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13902.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31559.85},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13630.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31559.85},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13630.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13630.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13902.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13630.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17570.9,"maximum":32841.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17922.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32841.13},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32841.13},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17922.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10016.84,"maximum":21444.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10016.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10217.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21444.51},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10016.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21444.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10016.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10016.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10217.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10016.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9008.78,"maximum":21006.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21006.18},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21006.18},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":8853.67,"10th_percentile":8853.67,"90th_percentile":8853.67},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14594.28,"maximum":34392.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14594.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14886.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34392.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14594.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34392.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14594.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14594.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14886.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14594.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":24857.12,"10th_percentile":24857.12,"90th_percentile":24857.12},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6018.28,"10th_percentile":6018.28,"90th_percentile":10695.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":15801.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10906.24,"10th_percentile":10906.24,"90th_percentile":11252.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28997.3,"10th_percentile":15958.8,"90th_percentile":210030.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9612.53,"10th_percentile":9612.53,"90th_percentile":9612.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9383.62,"90th_percentile":42435.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":13163.03,"10th_percentile":13163.03,"90th_percentile":13163.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8843.21,"maximum":17937.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8843.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17937.86},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8843.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17937.86},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8843.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8843.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8843.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7706.45,"10th_percentile":7706.45,"90th_percentile":7706.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13621.98,"10th_percentile":13621.98,"90th_percentile":13621.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25524.37,"10th_percentile":25524.37,"90th_percentile":25524.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":8250.94,"10th_percentile":8250.94,"90th_percentile":8250.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20036.16,"maximum":54251.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20036.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20436.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54251.92},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20036.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54251.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20036.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20036.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20436.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20036.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":63638.93,"10th_percentile":63638.93,"90th_percentile":158083.04},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":11175.2,"10th_percentile":1645.56,"90th_percentile":16973.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"14","median_amount":31001.91,"10th_percentile":10100.32,"90th_percentile":73374.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31654.59,"10th_percentile":29167.39,"90th_percentile":31822.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10764.79,"10th_percentile":1733.6,"90th_percentile":15887.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43241.24,"10th_percentile":17802.99,"90th_percentile":57237.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":131569.35,"10th_percentile":131569.35,"90th_percentile":131569.35},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":34248.25,"10th_percentile":34248.25,"90th_percentile":42701.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"11","median_amount":47987.35,"10th_percentile":9383.62,"90th_percentile":63246.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10713.26,"10th_percentile":10713.26,"90th_percentile":15186.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"15","median_amount":11880.2,"10th_percentile":8167.67,"90th_percentile":16134.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10673.47,"10th_percentile":10673.47,"90th_percentile":10673.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10320.54,"maximum":24917.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10320.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10526.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24917.45},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10320.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24917.45},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10320.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10320.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10526.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10320.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":30347.68,"10th_percentile":18069.49,"90th_percentile":77100.93},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6829.95,"10th_percentile":785.58,"90th_percentile":8180.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":16011.14,"10th_percentile":16011.14,"90th_percentile":16011.14},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9250.04,"90th_percentile":52193.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21309.64,"10th_percentile":21309.64,"90th_percentile":27960.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7483.72,"10th_percentile":6445.79,"90th_percentile":9088.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17349.54,"10th_percentile":13655.7,"90th_percentile":25589.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"11","median_amount":9653.07,"10th_percentile":9383.62,"90th_percentile":18314.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8847.53,"10th_percentile":8401.64,"90th_percentile":12914.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":18745.77,"10th_percentile":18745.77,"90th_percentile":18745.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"13","median_amount":7123.7,"10th_percentile":5765.42,"90th_percentile":8926.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11171.7,"10th_percentile":11171.7,"90th_percentile":11171.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7563.46,"maximum":20669.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7714.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20669.01},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20669.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7714.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":20872.6,"10th_percentile":20872.6,"90th_percentile":20872.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17106.16,"10th_percentile":17106.16,"90th_percentile":17106.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64114.6,"maximum":174186.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64114.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65396.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":174186.1},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64114.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174186.1},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64114.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64114.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65396.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64114.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":213651.1,"10th_percentile":213651.1,"90th_percentile":213651.1},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":57242.63,"10th_percentile":32364.92,"90th_percentile":91794.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":124836.57,"10th_percentile":68479.22,"90th_percentile":222988.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":173461.12,"10th_percentile":173461.12,"90th_percentile":173461.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58410.59,"10th_percentile":41122.91,"90th_percentile":92872.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":88114.71,"10th_percentile":88114.71,"90th_percentile":180063.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":223305.46,"10th_percentile":223305.46,"90th_percentile":223305.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"12","median_amount":172685.8,"10th_percentile":105015.77,"90th_percentile":241519.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95800.98,"10th_percentile":95800.98,"90th_percentile":95800.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":61205.32,"10th_percentile":59799.54,"90th_percentile":73496.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69134.87,"10th_percentile":69134.87,"90th_percentile":69134.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18657.63,"maximum":47070.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19030.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47070.03},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47070.03},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19030.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"12","median_amount":53953.17,"10th_percentile":35264.75,"90th_percentile":165511.62},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"78","median_amount":15900.12,"10th_percentile":1864.24,"90th_percentile":18411.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":162475.43,"10th_percentile":113018.35,"90th_percentile":194978.5},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"56","median_amount":17026.26,"10th_percentile":9556.96,"90th_percentile":96904.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17337.44,"10th_percentile":17292.93,"90th_percentile":18044.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48039.87,"10th_percentile":40105.17,"90th_percentile":50923.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"30","median_amount":14916.4,"10th_percentile":8365.85,"90th_percentile":17596.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"54","median_amount":46007.48,"10th_percentile":20500.42,"90th_percentile":48745.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":37030.57,"10th_percentile":27223.61,"90th_percentile":44695.0},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"20","median_amount":22492.51,"10th_percentile":9515.48,"90th_percentile":105836.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"72","median_amount":32242.88,"10th_percentile":9653.07,"90th_percentile":87979.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":15793.57,"10th_percentile":8218.15,"90th_percentile":18148.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":90910.62,"10th_percentile":24055.7,"90th_percentile":114130.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"70","median_amount":16266.39,"10th_percentile":9816.62,"90th_percentile":18780.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":36519.71,"10th_percentile":22784.76,"90th_percentile":69321.71},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":20308.26,"10th_percentile":17443.13,"90th_percentile":21649.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10249.19,"maximum":23973.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10249.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23973.35},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10249.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23973.35},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10249.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10249.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10249.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":16086.76,"10th_percentile":11246.34,"90th_percentile":53861.63},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":7663.65,"10th_percentile":979.58,"90th_percentile":10683.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":88309.1,"10th_percentile":88309.1,"90th_percentile":88309.1},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"19","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":52977.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":39296.39,"10th_percentile":39296.39,"90th_percentile":39296.39},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24894.33,"10th_percentile":16690.32,"90th_percentile":29400.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9125.21,"10th_percentile":7575.36,"90th_percentile":13236.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":22651.84,"10th_percentile":14346.17,"90th_percentile":25099.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":115030.19,"10th_percentile":115030.19,"90th_percentile":115030.19},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":10409.17,"10th_percentile":9515.48,"90th_percentile":27119.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"20","median_amount":12233.04,"10th_percentile":9653.07,"90th_percentile":127567.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9470.48,"10th_percentile":9470.48,"90th_percentile":12418.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":4898.78,"10th_percentile":4898.78,"90th_percentile":34186.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":9738.96,"10th_percentile":7848.47,"90th_percentile":20052.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":23424.79,"10th_percentile":23424.79,"90th_percentile":23424.79},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9960.35,"10th_percentile":9960.35,"90th_percentile":9960.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36242.9,"maximum":117911.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36242.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36967.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":117911.11},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36242.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117911.11},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36242.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36242.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36967.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36242.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":49538.55,"10th_percentile":49538.55,"90th_percentile":52810.4},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21301.21,"10th_percentile":21301.21,"90th_percentile":21301.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":13576.73,"10th_percentile":13576.73,"90th_percentile":38546.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21422.86,"10th_percentile":21422.86,"90th_percentile":21422.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11849.52,"10th_percentile":11849.52,"90th_percentile":11849.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":21358.99,"10th_percentile":13084.81,"90th_percentile":60952.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":15307.59,"10th_percentile":15307.59,"90th_percentile":15307.59},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":26903.18,"10th_percentile":26903.18,"90th_percentile":83460.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":27345.62,"10th_percentile":26681.81,"90th_percentile":33881.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":19501.77,"10th_percentile":19501.77,"90th_percentile":19501.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9671.98,"maximum":20062.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9671.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20062.09},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9671.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20062.09},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9671.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9671.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9671.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":14433.97,"10th_percentile":14433.97,"90th_percentile":14433.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17922.25,"10th_percentile":17922.25,"90th_percentile":17922.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15577.62,"10th_percentile":13284.81,"90th_percentile":47465.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":37122.64,"10th_percentile":37122.64,"90th_percentile":37122.64},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":6249.49,"10th_percentile":6249.49,"90th_percentile":6249.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9495.43,"maximum":12306.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9495.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9685.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12306.99},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9495.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12306.99},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9495.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9495.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9685.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9495.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":18805.55,"10th_percentile":18805.55,"90th_percentile":23686.55},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6069.76,"10th_percentile":6069.76,"90th_percentile":6069.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13837.91,"10th_percentile":13837.91,"90th_percentile":13837.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13637.91,"10th_percentile":13284.81,"90th_percentile":24574.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":13296.65,"10th_percentile":13296.65,"90th_percentile":13296.65},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9383.62,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10711.14,"maximum":11565.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10925.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11565.2},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11565.2},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10925.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18875.34,"maximum":34156.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18875.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19252.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34156.12},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18875.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34156.12},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18875.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18875.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19252.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18875.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":13679.61,"10th_percentile":13679.61,"90th_percentile":13679.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15606.0,"maximum":20938.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15918.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20938.75},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20938.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15918.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15606.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9491.06,"10th_percentile":7944.08,"90th_percentile":14105.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6596.56,"10th_percentile":6596.56,"90th_percentile":8596.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24735.22,"10th_percentile":24735.22,"90th_percentile":24735.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":9653.07,"10th_percentile":9653.07,"90th_percentile":9653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":9044.4,"10th_percentile":8414.77,"90th_percentile":11792.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8750.21,"10th_percentile":8750.21,"90th_percentile":8750.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13665.8,"maximum":17701.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13939.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17701.84},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17701.84},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13939.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8657.81,"10th_percentile":8657.81,"90th_percentile":11945.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11712.5,"10th_percentile":11712.5,"90th_percentile":11712.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33940.47,"10th_percentile":33940.47,"90th_percentile":35815.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":16441.46,"10th_percentile":16441.46,"90th_percentile":16441.46},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"1 through 10","median_amount":35867.2,"10th_percentile":18253.9,"90th_percentile":36140.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9751.13,"10th_percentile":9751.13,"90th_percentile":9751.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":6418.18,"10th_percentile":6418.18,"90th_percentile":6418.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19872.42,"maximum":35167.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20269.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35167.65},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35167.65},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20269.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19872.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":9515.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10684.61,"maximum":34527.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10898.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34527.02},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34527.02},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10898.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12256.31,"10th_percentile":12256.31,"90th_percentile":12256.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6531.62,"maximum":11261.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11261.74},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11261.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13837.78,"maximum":50880.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13837.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14114.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50880.15},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13837.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50880.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13837.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13837.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14114.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13837.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16851.9,"maximum":39618.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17188.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39618.4},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39618.4},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17188.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":11417.08,"10th_percentile":11417.08,"90th_percentile":11417.08},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10755.21,"10th_percentile":10755.21,"90th_percentile":10755.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"13","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":20997.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8925.88,"10th_percentile":8925.88,"90th_percentile":8925.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27471.59,"10th_percentile":27471.59,"90th_percentile":27471.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"1 through 10","median_amount":16774.9,"10th_percentile":16774.9,"90th_percentile":16774.9},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"1 through 10","median_amount":10440.01,"10th_percentile":9515.48,"90th_percentile":45842.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"12","median_amount":9653.07,"10th_percentile":9383.62,"90th_percentile":19536.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15879.35,"10th_percentile":15879.35,"90th_percentile":15879.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":9266.07,"10th_percentile":9266.07,"90th_percentile":9266.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8963.96,"maximum":16555.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8963.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9143.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16555.43},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8963.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16555.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8963.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8963.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9143.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8963.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":19919.38,"10th_percentile":19919.38,"90th_percentile":19919.38},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6927.25,"10th_percentile":6927.25,"90th_percentile":6927.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"24","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9987.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16236.94,"10th_percentile":16236.94,"90th_percentile":16236.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7875.74,"10th_percentile":7875.74,"90th_percentile":9173.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16930.0,"10th_percentile":15168.71,"90th_percentile":52931.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"11","median_amount":9515.48,"10th_percentile":9515.48,"90th_percentile":15431.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"27","median_amount":9383.62,"10th_percentile":9383.62,"90th_percentile":21594.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"1 through 10","median_amount":8555.22,"10th_percentile":8555.22,"90th_percentile":8555.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"1 through 10","median_amount":6471.57,"10th_percentile":6471.57,"90th_percentile":6471.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39277.14,"maximum":112212.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39277.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40062.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112212.81},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39277.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112212.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39277.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39277.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40062.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39277.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18401.49,"maximum":39955.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18401.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18769.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39955.58},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18401.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39955.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18401.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18401.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18769.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18401.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11587.48,"maximum":27041.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11587.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11819.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27041.67},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11587.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27041.67},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11587.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11587.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11819.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11587.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34488.39,"maximum":100108.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34488.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35178.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100108.12},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34488.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100108.12},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34488.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34488.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35178.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34488.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14457.98,"maximum":53712.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14457.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14747.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53712.44},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14457.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53712.44},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14457.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14457.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14747.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14457.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":104427.89,"maximum":106516.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104427.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106516.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104427.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104427.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104427.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106516.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104427.89,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":53092.7,"maximum":54154.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53092.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54154.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53092.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53092.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53092.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54154.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53092.7,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":62053.65,"maximum":63294.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62053.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63294.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62053.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62053.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62053.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63294.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62053.65,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23045.71,"maximum":23506.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23506.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23506.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.71,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":32343.29,"maximum":32990.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32343.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32343.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32343.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32343.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32343.29,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":22973.44,"maximum":23432.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23432.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23432.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.44,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":37666.26,"maximum":38419.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37666.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38419.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37666.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37666.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37666.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38419.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37666.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":101705.58,"maximum":103739.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101705.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103739.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101705.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101705.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101705.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103739.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101705.58,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":66921.07,"maximum":68259.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66921.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68259.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66921.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66921.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66921.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68259.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66921.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":52316.07,"maximum":53362.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52316.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53362.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52316.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52316.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52316.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53362.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52316.07,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":83304.35,"maximum":84970.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83304.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84970.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83304.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83304.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83304.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84970.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83304.35,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":53643.38,"maximum":54716.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54716.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54716.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53643.38,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":62008.83,"maximum":63249.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62008.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63249.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62008.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62008.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62008.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63249.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62008.83,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":39681.46,"maximum":40475.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39681.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40475.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39681.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39681.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39681.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40475.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39681.46,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":49641.33,"maximum":50634.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50634.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49641.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50634.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49641.33,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":30438.77,"maximum":31047.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30438.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31047.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30438.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30438.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30438.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31047.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30438.77,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":80101.79,"maximum":81703.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80101.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81703.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80101.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80101.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80101.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81703.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80101.79,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":14314.28,"10th_percentile":14314.28,"90th_percentile":14314.28},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":17406.7,"10th_percentile":17406.7,"90th_percentile":17406.7},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"1 through 10","median_amount":9556.96,"10th_percentile":9556.96,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 32439.38 | Excess % of Charge: 0] [Medical-Case Rate: 9556.96] [Surgical-Case Rate: 9556.96] [Normal Newborn-Case Rate: 3662.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":82.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 29545.31 | Excess % of Charge: 80.2653] [Medical-Case Rate: 9515.26] [Surgical-Case Rate: 9515.26] [Normal Newborn-Case Rate: 3646.05]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 27849.28 | Excess % of Charge: 82.1021] [Medical-Case Rate: 9383.46] [Surgical-Case Rate: 9383.46] [Normal Newborn-Case Rate: 3160.08]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Cardiac Surgery (%BC): 85] [All Other IP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 320]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"0763","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":83816.35,"10th_percentile":83816.35,"90th_percentile":83816.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":2619.64,"10th_percentile":2619.64,"90th_percentile":2619.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12938.37,"10th_percentile":12938.37,"90th_percentile":12938.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6275.13,"10th_percentile":6275.13,"90th_percentile":19881.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":39286.01,"10th_percentile":29407.16,"90th_percentile":59168.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":45309.22,"10th_percentile":45309.22,"90th_percentile":45309.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":21972.36,"10th_percentile":21972.36,"90th_percentile":21972.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":479.84,"10th_percentile":479.84,"90th_percentile":479.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20477.68,"10th_percentile":20477.68,"90th_percentile":20477.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":29947.1,"10th_percentile":12752.48,"90th_percentile":50892.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15730.58,"10th_percentile":15730.58,"90th_percentile":15730.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":90921.88,"10th_percentile":90921.88,"90th_percentile":90921.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":3855.32,"10th_percentile":3855.32,"90th_percentile":3855.32},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":5337.69,"10th_percentile":816.19,"90th_percentile":30030.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":53372.01,"10th_percentile":53372.01,"90th_percentile":53372.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":3880.17,"10th_percentile":3880.17,"90th_percentile":3880.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"45","median_amount":5095.79,"10th_percentile":1096.64,"90th_percentile":7223.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2459.96,"10th_percentile":2459.96,"90th_percentile":2459.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":12783.77,"10th_percentile":12783.77,"90th_percentile":12783.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2653.78,"10th_percentile":2653.78,"90th_percentile":2653.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":2286.39,"10th_percentile":2154.41,"90th_percentile":2508.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":1204.18,"10th_percentile":1187.89,"90th_percentile":1831.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1556.75,"10th_percentile":1556.75,"90th_percentile":1556.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1151.15,"10th_percentile":1151.15,"90th_percentile":1401.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":2664.25,"10th_percentile":2159.5,"90th_percentile":3921.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":919.34,"10th_percentile":327.43,"90th_percentile":1535.44},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, glycopyrrolate, 0.1 mg","code_information":[{"code":"0792","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":8512.15,"10th_percentile":8512.15,"90th_percentile":8512.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4557.54,"10th_percentile":4557.54,"90th_percentile":4557.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8309.61,"10th_percentile":8309.61,"90th_percentile":8309.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":8578.85,"10th_percentile":8578.85,"90th_percentile":8578.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":5082.69,"10th_percentile":5082.69,"90th_percentile":5603.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16302.66,"10th_percentile":16302.66,"90th_percentile":16302.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bumetanide, 0.5 mg","code_information":[{"code":"0794","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":5606.07,"10th_percentile":5606.07,"90th_percentile":5606.07},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred sod succ 5mg","code_information":[{"code":"0801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":4413.24,"10th_percentile":4413.24,"90th_percentile":4413.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":1199.86,"10th_percentile":1199.86,"90th_percentile":9102.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":4733.38,"10th_percentile":300.5,"90th_percentile":13635.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":345.16,"10th_percentile":345.16,"90th_percentile":29214.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":870.02,"10th_percentile":870.02,"90th_percentile":10417.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":18411.18,"10th_percentile":18411.18,"90th_percentile":18411.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10201.33,"10th_percentile":10201.33,"90th_percentile":10201.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Synvisc or synvisc-one","code_information":[{"code":"0874","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1316.77,"10th_percentile":1316.77,"90th_percentile":1316.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":706.66,"10th_percentile":706.66,"90th_percentile":706.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Albumin (human), 25%, 50ml","code_information":[{"code":"0965","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":65348.68,"10th_percentile":65348.68,"90th_percentile":65348.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Antihemophilic viii/vwf comp","code_information":[{"code":"1213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":1042.18,"10th_percentile":1042.18,"90th_percentile":1042.18},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degarelix injection","code_information":[{"code":"1296","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":372.28,"10th_percentile":372.28,"90th_percentile":372.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Injection, Pertuzumab, 1 mg","code_information":[{"code":"1471","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":38443.81,"10th_percentile":38443.81,"90th_percentile":38443.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11884.11,"10th_percentile":11884.11,"90th_percentile":11884.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj pembrolizumab","code_information":[{"code":"1490","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9348.52,"10th_percentile":9348.52,"90th_percentile":9348.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":13475.27,"10th_percentile":13475.27,"90th_percentile":13475.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23302.07,"10th_percentile":23302.07,"90th_percentile":23302.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13420.52,"10th_percentile":13420.52,"90th_percentile":13420.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epoetin alfa, non-esrd","code_information":[{"code":"1686","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":149.34,"10th_percentile":149.34,"90th_percentile":149.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Paclitaxel protein bound","code_information":[{"code":"1712","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":797.72,"10th_percentile":797.72,"90th_percentile":797.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj tbo filgrastim 1 microg","code_information":[{"code":"1748","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":546.09,"10th_percentile":546.09,"90th_percentile":546.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Injection, dalbavancin","code_information":[{"code":"1823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":55734.47,"10th_percentile":55734.47,"90th_percentile":55734.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"929","median_amount":253.92,"10th_percentile":138.0,"90th_percentile":357.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":297.16,"10th_percentile":253.92,"90th_percentile":297.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1468","median_amount":134.48,"10th_percentile":54.33,"90th_percentile":134.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"123","median_amount":168.8,"10th_percentile":94.79,"90th_percentile":374.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"803","median_amount":148.57,"10th_percentile":80.75,"90th_percentile":288.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":137.47,"10th_percentile":55.2,"90th_percentile":138.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"46","median_amount":215.6,"10th_percentile":120.15,"90th_percentile":329.3},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"394","median_amount":137.08,"10th_percentile":102.81,"90th_percentile":137.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"600","median_amount":134.34,"10th_percentile":53.73,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"3850","median_amount":137.08,"10th_percentile":123.38,"90th_percentile":167.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"29","median_amount":285.92,"10th_percentile":114.8,"90th_percentile":939.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"277","median_amount":156.94,"10th_percentile":77.47,"90th_percentile":517.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1111","median_amount":108.77,"10th_percentile":53.18,"90th_percentile":339.33},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"217","median_amount":110.69,"10th_percentile":51.96,"90th_percentile":138.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"16","median_amount":134.34,"10th_percentile":134.34,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"363","median_amount":288.88,"10th_percentile":138.0,"90th_percentile":577.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1059","median_amount":137.03,"10th_percentile":54.82,"90th_percentile":137.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"131","median_amount":146.0,"10th_percentile":109.5,"90th_percentile":229.22},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"136","median_amount":141.05,"10th_percentile":56.42,"90th_percentile":141.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":117.0,"10th_percentile":117.0,"90th_percentile":117.0}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"334","median_amount":476.56,"10th_percentile":249.88,"90th_percentile":1272.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"159","median_amount":93.66,"10th_percentile":91.79,"90th_percentile":125.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"48","median_amount":445.59,"10th_percentile":226.29,"90th_percentile":1155.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1233","median_amount":290.0,"10th_percentile":263.23,"90th_percentile":797.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":95.53,"10th_percentile":95.53,"90th_percentile":95.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"27","median_amount":420.87,"10th_percentile":322.71,"90th_percentile":922.94},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"92","median_amount":390.0,"10th_percentile":103.65,"90th_percentile":403.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"51","median_amount":93.66,"10th_percentile":91.79,"90th_percentile":173.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1224","median_amount":423.67,"10th_percentile":153.43,"90th_percentile":891.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"100","median_amount":426.83,"10th_percentile":150.0,"90th_percentile":1197.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"513","median_amount":456.19,"10th_percentile":318.27,"90th_percentile":1110.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1501","median_amount":181.51,"10th_percentile":169.39,"90th_percentile":508.48},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"48","median_amount":96.47,"10th_percentile":96.47,"90th_percentile":97.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"135","median_amount":437.0,"10th_percentile":167.39,"90th_percentile":1190.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"164","median_amount":95.53,"10th_percentile":93.62,"90th_percentile":236.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":632.91,"10th_percentile":632.91,"90th_percentile":632.91},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"67","median_amount":98.34,"10th_percentile":96.37,"90th_percentile":243.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"291","median_amount":1211.98,"10th_percentile":661.0,"90th_percentile":1950.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":982.79,"10th_percentile":982.79,"90th_percentile":982.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"188","median_amount":167.28,"10th_percentile":42.58,"90th_percentile":276.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"45","median_amount":728.59,"10th_percentile":398.63,"90th_percentile":1289.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"999","median_amount":892.64,"10th_percentile":490.53,"90th_percentile":1217.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":170.58,"10th_percentile":169.59,"90th_percentile":170.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"24","median_amount":830.71,"10th_percentile":581.68,"90th_percentile":1299.63},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"78","median_amount":701.43,"10th_percentile":363.15,"90th_percentile":1340.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"80","median_amount":165.08,"10th_percentile":42.58,"90th_percentile":275.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1201","median_amount":787.92,"10th_percentile":487.92,"90th_percentile":1506.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"109","median_amount":1062.14,"10th_percentile":597.73,"90th_percentile":1882.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"434","median_amount":692.35,"10th_percentile":318.27,"90th_percentile":1385.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1414","median_amount":499.87,"10th_percentile":306.39,"90th_percentile":760.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"44","median_amount":172.23,"10th_percentile":62.23,"90th_percentile":316.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"143","median_amount":1054.32,"10th_percentile":309.75,"90th_percentile":1799.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"179","median_amount":170.58,"10th_percentile":60.58,"90th_percentile":380.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":921.81,"10th_percentile":771.97,"90th_percentile":1799.08},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"49","median_amount":175.53,"10th_percentile":145.12,"90th_percentile":293.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"620","median_amount":2301.99,"10th_percentile":1190.4,"90th_percentile":4863.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"442","median_amount":401.3,"10th_percentile":272.63,"90th_percentile":665.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"115","median_amount":1296.4,"10th_percentile":727.27,"90th_percentile":2255.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1566","median_amount":1488.4,"10th_percentile":925.89,"90th_percentile":3027.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":425.17,"10th_percentile":321.93,"90th_percentile":504.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"31","median_amount":1790.0,"10th_percentile":915.97,"90th_percentile":4535.68},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"162","median_amount":1697.45,"10th_percentile":819.22,"90th_percentile":3079.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"176","median_amount":399.5,"10th_percentile":257.93,"90th_percentile":703.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"2520","median_amount":1970.06,"10th_percentile":1078.16,"90th_percentile":3548.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"187","median_amount":2147.97,"10th_percentile":1054.26,"90th_percentile":4815.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"620","median_amount":1281.25,"10th_percentile":527.51,"90th_percentile":2340.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"2103","median_amount":882.7,"10th_percentile":522.36,"90th_percentile":1917.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"85","median_amount":430.61,"10th_percentile":299.5,"90th_percentile":817.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"303","median_amount":2285.56,"10th_percentile":662.42,"90th_percentile":4847.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"346","median_amount":409.68,"10th_percentile":265.54,"90th_percentile":721.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"17","median_amount":1862.59,"10th_percentile":1131.5,"90th_percentile":5135.55},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"62","median_amount":449.83,"10th_percentile":303.07,"90th_percentile":740.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":2423.27,"10th_percentile":1731.58,"90th_percentile":2619.22}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"386","median_amount":6058.82,"10th_percentile":2604.79,"90th_percentile":11094.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":14424.04,"10th_percentile":14424.04,"90th_percentile":14424.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"397","median_amount":801.74,"10th_percentile":537.88,"90th_percentile":1255.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"73","median_amount":2305.69,"10th_percentile":716.05,"90th_percentile":4677.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"938","median_amount":3616.99,"10th_percentile":1774.78,"90th_percentile":7630.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":875.76,"10th_percentile":668.87,"90th_percentile":1295.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"24","median_amount":4792.21,"10th_percentile":1843.33,"90th_percentile":10621.6},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"125","median_amount":3361.82,"10th_percentile":1530.26,"90th_percentile":5316.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"156","median_amount":789.68,"10th_percentile":535.68,"90th_percentile":1572.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1555","median_amount":4169.67,"10th_percentile":2256.92,"90th_percentile":6874.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"117","median_amount":4982.75,"10th_percentile":2205.85,"90th_percentile":9234.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"366","median_amount":2453.97,"10th_percentile":1144.82,"90th_percentile":5134.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1256","median_amount":2190.91,"10th_percentile":957.16,"90th_percentile":4213.7},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"66","median_amount":945.16,"10th_percentile":587.92,"90th_percentile":1820.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":803.42,"10th_percentile":803.42,"90th_percentile":803.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"196","median_amount":5762.56,"10th_percentile":2474.8,"90th_percentile":14177.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"298","median_amount":803.05,"10th_percentile":536.96,"90th_percentile":1405.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"31","median_amount":5974.68,"10th_percentile":2861.41,"90th_percentile":8720.94},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"66","median_amount":942.72,"10th_percentile":563.21,"90th_percentile":1574.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":3449.75,"10th_percentile":3449.75,"90th_percentile":3449.75}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"243","median_amount":11503.86,"10th_percentile":3714.63,"90th_percentile":21727.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"286","median_amount":2490.61,"10th_percentile":870.7,"90th_percentile":2920.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"38","median_amount":5474.98,"10th_percentile":1091.05,"90th_percentile":12898.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"676","median_amount":5924.83,"10th_percentile":1985.11,"90th_percentile":14434.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2707.51,"10th_percentile":1422.55,"90th_percentile":2817.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"16","median_amount":8308.14,"10th_percentile":4828.45,"90th_percentile":18207.97},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"72","median_amount":6800.7,"10th_percentile":2715.64,"90th_percentile":12188.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"154","median_amount":2650.11,"10th_percentile":829.83,"90th_percentile":2934.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"865","median_amount":9854.36,"10th_percentile":3157.29,"90th_percentile":13637.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"59","median_amount":9057.5,"10th_percentile":2524.93,"90th_percentile":19685.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"268","median_amount":2980.43,"10th_percentile":973.9,"90th_percentile":8898.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"792","median_amount":2760.38,"10th_percentile":1183.78,"90th_percentile":8152.49},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"75","median_amount":2735.11,"10th_percentile":940.8,"90th_percentile":2935.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5845.57,"10th_percentile":5845.57,"90th_percentile":5845.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"103","median_amount":11513.62,"10th_percentile":3952.32,"90th_percentile":23937.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"241","median_amount":2707.51,"10th_percentile":910.46,"90th_percentile":2992.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"28","median_amount":9681.07,"10th_percentile":4055.88,"90th_percentile":20866.13},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"45","median_amount":2117.01,"10th_percentile":817.84,"90th_percentile":3078.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":8504.53,"10th_percentile":8504.53,"90th_percentile":8504.53}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":5412.39,"10th_percentile":4874.36,"90th_percentile":23800.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1379.07,"10th_percentile":1080.49,"90th_percentile":1396.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":9250.04,"10th_percentile":6571.58,"90th_percentile":24609.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9627.25,"10th_percentile":6127.18,"90th_percentile":17433.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":2881.56,"10th_percentile":2038.54,"90th_percentile":7231.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":2675.08,"10th_percentile":2525.22,"90th_percentile":5788.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":33148.93,"10th_percentile":33148.93,"90th_percentile":33148.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19541.94,"10th_percentile":19541.94,"90th_percentile":19541.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma Response with Critical Care","code_information":[{"code":"5045","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13421.81,"10th_percentile":13421.81,"90th_percentile":13421.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":10904.48,"10th_percentile":10904.48,"90th_percentile":10904.48},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"21","median_amount":1431.75,"10th_percentile":631.05,"90th_percentile":4554.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":207.13,"10th_percentile":134.94,"90th_percentile":342.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"43","median_amount":681.35,"10th_percentile":377.76,"90th_percentile":1361.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":178.12,"10th_percentile":178.12,"90th_percentile":213.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":1388.73,"10th_percentile":1388.73,"90th_percentile":1388.73},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":547.25,"10th_percentile":260.5,"90th_percentile":1311.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"65","median_amount":937.8,"10th_percentile":271.64,"90th_percentile":1476.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":747.3,"10th_percentile":465.97,"90th_percentile":16151.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":1060.9,"10th_percentile":414.14,"90th_percentile":1465.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"52","median_amount":308.79,"10th_percentile":175.46,"90th_percentile":528.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"26","median_amount":193.98,"10th_percentile":170.68,"90th_percentile":201.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":902.39,"10th_percentile":676.28,"90th_percentile":7464.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":212.14,"10th_percentile":161.83,"90th_percentile":349.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":1524.24,"10th_percentile":1524.24,"90th_percentile":1524.24},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":283.33,"10th_percentile":283.33,"90th_percentile":283.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"45","median_amount":2823.02,"10th_percentile":1299.04,"90th_percentile":5942.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"279","median_amount":418.19,"10th_percentile":146.99,"90th_percentile":943.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1328.68,"10th_percentile":1311.19,"90th_percentile":2574.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"193","median_amount":1770.74,"10th_percentile":824.95,"90th_percentile":6122.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":343.95,"10th_percentile":254.89,"90th_percentile":853.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":1256.68,"10th_percentile":1256.68,"90th_percentile":1431.12},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"58","median_amount":1585.5,"10th_percentile":1105.75,"90th_percentile":1973.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"76","median_amount":399.47,"10th_percentile":199.47,"90th_percentile":756.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"222","median_amount":1908.5,"10th_percentile":1251.75,"90th_percentile":3837.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"27","median_amount":1240.74,"10th_percentile":1124.45,"90th_percentile":3239.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"34","median_amount":1714.36,"10th_percentile":874.63,"90th_percentile":7185.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"227","median_amount":737.33,"10th_percentile":520.21,"90th_percentile":3122.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":453.88,"10th_percentile":343.19,"90th_percentile":735.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":416.49,"10th_percentile":416.49,"90th_percentile":550.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"36","median_amount":1985.94,"10th_percentile":1277.79,"90th_percentile":16631.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"146","median_amount":425.66,"10th_percentile":204.32,"90th_percentile":766.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"39","median_amount":439.1,"10th_percentile":69.82,"90th_percentile":721.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":2373.6,"10th_percentile":2373.6,"90th_percentile":30497.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":772.45,"10th_percentile":368.61,"90th_percentile":894.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3873.08,"10th_percentile":3873.08,"90th_percentile":3873.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"21","median_amount":10086.66,"10th_percentile":1577.37,"90th_percentile":19665.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":472.45,"10th_percentile":338.11,"90th_percentile":788.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":3141.52,"10th_percentile":1915.25,"90th_percentile":5463.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"19","median_amount":5627.02,"10th_percentile":2937.49,"90th_percentile":9275.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"38","median_amount":1237.23,"10th_percentile":601.11,"90th_percentile":4369.0},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":30118.94,"10th_percentile":30118.94,"90th_percentile":30118.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"22","median_amount":787.89,"10th_percentile":653.52,"90th_percentile":1301.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":32999.56,"10th_percentile":32999.56,"90th_percentile":32999.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":1914.66,"10th_percentile":1906.87,"90th_percentile":2874.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"25","median_amount":3808.88,"10th_percentile":2764.04,"90th_percentile":13205.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2890.31,"10th_percentile":2890.31,"90th_percentile":3296.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":8450.77,"10th_percentile":8329.29,"90th_percentile":9500.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":7446.74,"10th_percentile":7446.74,"90th_percentile":10607.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":2422.28,"10th_percentile":712.01,"90th_percentile":11307.76},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2270.46,"10th_percentile":2270.46,"90th_percentile":2270.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":12832.99,"10th_percentile":12832.99,"90th_percentile":12832.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"30","median_amount":1702.11,"10th_percentile":858.05,"90th_percentile":7606.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27087.34,"10th_percentile":19532.9,"90th_percentile":27087.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"34","median_amount":2528.76,"10th_percentile":2528.76,"90th_percentile":2665.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"25","median_amount":626.53,"10th_percentile":593.53,"90th_percentile":803.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"27","median_amount":3487.72,"10th_percentile":2248.48,"90th_percentile":7857.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":733.45,"10th_percentile":473.95,"90th_percentile":739.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":358.87,"10th_percentile":358.87,"90th_percentile":358.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"17","median_amount":2112.29,"10th_percentile":1791.59,"90th_percentile":7725.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":3078.38,"10th_percentile":3078.38,"90th_percentile":3078.38},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3116.42,"10th_percentile":2825.47,"90th_percentile":3504.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":733.45,"10th_percentile":730.95,"90th_percentile":3892.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"82","median_amount":3500.73,"10th_percentile":2908.25,"90th_percentile":3623.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":2989.88,"10th_percentile":1695.93,"90th_percentile":5257.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":2120.41,"10th_percentile":1198.82,"90th_percentile":5120.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"16","median_amount":1240.12,"10th_percentile":516.27,"90th_percentile":2144.22},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":758.54,"10th_percentile":758.54,"90th_percentile":906.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":3877.98,"10th_percentile":2837.49,"90th_percentile":4544.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"17","median_amount":751.18,"10th_percentile":598.5,"90th_percentile":839.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":7088.04,"10th_percentile":7088.04,"90th_percentile":11533.79},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":776.12,"10th_percentile":776.12,"90th_percentile":776.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"67","median_amount":6690.43,"10th_percentile":4674.25,"90th_percentile":19101.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":5266.4,"10th_percentile":5266.4,"90th_percentile":5266.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":1691.51,"10th_percentile":1419.91,"90th_percentile":1817.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4438.24,"10th_percentile":1249.81,"90th_percentile":6390.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"39","median_amount":3966.96,"10th_percentile":2591.2,"90th_percentile":8990.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":6110.32,"10th_percentile":6110.32,"90th_percentile":6110.32},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":7047.73,"10th_percentile":5102.77,"90th_percentile":7850.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":1689.01,"10th_percentile":1486.46,"90th_percentile":1775.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"268","median_amount":7681.09,"10th_percentile":5343.18,"90th_percentile":11307.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"19","median_amount":6060.29,"10th_percentile":3964.67,"90th_percentile":13985.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"20","median_amount":7821.3,"10th_percentile":3519.91,"90th_percentile":14168.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"59","median_amount":3233.09,"10th_percentile":1911.84,"90th_percentile":7009.64},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1492.52,"10th_percentile":1391.74,"90th_percentile":1746.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1689.01,"10th_percentile":1689.01,"90th_percentile":1689.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"28","median_amount":6162.21,"10th_percentile":3271.52,"90th_percentile":13425.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"30","median_amount":1807.13,"10th_percentile":1462.56,"90th_percentile":2518.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":9271.4,"10th_percentile":9271.4,"90th_percentile":9271.4},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1508.28,"10th_percentile":1492.77,"90th_percentile":1780.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":19525.27,"10th_percentile":15812.04,"90th_percentile":24704.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":2983.53,"10th_percentile":2983.53,"90th_percentile":3369.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":6351.12,"10th_percentile":6351.12,"90th_percentile":6351.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":10421.93,"10th_percentile":4819.66,"90th_percentile":16300.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13264.58,"10th_percentile":13264.58,"90th_percentile":13264.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2983.53,"10th_percentile":2983.53,"90th_percentile":3105.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":13481.45,"10th_percentile":9162.57,"90th_percentile":15051.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":12825.13,"10th_percentile":12825.13,"90th_percentile":12825.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":15359.13,"10th_percentile":15359.13,"90th_percentile":15359.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":10074.26,"10th_percentile":5376.66,"90th_percentile":10855.28},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3085.58,"10th_percentile":3085.58,"90th_percentile":3085.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2983.53,"10th_percentile":2983.53,"90th_percentile":2983.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":26580.38,"10th_percentile":26580.38,"90th_percentile":26580.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2882.49,"10th_percentile":2813.94,"90th_percentile":3043.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":9161.39,"10th_percentile":9161.39,"90th_percentile":12140.23},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"15","median_amount":26091.15,"10th_percentile":14695.73,"90th_percentile":33537.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":4172.97,"10th_percentile":3861.47,"90th_percentile":7017.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":14542.69,"10th_percentile":14542.69,"90th_percentile":14542.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":22826.29,"10th_percentile":22826.29,"90th_percentile":33182.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":19300.56,"10th_percentile":19300.56,"90th_percentile":19300.56},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30454.1,"10th_percentile":30454.1,"90th_percentile":33052.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4149.31,"10th_percentile":3991.81,"90th_percentile":7176.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"43","median_amount":20025.75,"10th_percentile":16491.73,"90th_percentile":33089.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":27547.21,"10th_percentile":16116.15,"90th_percentile":36570.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":14008.23,"10th_percentile":14008.23,"90th_percentile":15754.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"11","median_amount":6520.17,"10th_percentile":4719.79,"90th_percentile":10665.22},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5669.9,"10th_percentile":5669.9,"90th_percentile":5669.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":31412.91,"10th_percentile":31412.91,"90th_percentile":31482.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5695.82,"10th_percentile":3924.4,"90th_percentile":7123.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6857.49,"10th_percentile":6857.49,"90th_percentile":6857.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":55161.45,"10th_percentile":55161.45,"90th_percentile":55161.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":22088.57,"10th_percentile":22088.57,"90th_percentile":22088.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6756.11,"10th_percentile":6756.11,"90th_percentile":6756.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32771.36,"10th_percentile":32447.86,"90th_percentile":39121.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":18880.33,"10th_percentile":18880.33,"90th_percentile":18880.33},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":51019.07,"10th_percentile":51019.07,"90th_percentile":51019.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":107686.64,"10th_percentile":107686.64,"90th_percentile":107686.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":86884.67,"10th_percentile":86884.67,"90th_percentile":86884.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":889.18,"10th_percentile":75.0,"90th_percentile":2573.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"55","median_amount":252.89,"10th_percentile":104.14,"90th_percentile":623.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"42","median_amount":560.24,"10th_percentile":379.5,"90th_percentile":1320.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":127.94,"10th_percentile":79.88,"90th_percentile":1346.13},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":417.37,"10th_percentile":298.89,"90th_percentile":1612.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":597.64,"10th_percentile":46.72,"90th_percentile":1054.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":1166.45,"10th_percentile":300.0,"90th_percentile":5497.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":4359.76,"10th_percentile":4359.76,"90th_percentile":4359.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"30","median_amount":621.44,"10th_percentile":318.4,"90th_percentile":3718.88},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":2549.09,"10th_percentile":2549.09,"90th_percentile":2549.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"21","median_amount":243.84,"10th_percentile":151.34,"90th_percentile":304.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":260.12,"10th_percentile":259.07,"90th_percentile":372.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":1216.93,"10th_percentile":1152.3,"90th_percentile":1412.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":276.85,"10th_percentile":7.35,"90th_percentile":835.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":2815.31,"10th_percentile":1002.31,"90th_percentile":2815.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2489.05,"10th_percentile":874.57,"90th_percentile":2489.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":76.85,"10th_percentile":76.85,"90th_percentile":279.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":898.0,"10th_percentile":749.0,"90th_percentile":1504.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":1063.78,"10th_percentile":1012.7,"90th_percentile":1094.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"18","median_amount":442.94,"10th_percentile":197.97,"90th_percentile":537.64},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":505.08,"10th_percentile":505.08,"90th_percentile":505.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":282.39,"10th_percentile":282.39,"90th_percentile":284.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":400.77,"10th_percentile":400.77,"90th_percentile":400.77},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.21,"10th_percentile":119.21,"90th_percentile":119.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"24","median_amount":627.44,"10th_percentile":293.44,"90th_percentile":1508.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":250.07,"10th_percentile":171.85,"90th_percentile":384.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":466.55,"10th_percentile":407.66,"90th_percentile":625.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"19","median_amount":370.35,"10th_percentile":367.12,"90th_percentile":2152.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":303.8,"10th_percentile":103.8,"90th_percentile":303.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"72","median_amount":769.0,"10th_percentile":613.8,"90th_percentile":1383.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":333.55,"10th_percentile":291.86,"90th_percentile":1831.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"16","median_amount":390.58,"10th_percentile":387.18,"90th_percentile":1362.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"42","median_amount":236.24,"10th_percentile":218.92,"90th_percentile":529.46},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":259.23,"10th_percentile":259.23,"90th_percentile":312.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"11","median_amount":655.04,"10th_percentile":241.96,"90th_percentile":2274.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"18","median_amount":311.15,"10th_percentile":247.91,"90th_percentile":399.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":497.86,"10th_percentile":497.86,"90th_percentile":813.22},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":372.32,"10th_percentile":322.89,"90th_percentile":372.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"18","median_amount":6163.68,"10th_percentile":3411.24,"90th_percentile":17866.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":1669.84,"10th_percentile":1560.54,"90th_percentile":1757.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4119.28,"10th_percentile":4119.28,"90th_percentile":4245.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"13","median_amount":3910.69,"10th_percentile":2451.96,"90th_percentile":8322.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":2404.26,"10th_percentile":2404.26,"90th_percentile":2404.26},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6095.6,"10th_percentile":3071.37,"90th_percentile":7613.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1668.34,"10th_percentile":1668.34,"90th_percentile":1679.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"86","median_amount":6322.23,"10th_percentile":3533.62,"90th_percentile":8091.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":2259.72,"10th_percentile":2259.72,"90th_percentile":2259.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"29","median_amount":1965.81,"10th_percentile":691.94,"90th_percentile":5506.86},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":11750.23,"10th_percentile":11750.23,"90th_percentile":14700.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1703.72,"10th_percentile":1424.55,"90th_percentile":1777.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":5246.13,"10th_percentile":4293.47,"90th_percentile":13531.55},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1752.38,"10th_percentile":1752.38,"90th_percentile":1752.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":5379.38,"10th_percentile":5379.38,"90th_percentile":5379.38}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"13","median_amount":15536.73,"10th_percentile":5840.21,"90th_percentile":21763.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":3512.56,"10th_percentile":3387.83,"90th_percentile":7599.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"25","median_amount":14139.73,"10th_percentile":7058.03,"90th_percentile":21253.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14663.9,"10th_percentile":12438.58,"90th_percentile":22659.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3466.11,"10th_percentile":3190.47,"90th_percentile":7349.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"86","median_amount":16362.13,"10th_percentile":13091.77,"90th_percentile":17195.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":21335.69,"10th_percentile":18317.05,"90th_percentile":24384.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":14752.93,"10th_percentile":12681.52,"90th_percentile":20308.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"32","median_amount":7058.07,"10th_percentile":4255.07,"90th_percentile":12292.04},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3764.0,"10th_percentile":3764.0,"90th_percentile":3764.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":24143.06,"10th_percentile":14204.66,"90th_percentile":33396.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"13","median_amount":3554.14,"10th_percentile":3456.99,"90th_percentile":7735.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"12","median_amount":23864.08,"10th_percentile":19172.4,"90th_percentile":30342.77},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3565.95,"10th_percentile":3565.95,"90th_percentile":3565.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"22","median_amount":23420.06,"10th_percentile":10348.97,"90th_percentile":48403.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":7599.82,"10th_percentile":7378.35,"90th_percentile":8412.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":35989.12,"10th_percentile":35989.12,"90th_percentile":35989.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"22","median_amount":26159.41,"10th_percentile":12244.15,"90th_percentile":41913.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":44023.18,"10th_percentile":44023.18,"90th_percentile":44023.18},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31797.55,"10th_percentile":23194.19,"90th_percentile":54970.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7568.35,"10th_percentile":7246.95,"90th_percentile":11260.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"95","median_amount":35894.88,"10th_percentile":19915.18,"90th_percentile":47738.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":22793.06,"10th_percentile":20796.86,"90th_percentile":38653.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":16318.53,"10th_percentile":12765.86,"90th_percentile":38181.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"32","median_amount":15351.65,"10th_percentile":6909.82,"90th_percentile":20581.44},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6136.29,"10th_percentile":6136.29,"90th_percentile":6136.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7446.95,"10th_percentile":7446.95,"90th_percentile":7446.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"11","median_amount":35138.18,"10th_percentile":20933.32,"90th_percentile":55247.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"15","median_amount":7662.03,"10th_percentile":6258.05,"90th_percentile":10081.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"11","median_amount":40361.06,"10th_percentile":27140.59,"90th_percentile":56081.99},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":70834.3,"10th_percentile":70834.3,"90th_percentile":70834.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13875.13,"10th_percentile":13486.48,"90th_percentile":15525.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":47448.25,"10th_percentile":39025.58,"90th_percentile":52304.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57861.7,"10th_percentile":57521.92,"90th_percentile":57889.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13993.6,"10th_percentile":13509.76,"90th_percentile":14146.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":65179.88,"10th_percentile":57431.34,"90th_percentile":67542.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":67130.19,"10th_percentile":67130.19,"90th_percentile":67130.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":367.02,"10th_percentile":367.02,"90th_percentile":367.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":20283.85,"10th_percentile":6539.27,"90th_percentile":34239.0},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13990.92,"10th_percentile":13688.12,"90th_percentile":14054.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":61182.08,"10th_percentile":61182.08,"90th_percentile":85759.58},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14295.46,"10th_percentile":14295.46,"90th_percentile":14295.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":56464.72,"10th_percentile":56464.72,"90th_percentile":56464.72}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":69498.62,"10th_percentile":69498.62,"90th_percentile":72794.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19685.71,"10th_percentile":19463.23,"90th_percentile":24536.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":63146.16,"10th_percentile":63146.16,"90th_percentile":63146.16},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":82971.39,"10th_percentile":82971.39,"90th_percentile":82971.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19309.9,"10th_percentile":19309.9,"90th_percentile":19409.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91371.01,"10th_percentile":86611.01,"90th_percentile":93392.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":81419.78,"10th_percentile":81419.78,"90th_percentile":81419.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":22623.51,"10th_percentile":22623.51,"90th_percentile":22623.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15938.18,"10th_percentile":15938.18,"90th_percentile":15938.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":35599.05,"10th_percentile":35599.05,"90th_percentile":35599.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19754.4,"10th_percentile":17817.73,"90th_percentile":20169.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":87307.05,"10th_percentile":87307.05,"90th_percentile":87307.05},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.91,"10th_percentile":164.91,"90th_percentile":164.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":7970.14,"10th_percentile":7970.14,"90th_percentile":7970.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3997.79,"10th_percentile":3997.79,"90th_percentile":3997.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7370.45,"10th_percentile":7370.45,"90th_percentile":7370.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1872.49,"10th_percentile":1872.49,"90th_percentile":1872.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7530.88,"10th_percentile":6558.97,"90th_percentile":18437.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":5411.32,"10th_percentile":5411.32,"90th_percentile":5411.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":10964.98,"10th_percentile":10964.98,"90th_percentile":10964.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1931.52,"10th_percentile":1931.52,"90th_percentile":1935.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4023.87,"10th_percentile":3983.65,"90th_percentile":7435.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":12474.13,"10th_percentile":9555.25,"90th_percentile":37635.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16592.1,"10th_percentile":15742.56,"90th_percentile":16638.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6916.3,"10th_percentile":3777.13,"90th_percentile":6916.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":19118.7,"10th_percentile":16895.68,"90th_percentile":33591.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":4037.09,"10th_percentile":4037.09,"90th_percentile":5436.14},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3167.0,"10th_percentile":3167.0,"90th_percentile":3167.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":12409.46,"10th_percentile":12409.46,"90th_percentile":22133.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4038.17,"10th_percentile":4038.17,"90th_percentile":4080.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":11158.39,"10th_percentile":11158.39,"90th_percentile":11158.39},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4072.88,"10th_percentile":4072.88,"90th_percentile":4072.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":31374.6,"10th_percentile":31374.6,"90th_percentile":31520.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7411.64,"10th_percentile":7411.64,"90th_percentile":7411.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":21731.73,"10th_percentile":21731.73,"90th_percentile":23030.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31625.57,"10th_percentile":31625.57,"90th_percentile":31625.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7377.93,"10th_percentile":7377.93,"90th_percentile":7377.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":35649.12,"10th_percentile":34802.83,"90th_percentile":36011.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":30111.54,"10th_percentile":30111.54,"90th_percentile":30111.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":19713.52,"10th_percentile":19713.52,"90th_percentile":19713.52},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":46937.79,"10th_percentile":46937.79,"90th_percentile":46937.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7360.63,"10th_percentile":7360.63,"90th_percentile":7360.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"20","median_amount":11280.27,"10th_percentile":9064.85,"90th_percentile":20422.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"33","median_amount":7619.92,"10th_percentile":5576.53,"90th_percentile":11438.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":565.19,"10th_percentile":565.19,"90th_percentile":565.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":1196.03,"10th_percentile":582.37,"90th_percentile":1545.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"27","median_amount":8005.52,"10th_percentile":5981.8,"90th_percentile":9869.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"47","median_amount":4597.88,"10th_percentile":3130.22,"90th_percentile":7658.17},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":250.36,"10th_percentile":250.36,"90th_percentile":250.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":8494.48,"10th_percentile":524.67,"90th_percentile":25360.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":6921.15,"10th_percentile":6921.15,"90th_percentile":6921.15}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3611.46,"10th_percentile":3611.46,"90th_percentile":3611.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":4299.7,"10th_percentile":4299.7,"90th_percentile":4299.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4333.99,"10th_percentile":4333.99,"90th_percentile":4333.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":2622.11,"10th_percentile":2283.62,"90th_percentile":3097.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6708.61,"10th_percentile":6708.61,"90th_percentile":6708.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":5148.16,"10th_percentile":3784.87,"90th_percentile":6842.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":8466.58,"10th_percentile":8466.58,"90th_percentile":8466.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":1902.75,"10th_percentile":1902.75,"90th_percentile":1902.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"14","median_amount":2114.83,"10th_percentile":1763.26,"90th_percentile":3086.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1646.86,"10th_percentile":1646.86,"90th_percentile":1646.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":10063.56,"10th_percentile":5010.28,"90th_percentile":19107.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":5612.09,"10th_percentile":4241.19,"90th_percentile":9277.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2069.01,"10th_percentile":2069.01,"90th_percentile":2069.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6549.19,"10th_percentile":6428.57,"90th_percentile":11989.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3142.59,"10th_percentile":3142.59,"90th_percentile":3142.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"35","median_amount":9972.74,"10th_percentile":6207.88,"90th_percentile":14311.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":5431.4,"10th_percentile":5431.4,"90th_percentile":5431.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":5389.74,"10th_percentile":5389.74,"90th_percentile":5690.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"22","median_amount":3568.15,"10th_percentile":2841.33,"90th_percentile":5235.17},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":8793.15,"10th_percentile":7271.57,"90th_percentile":9326.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2843.37,"10th_percentile":2843.37,"90th_percentile":2843.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":2630.67,"10th_percentile":2630.67,"90th_percentile":2630.67}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":18455.79,"10th_percentile":18455.79,"90th_percentile":35429.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":5775.51,"10th_percentile":4904.67,"90th_percentile":7048.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":9453.52,"10th_percentile":8364.47,"90th_percentile":14406.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":14229.8,"10th_percentile":14229.8,"90th_percentile":14229.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":6631.73,"10th_percentile":4690.72,"90th_percentile":28937.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"12","median_amount":4198.54,"10th_percentile":3094.62,"90th_percentile":7496.73},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5081.41,"10th_percentile":5081.41,"90th_percentile":5081.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":647.14,"10th_percentile":385.01,"90th_percentile":656.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":9049.37,"10th_percentile":9049.37,"90th_percentile":9049.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":4419.63,"10th_percentile":4419.63,"90th_percentile":4419.63},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10876.51,"10th_percentile":10876.51,"90th_percentile":10876.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":644.51,"10th_percentile":399.51,"90th_percentile":644.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2384.5,"10th_percentile":2218.0,"90th_percentile":8425.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":782.17,"10th_percentile":782.17,"90th_percentile":813.83},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":531.07,"10th_percentile":531.07,"90th_percentile":531.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":657.4,"10th_percentile":442.74,"90th_percentile":2078.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":3651.36,"10th_percentile":3651.36,"90th_percentile":3651.36},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":6788.03,"10th_percentile":5988.09,"90th_percentile":17896.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1619.38,"10th_percentile":1619.38,"90th_percentile":1625.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":3950.49,"10th_percentile":3340.43,"90th_percentile":18095.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6880.72,"10th_percentile":6191.59,"90th_percentile":7890.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1584.23,"10th_percentile":1494.38,"90th_percentile":1619.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":6843.49,"10th_percentile":5572.75,"90th_percentile":7999.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":5735.85,"10th_percentile":5735.85,"90th_percentile":5735.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":4065.4,"10th_percentile":4065.4,"90th_percentile":13018.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":2562.65,"10th_percentile":2259.13,"90th_percentile":7314.88},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1543.97,"10th_percentile":1504.52,"90th_percentile":1735.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":5086.99,"10th_percentile":5086.99,"90th_percentile":5528.15},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"16","median_amount":18452.9,"10th_percentile":13875.05,"90th_percentile":25557.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":3282.02,"10th_percentile":3011.6,"90th_percentile":3467.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":136166.9,"10th_percentile":136166.9,"90th_percentile":136166.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"13","median_amount":10324.65,"10th_percentile":9719.4,"90th_percentile":15553.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":17837.58,"10th_percentile":17837.58,"90th_percentile":17837.58},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14127.66,"10th_percentile":13941.32,"90th_percentile":14576.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3281.1,"10th_percentile":1640.55,"90th_percentile":3379.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"42","median_amount":15950.41,"10th_percentile":14174.63,"90th_percentile":16509.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":15145.39,"10th_percentile":15145.39,"90th_percentile":15145.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":12103.05,"10th_percentile":9933.36,"90th_percentile":16407.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"23","median_amount":7402.35,"10th_percentile":3263.29,"90th_percentile":9643.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3093.19,"10th_percentile":3093.19,"90th_percentile":3393.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":20814.44,"10th_percentile":20434.61,"90th_percentile":93260.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"22","median_amount":3346.72,"10th_percentile":3171.31,"90th_percentile":3463.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":29355.15,"10th_percentile":29355.15,"90th_percentile":29355.15},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":36100.41,"10th_percentile":26459.42,"90th_percentile":37380.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6275.72,"10th_percentile":5984.51,"90th_percentile":8609.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":22292.73,"10th_percentile":18554.13,"90th_percentile":28020.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24699.03,"10th_percentile":24699.03,"90th_percentile":24699.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28666.97,"10th_percentile":28228.65,"90th_percentile":40251.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":30980.88,"10th_percentile":30980.88,"90th_percentile":30980.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":19879.84,"10th_percentile":19879.84,"90th_percentile":19879.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":16857.55,"10th_percentile":16857.55,"90th_percentile":17613.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4959.12,"10th_percentile":4959.12,"90th_percentile":5827.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7960.81,"10th_percentile":7960.81,"90th_percentile":7960.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6163.77,"10th_percentile":6163.77,"90th_percentile":7903.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":14259.42,"10th_percentile":13884.07,"90th_percentile":28642.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":3352.93,"10th_percentile":3063.83,"90th_percentile":3358.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4637.12,"10th_percentile":4637.12,"90th_percentile":4637.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":9201.52,"10th_percentile":8782.58,"90th_percentile":24139.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":15346.96,"10th_percentile":15346.96,"90th_percentile":15346.96},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14221.54,"10th_percentile":11838.04,"90th_percentile":14246.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":3352.93,"10th_percentile":3352.93,"90th_percentile":3352.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"66","median_amount":16003.41,"10th_percentile":14745.04,"90th_percentile":16563.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":13138.79,"10th_percentile":13138.79,"90th_percentile":13857.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":9412.46,"10th_percentile":9412.46,"90th_percentile":25112.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"12","median_amount":5885.82,"10th_percentile":5680.09,"90th_percentile":8566.23},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3467.62,"10th_percentile":3467.62,"90th_percentile":3467.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3352.93,"10th_percentile":3352.93,"90th_percentile":3352.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":14908.56,"10th_percentile":14609.36,"90th_percentile":21712.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"20","median_amount":3426.49,"10th_percentile":3420.0,"90th_percentile":3433.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":12646.07,"10th_percentile":12646.07,"90th_percentile":12646.07},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3520.58,"10th_percentile":3520.58,"90th_percentile":3652.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6146.0,"10th_percentile":6146.0,"90th_percentile":6146.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":42923.58,"10th_percentile":42923.58,"90th_percentile":42923.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24753.91,"10th_percentile":24753.91,"90th_percentile":24753.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5959.52,"10th_percentile":5959.52,"90th_percentile":5959.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29361.01,"10th_percentile":29211.01,"90th_percentile":35947.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":25253.94,"10th_percentile":25253.94,"90th_percentile":25253.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":14281.65,"10th_percentile":14281.65,"90th_percentile":14281.65},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":37977.88,"10th_percentile":25078.97,"90th_percentile":60043.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":11821.93,"10th_percentile":11552.43,"90th_percentile":11870.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":37178.35,"10th_percentile":37178.35,"90th_percentile":37178.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"11","median_amount":28310.16,"10th_percentile":22751.3,"90th_percentile":56659.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7306.93,"10th_percentile":7306.93,"90th_percentile":7306.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":44337.83,"10th_percentile":34176.83,"90th_percentile":51953.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":11821.93,"10th_percentile":11100.12,"90th_percentile":11821.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"39","median_amount":47050.02,"10th_percentile":31507.58,"90th_percentile":75064.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":34770.66,"10th_percentile":34138.98,"90th_percentile":35010.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":22036.8,"10th_percentile":22036.8,"90th_percentile":22036.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"11","median_amount":16014.11,"10th_percentile":14927.48,"90th_percentile":23034.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12226.29,"10th_percentile":12226.29,"90th_percentile":12226.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11821.93,"10th_percentile":11821.93,"90th_percentile":11821.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":43086.65,"10th_percentile":43086.65,"90th_percentile":48271.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"12","median_amount":12058.37,"10th_percentile":12058.37,"90th_percentile":12111.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12464.27,"10th_percentile":12464.27,"90th_percentile":12464.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":21155.57,"10th_percentile":21155.57,"90th_percentile":21155.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18718.9,"10th_percentile":18718.9,"90th_percentile":18718.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":92834.57,"10th_percentile":92621.37,"90th_percentile":92983.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":39769.44,"10th_percentile":39769.44,"90th_percentile":39769.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17632.66,"10th_percentile":17632.66,"90th_percentile":19355.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20910.59,"10th_percentile":20910.59,"90th_percentile":20910.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7923.43,"10th_percentile":7923.43,"90th_percentile":7923.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":35584.55,"10th_percentile":35584.55,"90th_percentile":35584.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38176.8,"10th_percentile":38176.8,"90th_percentile":38176.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":62354.88,"10th_percentile":47494.62,"90th_percentile":67880.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25942.56,"10th_percentile":25870.53,"90th_percentile":25974.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":92206.01,"10th_percentile":92206.01,"90th_percentile":92206.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":54222.95,"10th_percentile":54222.95,"90th_percentile":74827.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":77706.55,"10th_percentile":77706.55,"90th_percentile":77706.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25764.15,"10th_percentile":25764.15,"90th_percentile":25781.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":95083.56,"10th_percentile":79128.98,"90th_percentile":110019.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":70823.78,"10th_percentile":70823.78,"90th_percentile":70823.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":42129.63,"10th_percentile":42129.63,"90th_percentile":42129.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":35107.44,"10th_percentile":31063.46,"90th_percentile":38049.56},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":72078.44,"10th_percentile":72078.44,"90th_percentile":95621.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26355.93,"10th_percentile":26355.93,"90th_percentile":26372.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pacemaker and Similar Procedures","code_information":[{"code":"5221","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3616.06,"10th_percentile":3616.06,"90th_percentile":3616.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":31916.88,"10th_percentile":31916.88,"90th_percentile":31916.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8633.26,"10th_percentile":8633.26,"90th_percentile":8662.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":37737.02,"10th_percentile":37737.02,"90th_percentile":37737.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8467.26,"10th_percentile":8467.26,"90th_percentile":8467.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":41177.58,"10th_percentile":41027.58,"90th_percentile":42618.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":25100.12,"10th_percentile":25100.12,"90th_percentile":25100.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8802.1,"10th_percentile":8802.1,"90th_percentile":8835.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11046.25,"10th_percentile":10763.52,"90th_percentile":20345.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10909.54,"10th_percentile":10909.54,"90th_percentile":10909.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":47916.36,"10th_percentile":46632.74,"90th_percentile":53743.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":16160.8,"10th_percentile":16160.8,"90th_percentile":20279.33},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10909.54,"10th_percentile":10909.54,"90th_percentile":10909.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":57080.93,"10th_percentile":57080.93,"90th_percentile":57080.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11220.44,"10th_percentile":11127.73,"90th_percentile":11247.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20054.59,"10th_percentile":20054.59,"90th_percentile":20054.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":49369.22,"10th_percentile":49369.22,"90th_percentile":49369.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":37718.15,"10th_percentile":37718.15,"90th_percentile":37718.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18940.16,"10th_percentile":18940.16,"90th_percentile":18940.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23612.04,"10th_percentile":23612.04,"90th_percentile":23612.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":86035.97,"10th_percentile":86035.97,"90th_percentile":86035.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":111809.06,"10th_percentile":111809.06,"90th_percentile":111809.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":43946.73,"10th_percentile":43946.73,"90th_percentile":43946.73},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24113.12,"10th_percentile":24113.12,"90th_percentile":24113.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":148311.02,"10th_percentile":148311.02,"90th_percentile":148311.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":33570.72,"10th_percentile":33363.16,"90th_percentile":35557.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":107220.36,"10th_percentile":92530.3,"90th_percentile":131006.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":139718.58,"10th_percentile":139718.58,"90th_percentile":139718.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":33335.18,"10th_percentile":33335.18,"90th_percentile":33335.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":158700.9,"10th_percentile":149517.74,"90th_percentile":165227.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":89125.23,"10th_percentile":89125.23,"90th_percentile":89125.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":57410.11,"10th_percentile":57410.11,"90th_percentile":61009.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":34243.12,"10th_percentile":34239.69,"90th_percentile":34430.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":3588.98,"10th_percentile":3588.98,"90th_percentile":54751.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":636.69,"10th_percentile":634.1,"90th_percentile":1749.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":6111.18,"10th_percentile":6111.18,"90th_percentile":6111.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"15","median_amount":5995.87,"10th_percentile":1966.42,"90th_percentile":29090.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":848.76,"10th_percentile":848.76,"90th_percentile":2896.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9029.56,"10th_percentile":9029.56,"90th_percentile":9029.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":907.14,"10th_percentile":634.1,"90th_percentile":2760.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"55","median_amount":2927.0,"10th_percentile":1719.0,"90th_percentile":13285.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":6451.69,"10th_percentile":6451.69,"90th_percentile":6451.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"16","median_amount":2158.88,"10th_percentile":702.5,"90th_percentile":3844.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"11","median_amount":655.79,"10th_percentile":653.12,"90th_percentile":1524.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":23005.31,"10th_percentile":23005.31,"90th_percentile":23005.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":646.79,"10th_percentile":646.79,"90th_percentile":720.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2979.02,"10th_percentile":2979.02,"90th_percentile":2979.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"49","median_amount":4241.28,"10th_percentile":1971.55,"90th_percentile":8324.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"83","median_amount":987.35,"10th_percentile":717.85,"90th_percentile":1672.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4407.08,"10th_percentile":4407.08,"90th_percentile":4407.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"49","median_amount":2854.47,"10th_percentile":1674.04,"90th_percentile":13679.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1492.2,"10th_percentile":1492.2,"90th_percentile":1492.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"46","median_amount":3384.36,"10th_percentile":2436.59,"90th_percentile":4450.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":977.35,"10th_percentile":448.15,"90th_percentile":2623.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"219","median_amount":4828.13,"10th_percentile":3237.59,"90th_percentile":7473.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"19","median_amount":4274.05,"10th_percentile":2126.74,"90th_percentile":15764.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"13","median_amount":1998.72,"10th_percentile":1498.07,"90th_percentile":4140.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"80","median_amount":1995.99,"10th_percentile":864.04,"90th_percentile":4539.21},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"15","median_amount":1006.68,"10th_percentile":892.65,"90th_percentile":1674.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":4722.95,"10th_percentile":3534.42,"90th_percentile":7784.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"31","median_amount":1345.42,"10th_percentile":989.65,"90th_percentile":2067.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":8128.72,"10th_percentile":6746.85,"90th_percentile":8791.47},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1014.8,"10th_percentile":820.99,"90th_percentile":2230.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"14","median_amount":8485.43,"10th_percentile":5281.16,"90th_percentile":11875.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":2067.3,"10th_percentile":1664.33,"90th_percentile":2112.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":13167.66,"10th_percentile":13167.66,"90th_percentile":13481.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"16","median_amount":10230.24,"10th_percentile":5378.17,"90th_percentile":18832.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8696.41,"10th_percentile":8593.92,"90th_percentile":8885.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":1876.28,"10th_percentile":1841.36,"90th_percentile":2045.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"53","median_amount":9533.57,"10th_percentile":7002.0,"90th_percentile":9973.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":10184.53,"10th_percentile":5860.41,"90th_percentile":19726.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":6327.75,"10th_percentile":6253.77,"90th_percentile":15858.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"11","median_amount":4643.07,"10th_percentile":2669.0,"90th_percentile":8599.3},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2045.16,"10th_percentile":2045.16,"90th_percentile":2045.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":8642.71,"10th_percentile":6353.12,"90th_percentile":24832.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2093.75,"10th_percentile":1715.51,"90th_percentile":4135.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":10472.08,"10th_percentile":10472.08,"90th_percentile":10472.08},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1708.88,"10th_percentile":1708.88,"90th_percentile":1708.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":22385.41,"10th_percentile":22385.41,"90th_percentile":22385.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4122.42,"10th_percentile":4122.42,"90th_percentile":4122.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":16210.51,"10th_percentile":16210.51,"90th_percentile":16210.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":17148.6,"10th_percentile":17148.6,"90th_percentile":17148.6},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7301.11,"10th_percentile":7301.11,"90th_percentile":7301.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19706.07,"10th_percentile":19134.06,"90th_percentile":20485.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":29463.97,"10th_percentile":29463.97,"90th_percentile":29463.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":10815.74,"10th_percentile":10815.74,"90th_percentile":10815.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3268.0,"10th_percentile":3268.0,"90th_percentile":3268.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3853.42,"10th_percentile":3853.42,"90th_percentile":3853.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"26","median_amount":3460.71,"10th_percentile":3005.69,"90th_percentile":4128.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":1029.78,"10th_percentile":1018.02,"90th_percentile":1095.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4275.74,"10th_percentile":4275.74,"90th_percentile":4275.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"15","median_amount":2049.98,"10th_percentile":1991.73,"90th_percentile":2239.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":4249.08,"10th_percentile":4249.08,"90th_percentile":4249.08},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":3780.65,"10th_percentile":3429.12,"90th_percentile":3867.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1003.28,"10th_percentile":804.28,"90th_percentile":2666.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"154","median_amount":3861.02,"10th_percentile":3549.74,"90th_percentile":4333.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":3227.33,"10th_percentile":2938.11,"90th_percentile":3424.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":2201.18,"10th_percentile":2172.26,"90th_percentile":7546.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"18","median_amount":1556.26,"10th_percentile":1251.37,"90th_percentile":1817.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":978.91,"10th_percentile":978.91,"90th_percentile":978.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"13","median_amount":3454.75,"10th_percentile":3245.7,"90th_percentile":3707.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"24","median_amount":1028.94,"10th_percentile":1024.36,"90th_percentile":1043.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":3411.11,"10th_percentile":3411.11,"90th_percentile":3855.68},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"56","median_amount":5472.57,"10th_percentile":3727.24,"90th_percentile":8586.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"72","median_amount":1329.09,"10th_percentile":1298.22,"90th_percentile":1942.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":6337.3,"10th_percentile":3448.83,"90th_percentile":7747.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"28","median_amount":2917.01,"10th_percentile":2387.6,"90th_percentile":6429.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1262.66,"10th_percentile":1262.66,"90th_percentile":1262.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":4522.22,"10th_percentile":4224.48,"90th_percentile":7269.54},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":5405.27,"10th_percentile":4380.25,"90th_percentile":8175.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":1791.64,"10th_percentile":1287.99,"90th_percentile":2068.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"275","median_amount":5091.16,"10th_percentile":4343.86,"90th_percentile":8568.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"11","median_amount":4629.23,"10th_percentile":3734.29,"90th_percentile":6768.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":3864.3,"10th_percentile":2461.8,"90th_percentile":7616.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"45","median_amount":2408.12,"10th_percentile":1747.98,"90th_percentile":4199.94},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1266.0,"10th_percentile":1266.0,"90th_percentile":1266.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"25","median_amount":4541.12,"10th_percentile":3680.75,"90th_percentile":6993.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"42","median_amount":1831.21,"10th_percentile":1317.79,"90th_percentile":1976.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":30053.46,"10th_percentile":30053.46,"90th_percentile":30053.46},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1290.58,"10th_percentile":645.3,"90th_percentile":1935.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":11214.41,"10th_percentile":11214.41,"90th_percentile":11214.41}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"14","median_amount":16078.3,"10th_percentile":13410.61,"90th_percentile":20959.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3011.68,"10th_percentile":2967.58,"90th_percentile":4141.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":35483.17,"10th_percentile":35483.17,"90th_percentile":35483.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"11","median_amount":10770.99,"10th_percentile":6896.94,"90th_percentile":14764.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":8259.52,"10th_percentile":8259.52,"90th_percentile":8259.52},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12307.43,"10th_percentile":12299.66,"90th_percentile":12783.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29016.02,"10th_percentile":29016.02,"90th_percentile":29016.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"49","median_amount":14122.46,"10th_percentile":11976.53,"90th_percentile":14756.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":28429.16,"10th_percentile":28429.16,"90th_percentile":44071.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":13145.48,"10th_percentile":13145.48,"90th_percentile":16514.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"14","median_amount":5830.55,"10th_percentile":4940.47,"90th_percentile":10499.67},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2956.58,"10th_percentile":2956.58,"90th_percentile":2956.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":19755.34,"10th_percentile":19755.34,"90th_percentile":22843.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3031.58,"10th_percentile":3031.58,"90th_percentile":6861.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":16162.46,"10th_percentile":16162.46,"90th_percentile":16162.46},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":40822.44,"10th_percentile":40822.44,"90th_percentile":40822.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":51568.75,"10th_percentile":51568.75,"90th_percentile":51568.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":19827.22,"10th_percentile":19827.22,"90th_percentile":26773.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30655.06,"10th_percentile":29910.93,"90th_percentile":35613.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":22503.39,"10th_percentile":22503.39,"90th_percentile":23877.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":11542.78,"10th_percentile":11542.78,"90th_percentile":11542.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5113.31,"10th_percentile":5113.31,"90th_percentile":5113.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":3153.6,"10th_percentile":3153.6,"90th_percentile":3153.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6329.59,"10th_percentile":6139.27,"90th_percentile":8461.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":29180.04,"10th_percentile":24870.08,"90th_percentile":35096.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4204.88,"10th_percentile":4204.88,"90th_percentile":4204.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":21628.36,"10th_percentile":21628.36,"90th_percentile":21628.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":13390.97,"10th_percentile":12346.97,"90th_percentile":22322.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":25027.31,"10th_percentile":25027.31,"90th_percentile":25027.31},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15834.03,"10th_percentile":15834.03,"90th_percentile":15834.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9223.74,"10th_percentile":9223.74,"90th_percentile":9223.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":18263.03,"10th_percentile":15233.43,"90th_percentile":18837.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":29054.96,"10th_percentile":29054.96,"90th_percentile":29054.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":9602.52,"10th_percentile":9599.03,"90th_percentile":10274.07},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":23521.08,"10th_percentile":23521.08,"90th_percentile":23521.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4286.33,"10th_percentile":4160.21,"90th_percentile":6868.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":21536.34,"10th_percentile":21536.34,"90th_percentile":28206.07},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3897.66,"10th_percentile":3897.66,"90th_percentile":3897.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":37891.78,"10th_percentile":37891.78,"90th_percentile":37891.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7056.18,"10th_percentile":7056.18,"90th_percentile":7056.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":58598.36,"10th_percentile":58598.36,"90th_percentile":58598.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29454.09,"10th_percentile":29454.09,"90th_percentile":29454.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":29479.36,"10th_percentile":25076.81,"90th_percentile":41076.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":11872.27,"10th_percentile":11872.27,"90th_percentile":19469.08},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":46294.26,"10th_percentile":46294.26,"90th_percentile":46294.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11881.42,"10th_percentile":11881.42,"90th_percentile":11881.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":43423.62,"10th_percentile":43423.62,"90th_percentile":43423.62},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"45","median_amount":35236.33,"10th_percentile":20073.1,"90th_percentile":54035.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":59868.42,"10th_percentile":59868.42,"90th_percentile":59868.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":6436.28,"10th_percentile":5977.14,"90th_percentile":7887.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":43540.85,"10th_percentile":29423.3,"90th_percentile":69044.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"44","median_amount":21741.57,"10th_percentile":13854.43,"90th_percentile":34370.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":27100.13,"10th_percentile":27100.13,"90th_percentile":51455.64},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":26605.88,"10th_percentile":23497.39,"90th_percentile":35648.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6604.13,"10th_percentile":6378.94,"90th_percentile":6738.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"192","median_amount":29788.6,"10th_percentile":22916.51,"90th_percentile":38778.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"11","median_amount":32586.41,"10th_percentile":18398.68,"90th_percentile":45169.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"16","median_amount":18020.23,"10th_percentile":11166.66,"90th_percentile":24699.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"62","median_amount":13957.54,"10th_percentile":7780.42,"90th_percentile":18599.32},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6686.34,"10th_percentile":6686.34,"90th_percentile":6686.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"27","median_amount":40887.44,"10th_percentile":22271.21,"90th_percentile":49369.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6765.83,"10th_percentile":6702.71,"90th_percentile":9558.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":32147.84,"10th_percentile":30031.93,"90th_percentile":41821.82},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6802.27,"10th_percentile":6802.27,"90th_percentile":6802.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"19","median_amount":32615.63,"10th_percentile":27865.19,"90th_percentile":80674.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11179.0,"10th_percentile":10855.33,"90th_percentile":13680.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":44941.63,"10th_percentile":44941.63,"90th_percentile":44941.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":30551.07,"10th_percentile":18750.36,"90th_percentile":47791.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":27748.02,"10th_percentile":27748.02,"90th_percentile":27748.02},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38634.73,"10th_percentile":38634.73,"90th_percentile":48795.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11180.65,"10th_percentile":11180.65,"90th_percentile":11180.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"84","median_amount":41324.74,"10th_percentile":32738.62,"90th_percentile":56035.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":26402.31,"10th_percentile":22257.74,"90th_percentile":68381.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":22887.3,"10th_percentile":22887.3,"90th_percentile":22887.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"16","median_amount":14164.65,"10th_percentile":10631.51,"90th_percentile":26162.14},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":58344.81,"10th_percentile":32962.75,"90th_percentile":65037.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11205.79,"10th_percentile":11205.79,"90th_percentile":11205.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":291.39,"10th_percentile":291.39,"90th_percentile":291.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":107.42,"10th_percentile":107.42,"90th_percentile":107.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1389.63,"10th_percentile":1389.63,"90th_percentile":1389.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":1452.91,"10th_percentile":1452.91,"90th_percentile":1452.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":726.26,"10th_percentile":710.07,"90th_percentile":943.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":942.54,"10th_percentile":942.54,"90th_percentile":4822.47},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":429.18,"10th_percentile":429.18,"90th_percentile":429.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":3859.21,"10th_percentile":3859.21,"90th_percentile":3859.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2140.96,"10th_percentile":2140.96,"90th_percentile":2140.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":1675.14,"10th_percentile":1675.14,"90th_percentile":1675.14},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2017.0,"10th_percentile":2017.0,"90th_percentile":2017.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":752.67,"10th_percentile":752.67,"90th_percentile":752.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3321.03,"10th_percentile":2921.67,"90th_percentile":7971.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":2204.0,"10th_percentile":2204.0,"90th_percentile":5129.84},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1742.54,"10th_percentile":1742.54,"90th_percentile":1742.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"17","median_amount":13089.0,"10th_percentile":6766.39,"90th_percentile":19296.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"30","median_amount":2233.95,"10th_percentile":2135.46,"90th_percentile":2267.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"12","median_amount":3932.49,"10th_percentile":2527.26,"90th_percentile":11093.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":9025.68,"10th_percentile":9025.68,"90th_percentile":12972.15},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9600.64,"10th_percentile":9293.5,"90th_percentile":9662.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":2125.29,"10th_percentile":1935.46,"90th_percentile":2227.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"60","median_amount":10420.2,"10th_percentile":9217.01,"90th_percentile":10779.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":9669.15,"10th_percentile":9669.15,"90th_percentile":9669.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":5020.18,"10th_percentile":4414.59,"90th_percentile":13311.55},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2208.5,"10th_percentile":2208.5,"90th_percentile":2208.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":10647.32,"10th_percentile":8966.91,"90th_percentile":13494.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"26","median_amount":2245.48,"10th_percentile":1957.67,"90th_percentile":2286.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":22331.07,"10th_percentile":14996.48,"90th_percentile":29797.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":3683.28,"10th_percentile":3424.36,"90th_percentile":3717.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":18202.29,"10th_percentile":18202.29,"90th_percentile":19786.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":22356.3,"10th_percentile":13941.64,"90th_percentile":27832.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":31270.64,"10th_percentile":31270.64,"90th_percentile":31270.64},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15811.47,"10th_percentile":12256.65,"90th_percentile":15982.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3672.2,"10th_percentile":3556.35,"90th_percentile":6025.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"30","median_amount":17377.92,"10th_percentile":14148.7,"90th_percentile":18027.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":12666.86,"10th_percentile":12666.86,"90th_percentile":12666.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":12403.83,"10th_percentile":12403.83,"90th_percentile":12403.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":8788.25,"10th_percentile":5428.32,"90th_percentile":15901.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3718.34,"10th_percentile":3718.34,"90th_percentile":3718.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":26223.33,"10th_percentile":26223.33,"90th_percentile":26223.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3669.52,"10th_percentile":3639.94,"90th_percentile":3805.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":23313.4,"10th_percentile":20061.09,"90th_percentile":33029.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5391.63,"10th_percentile":5241.58,"90th_percentile":9760.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":32700.89,"10th_percentile":32700.89,"90th_percentile":32700.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":19282.54,"10th_percentile":14075.42,"90th_percentile":23971.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3663.23,"10th_percentile":3663.23,"90th_percentile":3663.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23362.22,"10th_percentile":21173.27,"90th_percentile":25197.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5466.32,"10th_percentile":5146.41,"90th_percentile":9740.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":25410.38,"10th_percentile":22710.8,"90th_percentile":26448.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":11161.36,"10th_percentile":11161.36,"90th_percentile":11161.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":10456.04,"10th_percentile":9768.16,"90th_percentile":14854.18},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4366.7,"10th_percentile":4366.7,"90th_percentile":4366.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":28159.82,"10th_percentile":28159.82,"90th_percentile":28159.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5415.13,"10th_percentile":4394.04,"90th_percentile":5535.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31073.05,"10th_percentile":31073.05,"90th_percentile":31073.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 8 Urology and Related Services","code_information":[{"code":"5378","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20982.93,"10th_percentile":20982.93,"90th_percentile":20982.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":38574.94,"10th_percentile":38574.94,"90th_percentile":38574.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21031.7,"10th_percentile":21031.7,"90th_percentile":21031.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80884.95,"10th_percentile":80884.95,"90th_percentile":80884.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10471.19,"10th_percentile":10471.19,"90th_percentile":10471.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":1154.7,"10th_percentile":175.95,"90th_percentile":1679.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"11","median_amount":1353.83,"10th_percentile":982.94,"90th_percentile":4990.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11659.11,"10th_percentile":11659.11,"90th_percentile":11659.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":1826.0,"10th_percentile":1348.2,"90th_percentile":7539.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":1204.62,"10th_percentile":1204.62,"90th_percentile":1204.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":1088.63,"10th_percentile":1060.9,"90th_percentile":1258.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"13","median_amount":985.64,"10th_percentile":317.55,"90th_percentile":1472.55},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":1173.69,"10th_percentile":1161.04,"90th_percentile":17559.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":6802.28,"10th_percentile":6802.28,"90th_percentile":6802.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1250.81,"10th_percentile":1250.81,"90th_percentile":1250.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":1188.84,"10th_percentile":1188.84,"90th_percentile":1188.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":418.97,"10th_percentile":418.97,"90th_percentile":418.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":1622.68,"10th_percentile":1622.68,"90th_percentile":1622.68},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1635.14,"10th_percentile":1187.5,"90th_percentile":5433.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":1192.44,"10th_percentile":1192.44,"90th_percentile":1192.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":454.1,"10th_percentile":204.2,"90th_percentile":7265.09},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":992.12,"10th_percentile":992.12,"90th_percentile":992.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":2773.86,"10th_percentile":1829.08,"90th_percentile":3245.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"13","median_amount":11269.64,"10th_percentile":7955.2,"90th_percentile":19026.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3314.49,"10th_percentile":3153.77,"90th_percentile":3417.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":8820.92,"10th_percentile":6432.57,"90th_percentile":11686.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"17","median_amount":7442.86,"10th_percentile":4605.92,"90th_percentile":12730.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":9508.91,"10th_percentile":9508.91,"90th_percentile":9508.91},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10134.13,"10th_percentile":8296.36,"90th_percentile":18705.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"59","median_amount":12091.01,"10th_percentile":8503.21,"90th_percentile":16401.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":14673.36,"10th_percentile":10163.6,"90th_percentile":15715.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":9450.19,"10th_percentile":9450.19,"90th_percentile":9450.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"28","median_amount":4730.94,"10th_percentile":3216.02,"90th_percentile":7047.67},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2731.13,"10th_percentile":2731.13,"90th_percentile":2731.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":13842.69,"10th_percentile":10294.0,"90th_percentile":14374.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3395.18,"10th_percentile":3395.18,"90th_percentile":3395.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":5281.24,"10th_percentile":5281.24,"90th_percentile":5281.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10980.19,"10th_percentile":10980.19,"90th_percentile":10980.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19264.97,"10th_percentile":15429.26,"90th_percentile":21471.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":19893.52,"10th_percentile":19893.52,"90th_percentile":19893.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":41333.7,"10th_percentile":41333.7,"90th_percentile":41333.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":6902.25,"10th_percentile":4149.89,"90th_percentile":17580.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2035.66,"10th_percentile":1747.96,"90th_percentile":2151.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":19298.15,"10th_percentile":19298.15,"90th_percentile":19298.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":2189.95,"10th_percentile":2189.95,"90th_percentile":2189.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6994.11,"10th_percentile":6994.11,"90th_percentile":8952.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2035.66,"10th_percentile":2035.66,"90th_percentile":2035.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":6614.85,"10th_percentile":5731.0,"90th_percentile":9142.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":2317.82,"10th_percentile":2317.82,"90th_percentile":2317.82},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1677.39,"10th_percentile":1677.39,"90th_percentile":1677.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2079.4,"10th_percentile":1701.87,"90th_percentile":2143.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1709.95,"10th_percentile":1709.95,"90th_percentile":1709.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27381.7,"10th_percentile":27381.7,"90th_percentile":27381.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"271","median_amount":792.01,"10th_percentile":629.66,"90th_percentile":1525.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"475","median_amount":362.93,"10th_percentile":172.56,"90th_percentile":596.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"42","median_amount":626.07,"10th_percentile":466.64,"90th_percentile":1239.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"210","median_amount":511.51,"10th_percentile":400.62,"90th_percentile":922.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":223.95,"10th_percentile":223.95,"90th_percentile":316.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"24","median_amount":619.73,"10th_percentile":117.91,"90th_percentile":1107.0},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"137","median_amount":1090.08,"10th_percentile":458.78,"90th_percentile":1609.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"145","median_amount":361.45,"10th_percentile":307.72,"90th_percentile":515.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1221","median_amount":1091.89,"10th_percentile":675.5,"90th_percentile":1822.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"64","median_amount":604.72,"10th_percentile":413.37,"90th_percentile":1260.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"54","median_amount":489.08,"10th_percentile":425.95,"90th_percentile":927.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"276","median_amount":346.9,"10th_percentile":242.18,"90th_percentile":634.75},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"43","median_amount":297.85,"10th_percentile":55.57,"90th_percentile":373.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":361.45,"10th_percentile":361.45,"90th_percentile":361.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"95","median_amount":738.08,"10th_percentile":451.3,"90th_percentile":2441.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"445","median_amount":375.1,"10th_percentile":242.12,"90th_percentile":610.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"23","median_amount":615.13,"10th_percentile":551.88,"90th_percentile":829.64},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"39","median_amount":332.93,"10th_percentile":170.16,"90th_percentile":625.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":669.85,"10th_percentile":669.85,"90th_percentile":669.85}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":3934.38,"10th_percentile":1170.24,"90th_percentile":8366.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":798.28,"10th_percentile":716.95,"90th_percentile":1097.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1990.81,"10th_percentile":1990.81,"90th_percentile":7094.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":7957.64,"10th_percentile":726.64,"90th_percentile":25004.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2520.48,"10th_percentile":2520.48,"90th_percentile":2759.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":721.92,"10th_percentile":611.92,"90th_percentile":13511.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"50","median_amount":3295.68,"10th_percentile":1347.38,"90th_percentile":7575.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":5367.53,"10th_percentile":5367.53,"90th_percentile":5367.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":3904.49,"10th_percentile":3904.49,"90th_percentile":3904.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"21","median_amount":2222.27,"10th_percentile":499.85,"90th_percentile":7478.01},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":639.14,"10th_percentile":639.14,"90th_percentile":995.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":6004.84,"10th_percentile":3101.94,"90th_percentile":8602.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1113.36,"10th_percentile":747.47,"90th_percentile":5953.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":52582.63,"10th_percentile":52582.63,"90th_percentile":52582.63},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":3055.28,"10th_percentile":2464.91,"90th_percentile":3165.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":940.24,"10th_percentile":751.84,"90th_percentile":1407.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":1486.11,"10th_percentile":1349.11,"90th_percentile":1695.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5924.69,"10th_percentile":5924.69,"90th_percentile":5924.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1401.45,"10th_percentile":1199.58,"90th_percentile":19342.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"59","median_amount":2765.22,"10th_percentile":2358.75,"90th_percentile":4429.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":4250.44,"10th_percentile":4250.44,"90th_percentile":4250.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":1010.41,"10th_percentile":1010.41,"90th_percentile":1010.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"18","median_amount":1339.36,"10th_percentile":868.13,"90th_percentile":2260.35},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":969.31,"10th_percentile":969.31,"90th_percentile":969.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":4000.66,"10th_percentile":4000.66,"90th_percentile":5643.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1431.63,"10th_percentile":1431.29,"90th_percentile":1499.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3786.01,"10th_percentile":3786.01,"90th_percentile":3786.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":11681.21,"10th_percentile":11681.21,"90th_percentile":11681.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18001.29,"10th_percentile":18001.29,"90th_percentile":18001.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":68059.39,"10th_percentile":68059.39,"90th_percentile":68059.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7105.34,"10th_percentile":7105.34,"90th_percentile":7105.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":74416.56,"10th_percentile":74416.56,"90th_percentile":74416.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":122.46,"10th_percentile":122.46,"90th_percentile":122.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"844","median_amount":287.0,"10th_percentile":184.1,"90th_percentile":821.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":596.4,"10th_percentile":596.4,"90th_percentile":1082.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"908","median_amount":91.79,"10th_percentile":73.43,"90th_percentile":189.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"137","median_amount":37.52,"10th_percentile":25.93,"90th_percentile":316.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"894","median_amount":60.91,"10th_percentile":38.4,"90th_percentile":423.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":60.85,"10th_percentile":60.85,"90th_percentile":180.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"50","median_amount":364.9,"10th_percentile":176.89,"90th_percentile":1089.36},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"329","median_amount":390.0,"10th_percentile":137.08,"90th_percentile":900.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"323","median_amount":91.79,"10th_percentile":66.79,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"3903","median_amount":408.09,"10th_percentile":137.08,"90th_percentile":934.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"224","median_amount":337.84,"10th_percentile":198.42,"90th_percentile":1039.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"279","median_amount":137.92,"10th_percentile":88.47,"90th_percentile":549.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1203","median_amount":142.02,"10th_percentile":91.1,"90th_percentile":460.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"123","median_amount":91.1,"10th_percentile":55.57,"90th_percentile":174.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91.79,"10th_percentile":91.79,"90th_percentile":91.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"347","median_amount":377.2,"10th_percentile":229.12,"90th_percentile":1031.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"656","median_amount":93.62,"10th_percentile":69.12,"90th_percentile":137.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"105","median_amount":219.73,"10th_percentile":191.99,"90th_percentile":383.98},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"84","median_amount":90.88,"10th_percentile":56.42,"90th_percentile":179.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":911.04,"10th_percentile":911.04,"90th_percentile":911.04}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1022","median_amount":546.7,"10th_percentile":263.6,"90th_percentile":1380.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":572.6,"10th_percentile":572.6,"90th_percentile":572.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1289","median_amount":110.86,"10th_percentile":91.26,"90th_percentile":220.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"184","median_amount":119.33,"10th_percentile":52.44,"90th_percentile":343.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1112","median_amount":138.3,"10th_percentile":59.81,"90th_percentile":403.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":83.93,"10th_percentile":73.5,"90th_percentile":188.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"74","median_amount":695.09,"10th_percentile":279.1,"90th_percentile":1667.97},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"454","median_amount":471.03,"10th_percentile":341.26,"90th_percentile":942.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"484","median_amount":110.86,"10th_percentile":100.86,"90th_percentile":220.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"4566","median_amount":529.12,"10th_percentile":304.0,"90th_percentile":1052.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"240","median_amount":643.54,"10th_percentile":300.0,"90th_percentile":1424.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"363","median_amount":425.83,"10th_percentile":176.94,"90th_percentile":884.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1396","median_amount":353.67,"10th_percentile":153.71,"90th_percentile":790.85},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"197","median_amount":114.18,"10th_percentile":91.35,"90th_percentile":209.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":110.86,"10th_percentile":110.86,"90th_percentile":110.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"421","median_amount":718.52,"10th_percentile":269.56,"90th_percentile":1729.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"815","median_amount":113.08,"10th_percentile":90.45,"90th_percentile":225.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"53","median_amount":544.58,"10th_percentile":191.99,"90th_percentile":1918.44},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"98","median_amount":116.4,"10th_percentile":56.42,"90th_percentile":231.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":817.44,"10th_percentile":487.34,"90th_percentile":1814.59}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"265","median_amount":2528.1,"10th_percentile":939.0,"90th_percentile":4369.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":989.0,"10th_percentile":989.0,"90th_percentile":989.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"388","median_amount":251.98,"10th_percentile":201.59,"90th_percentile":503.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"35","median_amount":368.27,"10th_percentile":178.53,"90th_percentile":1526.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"242","median_amount":274.42,"10th_percentile":175.07,"90th_percentile":1220.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":258.85,"10th_percentile":170.24,"90th_percentile":578.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"16","median_amount":1170.8,"10th_percentile":717.56,"90th_percentile":2984.17},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"128","median_amount":1070.65,"10th_percentile":693.11,"90th_percentile":1399.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"114","median_amount":251.98,"10th_percentile":106.98,"90th_percentile":503.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1299","median_amount":1202.68,"10th_percentile":843.11,"90th_percentile":1731.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"58","median_amount":1752.13,"10th_percentile":436.72,"90th_percentile":2609.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"77","median_amount":901.55,"10th_percentile":332.37,"90th_percentile":1197.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"340","median_amount":974.4,"10th_percentile":383.81,"90th_percentile":1514.12},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"68","median_amount":260.59,"10th_percentile":207.62,"90th_percentile":489.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"87","median_amount":2138.88,"10th_percentile":776.78,"90th_percentile":3411.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"241","median_amount":257.22,"10th_percentile":199.9,"90th_percentile":451.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":2079.04,"10th_percentile":2050.57,"90th_percentile":6361.22},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"27","median_amount":265.66,"10th_percentile":211.66,"90th_percentile":441.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":2282.28,"10th_percentile":2282.28,"90th_percentile":2282.28}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"146","median_amount":3040.6,"10th_percentile":2432.48,"90th_percentile":3040.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":3040.6,"10th_percentile":3040.6,"90th_percentile":3040.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"200","median_amount":571.58,"10th_percentile":571.58,"90th_percentile":584.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2021.31,"10th_percentile":1188.06,"90th_percentile":2894.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"73","median_amount":1779.08,"10th_percentile":1779.08,"90th_percentile":2479.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":587.17,"10th_percentile":587.17,"90th_percentile":587.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"11","median_amount":2206.09,"10th_percentile":2206.09,"90th_percentile":2941.45},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"73","median_amount":2428.61,"10th_percentile":2278.61,"90th_percentile":2513.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"50","median_amount":571.58,"10th_percentile":552.67,"90th_percentile":571.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"564","median_amount":2728.11,"10th_percentile":2117.69,"90th_percentile":2823.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"43","median_amount":2723.32,"10th_percentile":1228.66,"90th_percentile":2723.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"13","median_amount":1969.45,"10th_percentile":1969.45,"90th_percentile":3425.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"121","median_amount":1144.85,"10th_percentile":963.34,"90th_percentile":1643.77},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"16","median_amount":591.13,"10th_percentile":591.13,"90th_percentile":851.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":571.58,"10th_percentile":571.58,"90th_percentile":2773.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"55","median_amount":3040.6,"10th_percentile":1497.76,"90th_percentile":3622.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"122","median_amount":583.91,"10th_percentile":569.86,"90th_percentile":679.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":2412.65,"10th_percentile":2412.65,"90th_percentile":2412.65},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"11","median_amount":602.6,"10th_percentile":600.15,"90th_percentile":868.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"83","median_amount":3658.5,"10th_percentile":555.1,"90th_percentile":7978.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":7978.5,"10th_percentile":7978.5,"90th_percentile":7978.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"144","median_amount":189.36,"10th_percentile":109.41,"90th_percentile":453.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":491.16,"10th_percentile":108.27,"90th_percentile":779.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"69","median_amount":525.1,"10th_percentile":139.96,"90th_percentile":950.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":180.81,"10th_percentile":123.04,"90th_percentile":300.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":705.77,"10th_percentile":705.77,"90th_percentile":8272.55},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"40","median_amount":825.0,"10th_percentile":716.08,"90th_percentile":1994.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"68","median_amount":257.7,"10th_percentile":141.71,"90th_percentile":453.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"396","median_amount":885.73,"10th_percentile":733.38,"90th_percentile":2240.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"17","median_amount":1826.64,"10th_percentile":585.86,"90th_percentile":9041.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"19","median_amount":2627.8,"10th_percentile":266.77,"90th_percentile":3132.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"99","median_amount":1548.32,"10th_percentile":274.7,"90th_percentile":3219.78},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"36","median_amount":191.92,"10th_percentile":152.91,"90th_percentile":512.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"29","median_amount":3929.32,"10th_percentile":759.0,"90th_percentile":8282.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"96","median_amount":190.45,"10th_percentile":189.29,"90th_percentile":464.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"17","median_amount":3630.84,"10th_percentile":2349.69,"90th_percentile":6798.31},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":179.53,"10th_percentile":90.0,"90th_percentile":479.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"266","median_amount":4320.0,"10th_percentile":3017.34,"90th_percentile":8391.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":7938.0,"10th_percentile":7938.0,"90th_percentile":7938.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"279","median_amount":372.79,"10th_percentile":171.79,"90th_percentile":670.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"42","median_amount":425.13,"10th_percentile":338.45,"90th_percentile":2241.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"212","median_amount":613.72,"10th_percentile":427.8,"90th_percentile":6122.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":246.83,"10th_percentile":246.83,"90th_percentile":382.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"25","median_amount":4079.58,"10th_percentile":2067.47,"90th_percentile":6139.05},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"82","median_amount":1581.86,"10th_percentile":1222.21,"90th_percentile":3786.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"105","median_amount":372.29,"10th_percentile":222.29,"90th_percentile":891.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1058","median_amount":1839.12,"10th_percentile":1471.3,"90th_percentile":4462.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"50","median_amount":3865.2,"10th_percentile":2293.46,"90th_percentile":7121.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"72","median_amount":2400.71,"10th_percentile":1487.14,"90th_percentile":4075.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"280","median_amount":1989.55,"10th_percentile":1485.62,"90th_percentile":3268.93},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"42","median_amount":385.03,"10th_percentile":306.77,"90th_percentile":898.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":372.29,"10th_percentile":372.29,"90th_percentile":372.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"92","median_amount":5047.55,"10th_percentile":3137.22,"90th_percentile":9260.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"159","median_amount":380.65,"10th_percentile":253.37,"90th_percentile":923.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"13","median_amount":3817.9,"10th_percentile":3247.59,"90th_percentile":5408.94},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"16","median_amount":393.4,"10th_percentile":312.72,"90th_percentile":1079.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":21137.9,"10th_percentile":6336.0,"90th_percentile":24019.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2504.46,"10th_percentile":2188.85,"90th_percentile":2955.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":5978.98,"10th_percentile":5978.98,"90th_percentile":18196.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":12330.87,"10th_percentile":1824.43,"90th_percentile":18155.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3621.87,"10th_percentile":3499.43,"90th_percentile":5576.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2760.11,"10th_percentile":2760.11,"90th_percentile":2760.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"35","median_amount":4068.54,"10th_percentile":2875.5,"90th_percentile":13739.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":24414.31,"10th_percentile":24414.31,"90th_percentile":24414.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":8039.88,"10th_percentile":8039.88,"90th_percentile":8039.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"11","median_amount":2545.78,"10th_percentile":2462.6,"90th_percentile":6828.61},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2748.62,"10th_percentile":2748.62,"90th_percentile":2748.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":6671.61,"10th_percentile":3059.87,"90th_percentile":25226.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2829.21,"10th_percentile":2716.24,"90th_percentile":3108.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2476.6,"10th_percentile":2476.6,"90th_percentile":2476.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"30","median_amount":1902.3,"10th_percentile":1425.08,"90th_percentile":2358.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":2034.2,"10th_percentile":2034.2,"90th_percentile":2034.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":418.88,"10th_percentile":228.38,"90th_percentile":423.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"11","median_amount":796.42,"10th_percentile":561.5,"90th_percentile":1426.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1842.1,"10th_percentile":1779.82,"90th_percentile":82695.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":428.88,"10th_percentile":428.88,"90th_percentile":428.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"95","median_amount":2069.27,"10th_percentile":1799.37,"90th_percentile":2136.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"11","median_amount":1871.3,"10th_percentile":1276.38,"90th_percentile":2394.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":1572.12,"10th_percentile":1098.56,"90th_percentile":1706.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"29","median_amount":1104.49,"10th_percentile":937.18,"90th_percentile":1470.86},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":433.21,"10th_percentile":345.16,"90th_percentile":1452.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":2882.36,"10th_percentile":2202.85,"90th_percentile":88162.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"18","median_amount":427.27,"10th_percentile":341.8,"90th_percentile":437.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"15","median_amount":2199.92,"10th_percentile":1819.15,"90th_percentile":2824.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":563.41,"10th_percentile":522.33,"90th_percentile":671.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":1203.17,"10th_percentile":716.81,"90th_percentile":1981.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":229.62,"10th_percentile":229.62,"90th_percentile":229.62},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2384.18,"10th_percentile":2384.18,"90th_percentile":11858.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":561.12,"10th_percentile":561.12,"90th_percentile":571.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"70","median_amount":2678.2,"10th_percentile":2467.6,"90th_percentile":3066.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":938.99,"10th_percentile":938.99,"90th_percentile":938.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":2217.11,"10th_percentile":2217.11,"90th_percentile":4682.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":1091.48,"10th_percentile":876.02,"90th_percentile":2667.17},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":462.36,"10th_percentile":462.36,"90th_percentile":462.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":3148.88,"10th_percentile":1159.25,"90th_percentile":4948.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":572.54,"10th_percentile":511.46,"90th_percentile":574.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":2322.31,"10th_percentile":2322.31,"90th_percentile":2322.31},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":688.35,"10th_percentile":688.35,"90th_percentile":688.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"33","median_amount":4257.13,"10th_percentile":3278.94,"90th_percentile":12109.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"68","median_amount":1365.4,"10th_percentile":1140.4,"90th_percentile":1936.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2771.65,"10th_percentile":2748.05,"90th_percentile":3129.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"19","median_amount":2142.02,"10th_percentile":2003.14,"90th_percentile":14935.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":902.28,"10th_percentile":902.28,"90th_percentile":902.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":4580.97,"10th_percentile":4565.36,"90th_percentile":4585.14},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":5782.42,"10th_percentile":4336.81,"90th_percentile":6853.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":1360.9,"10th_percentile":1360.9,"90th_percentile":1422.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"144","median_amount":5984.75,"10th_percentile":4821.0,"90th_percentile":11888.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"11","median_amount":4393.91,"10th_percentile":3254.4,"90th_percentile":6551.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":11657.19,"10th_percentile":2877.35,"90th_percentile":12211.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"33","median_amount":2205.62,"10th_percentile":2011.25,"90th_percentile":5133.12},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1121.37,"10th_percentile":1121.37,"90th_percentile":1201.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"22","median_amount":4864.22,"10th_percentile":4235.91,"90th_percentile":7163.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"37","median_amount":1388.12,"10th_percentile":1110.49,"90th_percentile":1934.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":6144.59,"10th_percentile":6144.59,"90th_percentile":6144.59},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1143.15,"10th_percentile":1143.15,"90th_percentile":1661.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"32","median_amount":7325.1,"10th_percentile":7225.1,"90th_percentile":8631.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"93","median_amount":1520.9,"10th_percentile":1300.0,"90th_percentile":6601.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2201.09,"10th_percentile":2201.09,"90th_percentile":2557.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"19","median_amount":5707.84,"10th_percentile":5217.2,"90th_percentile":7046.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":6686.63,"10th_percentile":6406.91,"90th_percentile":10297.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"43","median_amount":1520.5,"10th_percentile":1380.5,"90th_percentile":6297.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"104","median_amount":7511.27,"10th_percentile":7052.37,"90th_percentile":12595.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":6706.54,"10th_percentile":6706.54,"90th_percentile":10872.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":5725.57,"10th_percentile":4844.06,"90th_percentile":5817.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"39","median_amount":3823.5,"10th_percentile":3357.31,"90th_percentile":5028.81},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"21","median_amount":1572.51,"10th_percentile":1417.88,"90th_percentile":2645.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1520.5,"10th_percentile":1520.5,"90th_percentile":1520.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"19","median_amount":10252.48,"10th_percentile":7133.31,"90th_percentile":13484.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"56","median_amount":1550.91,"10th_percentile":1350.41,"90th_percentile":6579.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":7075.16,"10th_percentile":7075.16,"90th_percentile":8135.12},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1596.53,"10th_percentile":1302.53,"90th_percentile":6752.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":2364.75,"10th_percentile":2364.75,"90th_percentile":2364.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":41626.32,"10th_percentile":41626.32,"90th_percentile":41626.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":2175.21,"10th_percentile":2135.7,"90th_percentile":2616.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":827.43,"10th_percentile":684.82,"90th_percentile":4956.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3356.4,"10th_percentile":2286.86,"90th_percentile":6712.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":520.02,"10th_percentile":520.02,"90th_percentile":520.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":3770.32,"10th_percentile":2482.02,"90th_percentile":27419.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":2695.3,"10th_percentile":2695.3,"90th_percentile":3218.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":1855.75,"10th_percentile":1855.75,"90th_percentile":1855.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":1249.91,"10th_percentile":1249.91,"90th_percentile":1249.91},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":901.63,"10th_percentile":901.63,"90th_percentile":901.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":1719.48,"10th_percentile":1719.48,"90th_percentile":3593.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":622.78,"10th_percentile":530.42,"90th_percentile":6734.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":2387.83,"10th_percentile":2387.83,"90th_percentile":2387.83},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":13109.6,"10th_percentile":10540.6,"90th_percentile":13220.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2732.02,"10th_percentile":1506.81,"90th_percentile":4652.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19232.11,"10th_percentile":19232.11,"90th_percentile":19232.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3124.8,"10th_percentile":3124.8,"90th_percentile":3124.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":15162.83,"10th_percentile":11067.65,"90th_percentile":18773.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":10733.46,"10th_percentile":10733.46,"90th_percentile":10733.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":8612.97,"10th_percentile":8039.83,"90th_percentile":8612.97},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2882.68,"10th_percentile":2146.32,"90th_percentile":3655.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":9563.59,"10th_percentile":9563.59,"90th_percentile":9563.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3283.39,"10th_percentile":3283.39,"90th_percentile":3781.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"20","median_amount":27486.2,"10th_percentile":3773.7,"90th_percentile":43037.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3321.57,"10th_percentile":689.31,"90th_percentile":6803.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":37469.0,"10th_percentile":37469.0,"90th_percentile":37469.0},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16870.89,"10th_percentile":6636.66,"90th_percentile":41751.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4558.16,"10th_percentile":2470.02,"90th_percentile":7345.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"71","median_amount":23054.56,"10th_percentile":5894.52,"90th_percentile":41745.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":28233.53,"10th_percentile":4144.72,"90th_percentile":47973.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":30077.01,"10th_percentile":30077.01,"90th_percentile":30077.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":13934.0,"10th_percentile":11520.22,"90th_percentile":23181.69},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7114.19,"10th_percentile":7114.19,"90th_percentile":7114.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":23590.64,"10th_percentile":23590.64,"90th_percentile":27990.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2239.09,"10th_percentile":984.65,"90th_percentile":6875.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":20003.46,"10th_percentile":20003.46,"90th_percentile":20003.46},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"11","median_amount":31672.2,"10th_percentile":21425.6,"90th_percentile":68302.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":7898.31,"10th_percentile":1347.25,"90th_percentile":12073.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"11","median_amount":12377.15,"10th_percentile":2338.38,"90th_percentile":24953.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":8857.51,"10th_percentile":3291.92,"90th_percentile":13217.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":33642.11,"10th_percentile":4560.58,"90th_percentile":65571.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":25882.54,"10th_percentile":2398.3,"90th_percentile":39898.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"22","median_amount":17502.25,"10th_percentile":8353.69,"90th_percentile":29175.51},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10936.53,"10th_percentile":9160.52,"90th_percentile":12408.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":65661.32,"10th_percentile":9654.48,"90th_percentile":97732.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7306.98,"10th_percentile":1376.95,"90th_percentile":12784.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":31295.83,"10th_percentile":31295.83,"90th_percentile":57962.73},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Radiation Therapy","code_information":[{"code":"5624","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3936.26,"10th_percentile":3936.26,"90th_percentile":3936.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26297.64,"10th_percentile":15598.72,"90th_percentile":40160.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":8795.96,"10th_percentile":8795.96,"90th_percentile":8795.96},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3644.33,"10th_percentile":3644.33,"90th_percentile":3644.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9544.59,"10th_percentile":9274.55,"90th_percentile":13180.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":8924.22,"10th_percentile":8924.22,"90th_percentile":8924.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":63815.68,"10th_percentile":63815.68,"90th_percentile":63815.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":48570.48,"10th_percentile":48570.48,"90th_percentile":48570.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7715.34,"10th_percentile":7715.34,"90th_percentile":7715.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12277.0,"10th_percentile":12277.0,"90th_percentile":12277.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Therapeutic Nuclear Medicine","code_information":[{"code":"5661","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":9209.8,"10th_percentile":9209.8,"90th_percentile":9209.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3186.58,"10th_percentile":3186.58,"90th_percentile":3186.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":415.66,"10th_percentile":415.66,"90th_percentile":415.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3428.16,"10th_percentile":1624.02,"90th_percentile":4392.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":1983.7,"10th_percentile":1983.7,"90th_percentile":1983.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":3092.67,"10th_percentile":3092.67,"90th_percentile":3092.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":519.8,"10th_percentile":484.84,"90th_percentile":3651.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.69,"10th_percentile":55.69,"90th_percentile":2072.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":327.84,"10th_percentile":304.14,"90th_percentile":2081.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57.22,"10th_percentile":57.22,"90th_percentile":57.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":5262.66,"10th_percentile":5262.66,"90th_percentile":5262.66},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":236.64,"10th_percentile":236.64,"90th_percentile":236.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.69,"10th_percentile":55.69,"90th_percentile":55.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"35","median_amount":265.82,"10th_percentile":225.13,"90th_percentile":835.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":434.25,"10th_percentile":434.25,"90th_percentile":434.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":464.08,"10th_percentile":464.08,"90th_percentile":464.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":193.85,"10th_percentile":188.03,"90th_percentile":1378.68},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1266.0,"10th_percentile":1266.0,"90th_percentile":1266.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":519.8,"10th_percentile":519.8,"90th_percentile":519.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57.97,"10th_percentile":56.82,"90th_percentile":702.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":38608.03,"10th_percentile":38608.03,"90th_percentile":38608.03},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":1803.2,"10th_percentile":1803.2,"90th_percentile":1803.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":178.63,"10th_percentile":134.89,"90th_percentile":8355.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":7759.42,"10th_percentile":7759.42,"90th_percentile":7759.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":679.87,"10th_percentile":679.87,"90th_percentile":1377.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":256.43,"10th_percentile":256.43,"90th_percentile":256.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":759.01,"10th_percentile":759.01,"90th_percentile":759.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":178.63,"10th_percentile":178.63,"90th_percentile":2058.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":852.61,"10th_percentile":714.19,"90th_percentile":8752.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":754.54,"10th_percentile":754.54,"90th_percentile":754.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":731.6,"10th_percentile":731.6,"90th_percentile":6669.62},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"26","median_amount":183.99,"10th_percentile":147.2,"90th_percentile":183.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":2448.58,"10th_percentile":2448.58,"90th_percentile":2448.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":137.03,"10th_percentile":137.03,"90th_percentile":137.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"15","median_amount":6788.01,"10th_percentile":5821.44,"90th_percentile":8356.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":374.99,"10th_percentile":374.99,"90th_percentile":586.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1218.39,"10th_percentile":1218.39,"90th_percentile":4433.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":4040.49,"10th_percentile":1298.4,"90th_percentile":9250.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":398.7,"10th_percentile":398.7,"90th_percentile":398.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":1786.14,"10th_percentile":1593.31,"90th_percentile":28439.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":509.33,"10th_percentile":509.33,"90th_percentile":509.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"77","median_amount":1852.44,"10th_percentile":1739.8,"90th_percentile":4678.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":10698.36,"10th_percentile":10698.36,"90th_percentile":10698.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":2823.75,"10th_percentile":2823.75,"90th_percentile":3305.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"20","median_amount":2197.89,"10th_percentile":823.69,"90th_percentile":4867.19},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":308.99,"10th_percentile":308.99,"90th_percentile":384.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":6332.36,"10th_percentile":6077.96,"90th_percentile":8602.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":465.18,"10th_percentile":382.49,"90th_percentile":613.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":371.18,"10th_percentile":371.18,"90th_percentile":2900.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"13","median_amount":12251.41,"10th_percentile":12251.41,"90th_percentile":12386.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":395.47,"10th_percentile":226.45,"90th_percentile":931.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":10807.62,"10th_percentile":1225.71,"90th_percentile":20983.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":2045.9,"10th_percentile":2045.9,"90th_percentile":2045.9},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":444.14,"10th_percentile":444.13,"90th_percentile":3398.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":833.77,"10th_percentile":734.87,"90th_percentile":833.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"87","median_amount":938.4,"10th_percentile":469.33,"90th_percentile":1309.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"16","median_amount":14837.15,"10th_percentile":11130.29,"90th_percentile":15116.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"33","median_amount":2183.93,"10th_percentile":1405.8,"90th_percentile":3766.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":7427.09,"10th_percentile":1689.85,"90th_percentile":11332.39},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2853.26,"10th_percentile":2853.26,"90th_percentile":2853.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":11798.08,"10th_percentile":11798.08,"90th_percentile":15892.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":290.69,"10th_percentile":290.69,"90th_percentile":2868.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"75","median_amount":953.86,"10th_percentile":141.68,"90th_percentile":12703.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"171","median_amount":205.78,"10th_percentile":59.35,"90th_percentile":3326.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2885.05,"10th_percentile":2885.05,"90th_percentile":3112.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"88","median_amount":6102.04,"10th_percentile":111.97,"90th_percentile":10434.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1714.75,"10th_percentile":284.61,"90th_percentile":10114.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"18","median_amount":5643.94,"10th_percentile":150.23,"90th_percentile":7476.45},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1059.91,"10th_percentile":228.37,"90th_percentile":2125.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":89.19,"10th_percentile":74.19,"90th_percentile":2733.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"363","median_amount":526.89,"10th_percentile":210.25,"90th_percentile":9675.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"33","median_amount":14650.31,"10th_percentile":173.25,"90th_percentile":18680.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"35","median_amount":96.14,"10th_percentile":76.97,"90th_percentile":2851.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"99","median_amount":1047.23,"10th_percentile":72.06,"90th_percentile":7595.55},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"21","median_amount":76.41,"10th_percentile":61.13,"90th_percentile":257.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"16","median_amount":196.19,"10th_percentile":141.68,"90th_percentile":11500.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"115","median_amount":1699.44,"10th_percentile":64.52,"90th_percentile":3599.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":1847.27,"10th_percentile":715.04,"90th_percentile":1847.27},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9802.02,"10th_percentile":9802.02,"90th_percentile":9802.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"297","median_amount":1371.95,"10th_percentile":961.63,"90th_percentile":3258.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"132","median_amount":277.9,"10th_percentile":219.64,"90th_percentile":575.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"53","median_amount":1165.51,"10th_percentile":737.8,"90th_percentile":2717.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"502","median_amount":1038.52,"10th_percentile":775.69,"90th_percentile":2207.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":225.63,"10th_percentile":225.63,"90th_percentile":643.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"17","median_amount":1187.2,"10th_percentile":1143.09,"90th_percentile":8772.07},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"80","median_amount":1187.16,"10th_percentile":653.27,"90th_percentile":2078.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"60","median_amount":219.82,"10th_percentile":219.64,"90th_percentile":586.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1048","median_amount":1189.56,"10th_percentile":893.92,"90th_percentile":2466.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"50","median_amount":1443.0,"10th_percentile":479.87,"90th_percentile":2856.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"188","median_amount":693.89,"10th_percentile":473.27,"90th_percentile":1526.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"643","median_amount":574.78,"10th_percentile":412.06,"90th_percentile":1242.62},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"44","median_amount":276.89,"10th_percentile":220.61,"90th_percentile":2460.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"117","median_amount":1366.43,"10th_percentile":900.16,"90th_percentile":9513.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"76","median_amount":318.97,"10th_percentile":224.03,"90th_percentile":658.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":2311.26,"10th_percentile":2311.26,"90th_percentile":2311.26},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"12","median_amount":382.89,"10th_percentile":230.62,"90th_percentile":785.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"301","median_amount":9502.22,"10th_percentile":3470.61,"90th_percentile":36092.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":39144.39,"10th_percentile":39144.39,"90th_percentile":39144.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"214","median_amount":10774.63,"10th_percentile":564.86,"90th_percentile":15852.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":11506.61,"10th_percentile":11506.61,"90th_percentile":11506.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"143","median_amount":10985.11,"10th_percentile":1759.85,"90th_percentile":18529.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":565.37,"10th_percentile":331.56,"90th_percentile":6342.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"32","median_amount":8471.25,"10th_percentile":6639.19,"90th_percentile":52623.72},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"114","median_amount":6972.68,"10th_percentile":3019.93,"90th_percentile":13778.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"174","median_amount":3121.9,"10th_percentile":682.14,"90th_percentile":12463.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"902","median_amount":7335.96,"10th_percentile":2589.17,"90th_percentile":18572.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"30","median_amount":33147.86,"10th_percentile":7932.67,"90th_percentile":46903.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"38","median_amount":9282.1,"10th_percentile":1017.12,"90th_percentile":14059.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"144","median_amount":8126.37,"10th_percentile":2778.55,"90th_percentile":12756.55},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"98","median_amount":4658.71,"10th_percentile":583.55,"90th_percentile":16551.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"55","median_amount":4041.56,"10th_percentile":3601.57,"90th_percentile":27568.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"193","median_amount":1155.27,"10th_percentile":450.82,"90th_percentile":14194.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":2846.45,"10th_percentile":2846.45,"90th_percentile":3182.79},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"19","median_amount":12214.02,"10th_percentile":9800.31,"90th_percentile":12770.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"40","median_amount":2614.64,"10th_percentile":1261.38,"90th_percentile":2614.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":163.1,"10th_percentile":53.59,"90th_percentile":180.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":78.81,"10th_percentile":78.81,"90th_percentile":2797.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"39","median_amount":1529.85,"10th_percentile":1529.85,"90th_percentile":1529.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":27616.12,"10th_percentile":2378.21,"90th_percentile":32463.24},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":716.26,"10th_percentile":658.01,"90th_percentile":717.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":163.1,"10th_percentile":163.1,"90th_percentile":778.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"290","median_amount":778.48,"10th_percentile":693.01,"90th_percentile":805.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"13","median_amount":2341.81,"10th_percentile":1873.45,"90th_percentile":2341.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":110.34,"10th_percentile":110.34,"90th_percentile":1406.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"58","median_amount":975.09,"10th_percentile":362.33,"90th_percentile":1203.25},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":125.62,"10th_percentile":125.62,"90th_percentile":125.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"43","median_amount":2222.44,"10th_percentile":696.54,"90th_percentile":2614.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"19","median_amount":166.37,"10th_percentile":99.12,"90th_percentile":2815.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":214.15,"10th_percentile":214.15,"90th_percentile":214.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"43","median_amount":1197.84,"10th_percentile":850.82,"90th_percentile":1531.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":1531.8,"10th_percentile":1531.8,"90th_percentile":1531.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":324.62,"10th_percentile":259.69,"90th_percentile":334.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1464.71,"10th_percentile":1464.71,"90th_percentile":1474.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"37","median_amount":891.43,"10th_percentile":622.27,"90th_percentile":896.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":333.47,"10th_percentile":333.47,"90th_percentile":333.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":1111.39,"10th_percentile":1028.84,"90th_percentile":1131.39},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":1379.28,"10th_percentile":1156.0,"90th_percentile":1651.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":324.62,"10th_percentile":314.62,"90th_percentile":325.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"170","median_amount":1354.4,"10th_percentile":903.0,"90th_percentile":1633.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"12","median_amount":1072.85,"10th_percentile":858.28,"90th_percentile":1371.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":775.86,"10th_percentile":640.64,"90th_percentile":913.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"55","median_amount":568.17,"10th_percentile":396.62,"90th_percentile":581.24},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"12","median_amount":302.41,"10th_percentile":267.48,"90th_percentile":378.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":324.62,"10th_percentile":324.62,"90th_percentile":324.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"19","median_amount":1327.04,"10th_percentile":958.27,"90th_percentile":1909.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"33","median_amount":331.11,"10th_percentile":264.88,"90th_percentile":341.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":846.07,"10th_percentile":846.07,"90th_percentile":846.07},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":306.66,"10th_percentile":71.19,"90th_percentile":346.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":3243.92,"10th_percentile":3243.92,"90th_percentile":3243.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":553.12,"10th_percentile":553.12,"90th_percentile":1112.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1779.73,"10th_percentile":1779.73,"90th_percentile":1779.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":1096.52,"10th_percentile":708.8,"90th_percentile":1898.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1349.0,"10th_percentile":1349.0,"90th_percentile":1349.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":553.12,"10th_percentile":553.12,"90th_percentile":553.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":2432.44,"10th_percentile":1310.0,"90th_percentile":2732.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":2905.42,"10th_percentile":2905.42,"90th_percentile":2905.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":780.63,"10th_percentile":780.63,"90th_percentile":780.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":1209.77,"10th_percentile":883.33,"90th_percentile":1209.77},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":1211.41,"10th_percentile":1211.41,"90th_percentile":1211.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":564.19,"10th_percentile":564.19,"90th_percentile":566.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"82","median_amount":6417.92,"10th_percentile":5188.98,"90th_percentile":7259.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":552.06,"10th_percentile":469.25,"90th_percentile":577.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"57","median_amount":3755.18,"10th_percentile":3755.18,"90th_percentile":4276.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":7071.05,"10th_percentile":7071.05,"90th_percentile":7071.05},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":4663.04,"10th_percentile":4471.36,"90th_percentile":4664.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1060.58,"10th_percentile":1050.58,"90th_percentile":1060.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"284","median_amount":5062.08,"10th_percentile":4598.82,"90th_percentile":5239.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"21","median_amount":5748.22,"10th_percentile":4598.57,"90th_percentile":6546.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":657.07,"10th_percentile":626.81,"90th_percentile":3452.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"45","median_amount":2416.49,"10th_percentile":2393.47,"90th_percentile":2752.15},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":484.13,"10th_percentile":404.35,"90th_percentile":507.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"14","median_amount":6578.46,"10th_percentile":5134.34,"90th_percentile":7309.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"21","median_amount":491.81,"10th_percentile":466.55,"90th_percentile":517.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":520.18,"10th_percentile":496.23,"90th_percentile":524.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":134.34,"10th_percentile":134.34,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":137.08,"10th_percentile":137.08,"90th_percentile":137.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":409.4,"10th_percentile":409.4,"90th_percentile":409.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":245.46,"10th_percentile":122.73,"90th_percentile":593.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":119.12,"10th_percentile":119.12,"90th_percentile":119.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":17093.13,"10th_percentile":17093.13,"90th_percentile":17093.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":40.92,"10th_percentile":40.92,"90th_percentile":40.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":195.29,"10th_percentile":142.0,"90th_percentile":2045.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"243","median_amount":347.76,"10th_percentile":135.24,"90th_percentile":778.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"186","median_amount":61.92,"10th_percentile":38.35,"90th_percentile":75.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"16","median_amount":333.55,"10th_percentile":250.16,"90th_percentile":633.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"190","median_amount":203.48,"10th_percentile":203.48,"90th_percentile":894.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":63.6,"10th_percentile":63.6,"90th_percentile":63.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"28","median_amount":130.83,"10th_percentile":130.83,"90th_percentile":377.89},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"102","median_amount":263.08,"10th_percentile":108.91,"90th_percentile":272.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"85","median_amount":61.92,"10th_percentile":30.96,"90th_percentile":61.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"901","median_amount":295.52,"10th_percentile":147.0,"90th_percentile":322.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"68","median_amount":311.47,"10th_percentile":121.13,"90th_percentile":1091.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"60","median_amount":188.92,"10th_percentile":188.92,"90th_percentile":628.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"239","median_amount":130.94,"10th_percentile":50.92,"90th_percentile":580.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"36","median_amount":64.04,"10th_percentile":51.02,"90th_percentile":94.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"70","median_amount":347.76,"10th_percentile":278.21,"90th_percentile":1212.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"118","median_amount":63.16,"10th_percentile":25.37,"90th_percentile":73.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":810.3,"10th_percentile":810.3,"90th_percentile":810.3},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"19","median_amount":65.01,"10th_percentile":26.11,"90th_percentile":79.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":837.41,"10th_percentile":837.41,"90th_percentile":837.41}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"123","median_amount":518.88,"10th_percentile":278.76,"90th_percentile":1721.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"111","median_amount":134.37,"10th_percentile":134.37,"90th_percentile":134.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"13","median_amount":360.21,"10th_percentile":71.97,"90th_percentile":1600.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"138","median_amount":631.98,"10th_percentile":268.62,"90th_percentile":4746.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"19","median_amount":297.64,"10th_percentile":266.22,"90th_percentile":334.64},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"108","median_amount":545.0,"10th_percentile":376.0,"90th_percentile":609.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"66","median_amount":134.37,"10th_percentile":134.34,"90th_percentile":147.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"521","median_amount":641.33,"10th_percentile":360.0,"90th_percentile":728.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"39","median_amount":569.38,"10th_percentile":276.86,"90th_percentile":3979.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"36","median_amount":350.86,"10th_percentile":141.29,"90th_percentile":935.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"112","median_amount":290.96,"10th_percentile":152.68,"90th_percentile":821.66},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"21","median_amount":110.72,"10th_percentile":110.72,"90th_percentile":138.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"49","median_amount":667.92,"10th_percentile":345.92,"90th_percentile":1253.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"88","median_amount":137.26,"10th_percentile":137.06,"90th_percentile":139.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":1365.83,"10th_percentile":1365.83,"90th_percentile":1365.83},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":141.09,"10th_percentile":112.88,"90th_percentile":154.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7416.59,"10th_percentile":7416.59,"90th_percentile":7416.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":894.24,"10th_percentile":894.24,"90th_percentile":894.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38.88,"10th_percentile":38.88,"90th_percentile":50.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":98.3,"10th_percentile":98.3,"90th_percentile":98.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":416.57,"10th_percentile":416.57,"90th_percentile":416.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":800.93,"10th_percentile":800.93,"90th_percentile":800.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":128.95,"10th_percentile":128.95,"90th_percentile":128.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":88.52,"10th_percentile":88.52,"90th_percentile":88.52},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electronic Analysis of Devices","code_information":[{"code":"5742","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":894.24,"10th_percentile":894.24,"90th_percentile":894.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":95.69,"10th_percentile":95.69,"90th_percentile":95.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":523.23,"10th_percentile":523.23,"90th_percentile":523.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":95.69,"10th_percentile":95.69,"90th_percentile":95.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":456.71,"10th_percentile":456.71,"90th_percentile":456.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":800.93,"10th_percentile":800.93,"90th_percentile":800.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":894.24,"10th_percentile":894.24,"90th_percentile":894.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"17","median_amount":1642.92,"10th_percentile":441.6,"90th_percentile":2649.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"41","median_amount":922.53,"10th_percentile":262.5,"90th_percentile":1575.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1726.4,"10th_percentile":1726.4,"90th_percentile":1726.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":1033.52,"10th_percentile":398.88,"90th_percentile":1550.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1729.0,"10th_percentile":1729.0,"90th_percentile":1976.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":1181.25,"10th_percentile":393.75,"90th_percentile":1575.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"55","median_amount":1440.0,"10th_percentile":441.43,"90th_percentile":2717.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":1384.32,"10th_percentile":1384.32,"90th_percentile":1977.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":493.8,"10th_percentile":493.8,"90th_percentile":959.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"12","median_amount":249.39,"10th_percentile":83.13,"90th_percentile":831.3},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":757.05,"10th_percentile":757.05,"90th_percentile":757.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":454.48,"10th_percentile":454.48,"90th_percentile":454.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1075.36,"10th_percentile":401.64,"90th_percentile":1740.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":4048.87,"10th_percentile":4048.87,"90th_percentile":4048.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":761.54,"10th_percentile":757.25,"90th_percentile":1384.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":4235.48,"10th_percentile":4235.48,"90th_percentile":4235.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3025.29,"10th_percentile":3025.29,"90th_percentile":5513.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":652.0,"10th_percentile":652.0,"90th_percentile":652.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":3514.79,"10th_percentile":3387.9,"90th_percentile":7076.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":24542.88,"10th_percentile":24542.88,"90th_percentile":24542.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":3277.12,"10th_percentile":3277.12,"90th_percentile":3277.12},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":5045.48,"10th_percentile":5045.48,"90th_percentile":5045.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":763.58,"10th_percentile":763.33,"90th_percentile":777.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":5636.15,"10th_percentile":5636.15,"90th_percentile":5636.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2600.68,"10th_percentile":2600.68,"90th_percentile":2600.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":3882.23,"10th_percentile":3882.23,"90th_percentile":3882.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2760.11,"10th_percentile":2760.11,"90th_percentile":2760.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1611.44,"10th_percentile":1611.44,"90th_percentile":1611.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":10186.29,"10th_percentile":10186.29,"90th_percentile":10186.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":4459.92,"10th_percentile":4459.92,"90th_percentile":4459.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":1888.6,"10th_percentile":1888.6,"90th_percentile":1888.6},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventilation Initiation and Management","code_information":[{"code":"5801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":19148.38,"10th_percentile":19148.38,"90th_percentile":19148.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":45757.22,"10th_percentile":45757.22,"90th_percentile":45757.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":16508.92,"10th_percentile":16508.92,"90th_percentile":16508.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":18002.39,"10th_percentile":18002.39,"90th_percentile":21096.26},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Glucagon hydrochloride","code_information":[{"code":"9042","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2810.24,"10th_percentile":2810.24,"90th_percentile":2810.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gallium ga-68","code_information":[{"code":"9056","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9007.03,"10th_percentile":9007.03,"90th_percentile":9007.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, clevidipine, 1 mg","code_information":[{"code":"9087","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":25930.62,"10th_percentile":25930.62,"90th_percentile":25930.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prothrombin complex kcentra","code_information":[{"code":"9132","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":44899.1,"10th_percentile":44899.1,"90th_percentile":44899.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Injection, udenyca 0.5 mg","code_information":[{"code":"9195","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":2909.92,"10th_percentile":2909.92,"90th_percentile":2909.92},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rabies ig ht&sol human im/sc","code_information":[{"code":"9201","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3458.46,"10th_percentile":3458.46,"90th_percentile":3458.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Leuprolide acetate suspnsion","code_information":[{"code":"9217","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7566.59,"10th_percentile":7566.59,"90th_percentile":7566.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, calcium gluconate, nos","code_information":[{"code":"9226","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"90th_percentile":200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10542.31,"10th_percentile":10542.31,"90th_percentile":10542.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Belatacept injection","code_information":[{"code":"9286","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":12551.56,"10th_percentile":12551.56,"90th_percentile":12551.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":60031.98,"10th_percentile":60031.98,"90th_percentile":60031.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Injection, Carfilzomib, 1 mg","code_information":[{"code":"9295","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7131.7,"10th_percentile":7131.7,"90th_percentile":7131.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj., kanjinti, 10 mg","code_information":[{"code":"9330","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4513.39,"10th_percentile":4513.39,"90th_percentile":4513.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, esmolol hcl, 10mg","code_information":[{"code":"9363","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":132880.21,"10th_percentile":132880.21,"90th_percentile":132880.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Daratumumab, hyaluronidase","code_information":[{"code":"9378","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12923.49,"10th_percentile":9604.29,"90th_percentile":13714.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":6124.5,"10th_percentile":6124.5,"90th_percentile":6124.5},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Piflu f-18, dia 1 millicurie","code_information":[{"code":"9430","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4874.19,"10th_percentile":4874.19,"90th_percentile":4874.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj pegfilgrast ex bio 0.5mg","code_information":[{"code":"9436","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":12251.41,"10th_percentile":12251.41,"90th_percentile":12251.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":938.4,"10th_percentile":938.4,"90th_percentile":938.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Injection, mepolizumab, 1mg","code_information":[{"code":"9473","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3156.11,"10th_percentile":3156.11,"90th_percentile":3156.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj., durvalumab, 10 mg","code_information":[{"code":"9492","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8687.53,"10th_percentile":8687.53,"90th_percentile":8687.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1111.46,"10th_percentile":1111.46,"90th_percentile":1111.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3879.0,"10th_percentile":3879.0,"90th_percentile":3879.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"33","median_amount":1144.8,"10th_percentile":965.01,"90th_percentile":1149.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Plasma, frz between 8-24hour","code_information":[{"code":"9513","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":36400.52,"10th_percentile":36400.52,"90th_percentile":36400.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelets pheresis path redu","code_information":[{"code":"9536","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1245.92,"10th_percentile":1066.55,"90th_percentile":1251.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"828","median_amount":246.56,"10th_percentile":138.0,"90th_percentile":330.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":297.16,"10th_percentile":253.92,"90th_percentile":297.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1205","median_amount":134.48,"10th_percentile":104.94,"90th_percentile":134.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"100","median_amount":147.58,"10th_percentile":94.79,"90th_percentile":282.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"582","median_amount":144.26,"10th_percentile":80.75,"90th_percentile":173.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":137.47,"10th_percentile":55.2,"90th_percentile":138.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"41","median_amount":209.59,"10th_percentile":100.12,"90th_percentile":319.51},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"300","median_amount":137.08,"10th_percentile":95.96,"90th_percentile":137.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"545","median_amount":134.34,"10th_percentile":53.73,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"2565","median_amount":137.08,"10th_percentile":135.13,"90th_percentile":137.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"15","median_amount":186.68,"10th_percentile":123.6,"90th_percentile":314.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"190","median_amount":133.95,"10th_percentile":74.97,"90th_percentile":179.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"773","median_amount":92.84,"10th_percentile":51.96,"90th_percentile":124.35},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"171","median_amount":110.69,"10th_percentile":51.96,"90th_percentile":138.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"13","median_amount":134.34,"10th_percentile":134.34,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"270","median_amount":253.92,"10th_percentile":138.0,"90th_percentile":297.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"812","median_amount":137.03,"10th_percentile":54.82,"90th_percentile":137.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"128","median_amount":146.0,"10th_percentile":109.5,"90th_percentile":229.22},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"92","median_amount":141.05,"10th_percentile":134.34,"90th_percentile":141.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":117.0,"10th_percentile":117.0,"90th_percentile":117.0}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1823","median_amount":414.92,"10th_percentile":97.2,"90th_percentile":1361.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"14","median_amount":609.04,"10th_percentile":399.28,"90th_percentile":928.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"3520","median_amount":43.3,"10th_percentile":16.46,"90th_percentile":117.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"324","median_amount":80.38,"10th_percentile":30.68,"90th_percentile":219.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"2884","median_amount":311.68,"10th_percentile":76.98,"90th_percentile":944.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"79","median_amount":47.56,"10th_percentile":17.88,"90th_percentile":125.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"177","median_amount":59.32,"10th_percentile":28.79,"90th_percentile":187.89},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1259","median_amount":142.3,"10th_percentile":35.23,"90th_percentile":508.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1254","median_amount":33.79,"10th_percentile":9.52,"90th_percentile":108.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11274","median_amount":192.71,"10th_percentile":44.81,"90th_percentile":616.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"572","median_amount":384.81,"10th_percentile":83.22,"90th_percentile":1181.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"817","median_amount":205.53,"10th_percentile":57.19,"90th_percentile":600.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"3862","median_amount":167.31,"10th_percentile":30.19,"90th_percentile":585.36},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"595","median_amount":43.35,"10th_percentile":16.52,"90th_percentile":117.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29.03,"10th_percentile":29.03,"90th_percentile":29.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"777","median_amount":416.48,"10th_percentile":100.93,"90th_percentile":1378.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"2199","median_amount":46.55,"10th_percentile":17.55,"90th_percentile":123.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":182.5,"10th_percentile":54.02,"90th_percentile":375.22},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"291","median_amount":56.42,"10th_percentile":17.78,"90th_percentile":137.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":280.18,"10th_percentile":241.02,"90th_percentile":1241.14}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"162","median_amount":773.71,"10th_percentile":301.76,"90th_percentile":2193.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":929.2,"10th_percentile":929.2,"90th_percentile":929.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"269","median_amount":210.76,"10th_percentile":66.9,"90th_percentile":467.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":286.57,"10th_percentile":199.43,"90th_percentile":286.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"242","median_amount":588.35,"10th_percentile":212.09,"90th_percentile":1505.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":122.34,"10th_percentile":78.87,"90th_percentile":436.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":291.92,"10th_percentile":218.94,"90th_percentile":3129.24},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"104","median_amount":827.13,"10th_percentile":328.0,"90th_percentile":1819.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"89","median_amount":233.07,"10th_percentile":81.18,"90th_percentile":584.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1137","median_amount":824.67,"10th_percentile":268.49,"90th_percentile":2235.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"42","median_amount":825.0,"10th_percentile":160.0,"90th_percentile":2223.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"51","median_amount":485.81,"10th_percentile":163.93,"90th_percentile":1414.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"236","median_amount":429.54,"10th_percentile":135.18,"90th_percentile":1137.5},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"39","median_amount":111.98,"10th_percentile":72.4,"90th_percentile":398.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"93","median_amount":483.92,"10th_percentile":197.8,"90th_percentile":2467.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"116","median_amount":187.98,"10th_percentile":91.89,"90th_percentile":441.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":236.52,"10th_percentile":236.52,"90th_percentile":236.52},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"16","median_amount":261.6,"10th_percentile":96.78,"90th_percentile":615.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"798","median_amount":486.5,"10th_percentile":486.5,"90th_percentile":486.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"458","median_amount":109.73,"10th_percentile":109.73,"90th_percentile":109.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"81","median_amount":167.96,"10th_percentile":167.96,"90th_percentile":167.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"253","median_amount":191.56,"10th_percentile":191.56,"90th_percentile":191.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":111.93,"10th_percentile":111.93,"90th_percentile":132.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"47","median_amount":618.55,"10th_percentile":618.55,"90th_percentile":618.55},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"321","median_amount":479.82,"10th_percentile":466.24,"90th_percentile":482.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"132","median_amount":109.73,"10th_percentile":109.73,"90th_percentile":109.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"3139","median_amount":538.99,"10th_percentile":523.74,"90th_percentile":542.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"168","median_amount":572.68,"10th_percentile":572.68,"90th_percentile":572.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"67","median_amount":347.36,"10th_percentile":347.36,"90th_percentile":347.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"316","median_amount":240.74,"10th_percentile":238.46,"90th_percentile":240.74},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"40","median_amount":113.02,"10th_percentile":113.02,"90th_percentile":113.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":116.53,"10th_percentile":116.53,"90th_percentile":116.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"279","median_amount":639.4,"10th_percentile":639.4,"90th_percentile":639.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"251","median_amount":111.93,"10th_percentile":111.93,"90th_percentile":111.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"52","median_amount":115.21,"10th_percentile":115.21,"90th_percentile":115.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":542.1,"10th_percentile":542.1,"90th_percentile":542.1}]}]},{"description":"Durable Medical Equipment","code_information":[{"code":"N805","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":1167.48,"10th_percentile":1167.48,"90th_percentile":1167.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":223.75,"10th_percentile":223.75,"90th_percentile":353.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":683.1,"10th_percentile":683.1,"90th_percentile":683.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":284.06,"10th_percentile":284.06,"90th_percentile":284.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2073.0,"10th_percentile":2002.0,"90th_percentile":3298.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":707.82,"10th_percentile":707.82,"90th_percentile":707.82},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":2795.57,"10th_percentile":2795.57,"90th_percentile":2795.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":463.59,"10th_percentile":463.59,"90th_percentile":463.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pharmacy Services","code_information":[{"code":"N806","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11206.29,"10th_percentile":11206.29,"90th_percentile":11206.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5720.35,"10th_percentile":5720.35,"90th_percentile":5720.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4723.44,"10th_percentile":3168.11,"90th_percentile":5053.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":1173.69,"10th_percentile":1173.69,"90th_percentile":1173.69},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":120.7,"10th_percentile":120.7,"90th_percentile":120.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":176.66,"10th_percentile":72.29,"90th_percentile":242.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":987.24,"10th_percentile":987.24,"90th_percentile":987.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":437.88,"10th_percentile":437.88,"90th_percentile":437.88},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1075.47,"10th_percentile":1075.47,"90th_percentile":1075.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":216.96,"10th_percentile":216.96,"90th_percentile":216.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":492.0,"10th_percentile":452.0,"90th_percentile":1760.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":409.53,"10th_percentile":409.53,"90th_percentile":409.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":170.52,"10th_percentile":170.52,"90th_percentile":170.52},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":141.01,"10th_percentile":141.01,"90th_percentile":141.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":989.92,"10th_percentile":989.92,"90th_percentile":989.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":180.92,"10th_percentile":180.92,"90th_percentile":214.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":186.25,"10th_percentile":186.25,"90th_percentile":186.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Observation, Other","code_information":[{"code":"N811","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":9721.91,"10th_percentile":9721.91,"90th_percentile":9721.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2771.38,"10th_percentile":2490.61,"90th_percentile":2931.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":2807.64,"10th_percentile":2807.64,"90th_percentile":7205.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":25576.05,"10th_percentile":25576.05,"90th_percentile":25576.05},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12382.74,"10th_percentile":12382.74,"90th_percentile":12382.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1248.55,"10th_percentile":1248.55,"90th_percentile":1248.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":13335.3,"10th_percentile":7337.25,"90th_percentile":27164.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":46706.29,"10th_percentile":46706.29,"90th_percentile":46706.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":2577.31,"10th_percentile":2577.31,"90th_percentile":2577.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":732.29,"10th_percentile":732.29,"90th_percentile":732.29},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2845.11,"10th_percentile":2845.11,"90th_percentile":2845.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":26885.92,"10th_percentile":26885.92,"90th_percentile":26885.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2817.51,"10th_percentile":2815.32,"90th_percentile":3420.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"22","median_amount":471.8,"10th_percentile":471.8,"90th_percentile":585.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":120.1,"10th_percentile":97.45,"90th_percentile":120.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":322.42,"10th_percentile":322.42,"90th_percentile":322.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"48","median_amount":537.9,"10th_percentile":175.64,"90th_percentile":2303.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":451.6,"10th_percentile":451.6,"90th_percentile":599.86},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":528.15,"10th_percentile":449.07,"90th_percentile":24350.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":97.45,"10th_percentile":97.45,"90th_percentile":105.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"126","median_amount":481.41,"10th_percentile":428.56,"90th_percentile":9556.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":688.86,"10th_percentile":688.86,"90th_percentile":688.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":417.83,"10th_percentile":336.86,"90th_percentile":417.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"40","median_amount":289.59,"10th_percentile":152.34,"90th_percentile":1092.87},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":100.78,"10th_percentile":100.78,"90th_percentile":100.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"11","median_amount":620.08,"10th_percentile":191.0,"90th_percentile":769.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":122.5,"10th_percentile":99.41,"90th_percentile":122.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"1 through 10","median_amount":146.0,"10th_percentile":146.0,"90th_percentile":610.28},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":126.09,"10th_percentile":126.09,"90th_percentile":126.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"20","median_amount":15495.56,"10th_percentile":6194.46,"90th_percentile":41048.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":1520.5,"10th_percentile":340.62,"90th_percentile":18419.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"15","median_amount":9795.27,"10th_percentile":4646.58,"90th_percentile":42161.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":5217.2,"10th_percentile":2165.84,"90th_percentile":29165.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1109.67,"10th_percentile":1109.67,"90th_percentile":1109.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6686.63,"10th_percentile":5423.9,"90th_percentile":15783.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":2655.81,"10th_percentile":448.15,"90th_percentile":20372.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"104","median_amount":5154.91,"10th_percentile":1662.16,"90th_percentile":19406.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"11","median_amount":9138.77,"10th_percentile":1322.83,"90th_percentile":30839.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"12","median_amount":3696.93,"10th_percentile":1395.64,"90th_percentile":17792.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"69","median_amount":3823.5,"10th_percentile":393.6,"90th_percentile":7416.53},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"15","median_amount":960.82,"10th_percentile":385.03,"90th_percentile":2912.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"16","median_amount":6042.39,"10th_percentile":158.24,"90th_percentile":19904.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1141.67,"10th_percentile":157.58,"90th_percentile":3347.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3001.94,"10th_percentile":1092.64,"90th_percentile":10649.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"17","median_amount":4496.4,"10th_percentile":1921.6,"90th_percentile":4496.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"11","median_amount":452.67,"10th_percentile":451.71,"90th_percentile":467.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"1 through 10","median_amount":4527.21,"10th_percentile":4527.21,"90th_percentile":4527.21},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":1637.21,"10th_percentile":1581.86,"90th_percentile":1702.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":102.14,"10th_percentile":102.14,"90th_percentile":102.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"166","median_amount":1839.12,"10th_percentile":1723.9,"90th_percentile":1839.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"1 through 10","median_amount":4715.36,"10th_percentile":4715.36,"90th_percentile":4715.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":2281.38,"10th_percentile":2281.38,"90th_percentile":2301.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":1772.44,"10th_percentile":1745.27,"90th_percentile":2347.58},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":306.77,"10th_percentile":306.77,"90th_percentile":306.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"1 through 10","median_amount":4707.41,"10th_percentile":3345.47,"90th_percentile":6432.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":379.75,"10th_percentile":303.79,"90th_percentile":381.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Billable to FI","code_information":[{"code":"N907","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Cardiac Cath (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [CT OP Scan (%BC): 90] [MRI OP (%BC): 90] [Positron Emission Tomography (%BC): 90] [Radiology (%BC): 70] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2765.61,"10th_percentile":2765.61,"90th_percentile":2765.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 53.83] [Cardiac Cath (%BC): 53.83] [Observation (%BC): 53.83] [Emergency Department (%BC): 53.83] [Chemotherapy (%BC): 53.83] [Radiation Therapy  (%BC): 53.83] [Positron Emission Tomography (%BC): 53.83] [Radiology Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs (%BC): 53.83] [All Other OP (%BC): 53.83]","count":"1 through 10","median_amount":3544.42,"10th_percentile":3544.42,"90th_percentile":3544.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"percent of total billed charges","standard_charge_percentage":89.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 82.4] [Observation (%BC): 82.4] [Emergency Department (%BC): 82.4] [Urgent Care ($): 133] [Occupational Therapy (%BC): 82.4] [Physical Therapy (%BC): 82.4] [Respiratory Services/Therapy  (%BC): 82.4] [Speech Therapy (%BC): 82.4] [All Other OP (%BC): 82.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Delaware First Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 59.59] [Observation (%BC): 33.64] [ED Level 1--99281 ($): 318.27] [ED Level 2--99282 ($): 318.27] [ED Level 3--99283 ($): 1060.90] [ED Level 4--99284 ($): 1060.90] [ED Level 5--99285 ($): 1060.90] [Radiation Therapy  (%BC): 50.94] [Laboratory (%BC): 33.64] [Occupational Therapy (%BC): 49.98] [Physical Therapy (%BC): 49.98] [Respiratory Services/Therapy  (%BC): 49.98] [Speech Therapy (%BC): 49.98] [All Other OP (%BC): 49.98]","count":"1 through 10","median_amount":10138.42,"10th_percentile":10138.42,"90th_percentile":10138.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Health Options","plan_name":"Medicaid Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":34.64,"count":"1 through 10","median_amount":11.43,"10th_percentile":11.43,"90th_percentile":11.43},{"payer_name":"Health Options","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Pace Your Life","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 92] [Observation (%BC): 92] [Emergency Department (%BC): 92] [Occupational Therapy (%BC): 92] [Physical Therapy (%BC): 92] [Respiratory Services/Therapy  (%BC): 92] [Speech Therapy (%BC): 92] [All Other OP (%BC): 92]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vitalcore","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":73.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare/Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaidpublications.dhss.delaware.gov/docs/search] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Welsh & Associates","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rbc dna hea 35 ag 11 bld grp","code_information":[{"code":"0001U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":3367.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1080.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2998.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3367.8,"additional_payer_notes":"APC"}]}]},{"description":"Liver dis 10 assays w/ash","code_information":[{"code":"0002M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":2354.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":755.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2096.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2354.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct 3 ur metab alg plp","code_information":[{"code":"0002U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.0,"maximum":116.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":104.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116.94,"additional_payer_notes":"APC"}]}]},{"description":"Liver dis 10 assays w/nash","code_information":[{"code":"0003M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":2354.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":755.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2096.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2354.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovar 5 prtn ser alg scor","code_information":[{"code":"0003U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.0,"maximum":4443.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1425.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":969.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3955.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4443.62,"additional_payer_notes":"APC"}]}]},{"description":"Scoliosis dna alys","code_information":[{"code":"0004M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.0,"maximum":369.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":79.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":328.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":369.52,"additional_payer_notes":"APC"}]}]},{"description":"Onco prst8 3 gene ur alg","code_information":[{"code":"0005U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc hep gene risk classifier","code_information":[{"code":"0006M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.0,"maximum":701.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":225.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":150.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc gastro 51 gene nomogram","code_information":[{"code":"0007M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.0,"maximum":1754.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":562.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":375.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1561.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1754.06,"additional_payer_notes":"APC"}]}]},{"description":"Rx test prsmv ur w/def conf","code_information":[{"code":"0007U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":535.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":171.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":476.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":535.25,"additional_payer_notes":"APC"}]}]},{"description":"Hpylori detcj abx rstnc dna","code_information":[{"code":"0008U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":2796.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":896.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2489.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2796.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca erbb2 amp/nonamp","code_information":[{"code":"0009U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.0,"maximum":500.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":160.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":107.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":445.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":500.49,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds strn typ whl gen seq","code_information":[{"code":"0010U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":427.26,"maximum":1998.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":640.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":427.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1779.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1998.51,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca mrna 12 gen alg","code_information":[{"code":"0011M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr lc-ms/ms oral fluid","code_information":[{"code":"0011U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":535.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":171.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":476.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":535.25,"additional_payer_notes":"APC"}]}]},{"description":"Adrnl cortcl tum bchm asy 25","code_information":[{"code":"0015M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.37,"maximum":6105.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1958.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1331.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1305.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5435.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6105.87,"additional_payer_notes":"APC"}]}]},{"description":"Onc bladder mrna 209 gen alg","code_information":[{"code":"0016M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3489.63,"maximum":16322.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5234.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3559.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3489.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14531.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16322.74,"additional_payer_notes":"APC"}]}]},{"description":"Onc hmtlmf neo rna bcr/abl1","code_information":[{"code":"0016U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.96,"maximum":766.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":245.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":163.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":682.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":766.92,"additional_payer_notes":"APC"}]}]},{"description":"Onc dlbcl mrna 20 genes alg","code_information":[{"code":"0017M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.21,"maximum":11741.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3765.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2560.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10452.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11741.51,"additional_payer_notes":"APC"}]}]},{"description":"Onc hmtlmf neo jak2 mut dna","code_information":[{"code":"0017U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.66,"maximum":428.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":91.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":381.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":428.74,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj rnl meas cd154+cll","code_information":[{"code":"0018M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":640.73,"maximum":2997.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":961.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":653.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":640.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2668.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2997.01,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr 10 microrna seq alg","code_information":[{"code":"0018U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3002.09,"maximum":14042.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4503.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3062.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3002.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12501.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14042.28,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds plasma alys prtn bmrk","code_information":[{"code":"0019M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.4,"maximum":3332.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1068.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":726.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":712.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2966.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3332.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc rna tiss predict alg","code_information":[{"code":"0019U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3675.0,"maximum":17189.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5512.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3748.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15303.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17189.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 detcj 8 autoantb","code_information":[{"code":"0021U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna&rna 23 gene","code_information":[{"code":"0022U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":9121.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2925.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8120.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9121.12,"additional_payer_notes":"APC"}]}]},{"description":"Onc aml dna detcj/nondetcj","code_information":[{"code":"0023U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.51,"maximum":1162.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":372.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":248.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1034.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1162.41,"additional_payer_notes":"APC"}]}]},{"description":"Glyca nuc mr spectrsc quan","code_information":[{"code":"0024U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.19,"maximum":159.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":142.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159.92,"additional_payer_notes":"APC"}]}]},{"description":"Tenofovir liq chrom ur quan","code_information":[{"code":"0025U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":535.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":171.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":476.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":535.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr dna&mrna 112 genes","code_information":[{"code":"0026U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":16839.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5400.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14990.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16839.0,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene trgt seq alys","code_information":[{"code":"0027U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.91,"maximum":570.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":182.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":121.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":507.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":570.23,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs trgt seq alys","code_information":[{"code":"0029U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.27,"maximum":3471.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1113.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":757.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3090.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3471.97,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab warf trgt seq alys","code_information":[{"code":"0030U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.13,"maximum":627.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":201.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":134.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":558.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":627.39,"additional_payer_notes":"APC"}]}]},{"description":"Cyp1a2 gene","code_information":[{"code":"0031U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"Comt gene","code_information":[{"code":"0032U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"Tpmt nudt15 genes","code_information":[{"code":"0034U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.17,"maximum":2180.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":699.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":475.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1941.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2180.51,"additional_payer_notes":"APC"}]}]},{"description":"Neuro csf prion prtn qual","code_information":[{"code":"0035U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":540.99,"maximum":2530.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":811.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":551.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2252.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2530.48,"additional_payer_notes":"APC"}]}]},{"description":"Xome tum & nml spec seq alys","code_information":[{"code":"0036U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4780.0,"maximum":22358.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7170.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4875.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4780.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19904.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22358.45,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna 324 genes","code_information":[{"code":"0037U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":16371.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5250.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14574.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16371.25,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin d srm microsamp quan","code_information":[{"code":"0038U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.6,"maximum":138.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":123.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138.45,"additional_payer_notes":"APC"}]}]},{"description":"Dna antb 2strand hi avidity","code_information":[{"code":"0039U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.74,"maximum":64.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.27,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene major bp quan","code_information":[{"code":"0040U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":409.9,"maximum":1917.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":614.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":409.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1706.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1917.31,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi antb 5 prtn igm","code_information":[{"code":"0041U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.21,"maximum":80.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.5,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi antb 12 prtn igg","code_information":[{"code":"0042U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.21,"maximum":80.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.5,"additional_payer_notes":"APC"}]}]},{"description":"Tbrf b grp antb 4 prtn igm","code_information":[{"code":"0043U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.86,"maximum":69.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"}]}]},{"description":"Tbrf b grp antb 4 prtn igg","code_information":[{"code":"0044U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.86,"maximum":69.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69.51,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst dux carc is 12 gene","code_information":[{"code":"0045U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene itd variants quan","code_information":[{"code":"0046U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.43,"maximum":1905.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":611.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":415.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1696.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1905.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna 17 gene alg","code_information":[{"code":"0047U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld org neo dna 468 gene","code_information":[{"code":"0048U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Npm1 gene analysis quan","code_information":[{"code":"0049U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.43,"maximum":1905.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":611.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":415.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1696.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1905.75,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna 194 genes","code_information":[{"code":"0050U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2916.6,"maximum":13642.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4374.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2916.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12145.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13642.4,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr lc-ms/ms ur 31 pnl","code_information":[{"code":"0051U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":1154.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1028.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.97,"additional_payer_notes":"APC"}]}]},{"description":"Lpoprtn bld w/5 maj classes","code_information":[{"code":"0052U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.86,"maximum":158.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":141.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158.38,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 14+ drugs & sbsts","code_information":[{"code":"0054U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":929.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":298.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":827.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":929.61,"additional_payer_notes":"APC"}]}]},{"description":"Card hrt trnspl 96 dna seq","code_information":[{"code":"0055U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":15155.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4860.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13491.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15155.1,"additional_payer_notes":"APC"}]}]},{"description":"Onc merkel cll carc srm quan","code_information":[{"code":"0058U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":1510.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":484.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1344.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1510.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc merkel cll carc srm +/-","code_information":[{"code":"0059U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":1510.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":484.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1344.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1510.65,"additional_payer_notes":"APC"}]}]},{"description":"Twn zyg gen seq alys chrms2","code_information":[{"code":"0060U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":3550.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1138.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3160.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3550.46,"additional_payer_notes":"APC"}]}]},{"description":"Tc meas 5 bmrk sfdi m-s alys","code_information":[{"code":"0061U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.1,"maximum":117.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":104.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117.41,"additional_payer_notes":"APC"}]}]},{"description":"Ai sle igg&igm alys 80 bmrk","code_information":[{"code":"0062U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.72,"maximum":1780.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":571.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":388.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":380.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1585.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1780.82,"additional_payer_notes":"APC"}]}]},{"description":"Neuro autism 32 amines alg","code_information":[{"code":"0063U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":3508.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1125.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3123.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3508.12,"additional_payer_notes":"APC"}]}]},{"description":"Antb tp total&rpr ia qual","code_information":[{"code":"0064U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.33,"maximum":146.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":130.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":146.55,"additional_payer_notes":"APC"}]}]},{"description":"Syfls tst nontreponemal antb","code_information":[{"code":"0065U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.09,"maximum":84.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst imhchem prfl 4 bmrk","code_information":[{"code":"0067U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1897.0,"maximum":8873.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2845.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1934.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1897.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7899.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8873.22,"additional_payer_notes":"APC"}]}]},{"description":"Candida species pnl amp prb","code_information":[{"code":"0068U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":667.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":213.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":593.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct microrna mir-31-3p","code_information":[{"code":"0069U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.0,"maximum":1777.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":570.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":387.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":380.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1582.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1777.45,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen com&slct rar vrnt","code_information":[{"code":"0070U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.37,"maximum":3163.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1014.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":689.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":676.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2816.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3163.72,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 full gene sequence","code_information":[{"code":"0071U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":2806.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":900.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2498.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2806.5,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen cyp2d6-2d7 hybrid","code_information":[{"code":"0072U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":2109.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":676.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1877.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2109.13,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen cyp2d7-2d6 hybrid","code_information":[{"code":"0073U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":2109.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":676.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1877.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2109.13,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 nonduplicated gene","code_information":[{"code":"0074U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":2109.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":676.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1877.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2109.13,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 5' gene dup/mlt","code_information":[{"code":"0075U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":2109.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":676.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1877.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2109.13,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 3' gene dup/mlt","code_information":[{"code":"0076U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":2109.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":676.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1877.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2109.13,"additional_payer_notes":"APC"}]}]},{"description":"Ig paraprotein qual bld/ur","code_information":[{"code":"0077U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.43,"maximum":203.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":180.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng 5 clin rsk factr alg","code_information":[{"code":"0080U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3520.0,"maximum":16464.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5280.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3590.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3520.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14657.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16464.8,"additional_payer_notes":"APC"}]}]},{"description":"Rx test def 90+ rx/sbsts ur","code_information":[{"code":"0082U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":1154.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1028.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.97,"additional_payer_notes":"APC"}]}]},{"description":"Onc rspse chemo cntrst tomog","code_information":[{"code":"0083U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.35,"maximum":782.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":251.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":170.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":167.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":696.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":782.78,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gnotyp 10 bld groups","code_information":[{"code":"0084U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":3367.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1080.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2998.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3367.8,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng org id 6+","code_information":[{"code":"0086U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.0,"maximum":935.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":204.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":200.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":832.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":935.5,"additional_payer_notes":"APC"}]}]},{"description":"Crd hrt trnspl mrna 1283 gen","code_information":[{"code":"0087U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":14778.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4739.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13156.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14778.19,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj kdn algrft rej 1494","code_information":[{"code":"0088U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":14778.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4739.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13156.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14778.19,"additional_payer_notes":"APC"}]}]},{"description":"Onc mlnma prame & linc00518","code_information":[{"code":"0089U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 23 gene","code_information":[{"code":"0090U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":9121.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2925.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8120.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9121.12,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng 3 prtn bmrk plsm alg","code_information":[{"code":"0092U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2488.0,"maximum":11637.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3732.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2537.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2488.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10360.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11637.62,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 65 com drugs urine","code_information":[{"code":"0093U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":290.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":93.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":258.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":290.66,"additional_payer_notes":"APC"}]}]},{"description":"Genome rapid sequence alys","code_information":[{"code":"0094U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7582.2,"maximum":35465.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11373.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7733.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31573.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35465.74,"additional_payer_notes":"APC"}]}]},{"description":"Inflm ee elisa alys alg","code_information":[{"code":"0095U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.98,"maximum":3610.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1157.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":771.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3214.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3610.94,"additional_payer_notes":"APC"}]}]},{"description":"Hpv hi risk types male urine","code_information":[{"code":"0096U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca do 15 genes","code_information":[{"code":"0101U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1743.95,"maximum":8157.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2615.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1778.83,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1743.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7261.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8157.33,"additional_payer_notes":"APC"}]}]},{"description":"Hered brst ca rltd do 17 gen","code_information":[{"code":"0102U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":6099.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1955.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5429.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6099.23,"additional_payer_notes":"APC"}]}]},{"description":"Hered ova ca pnl 24 genes","code_information":[{"code":"0103U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1743.95,"maximum":8157.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2615.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1778.83,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1743.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7261.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8157.33,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd mult eclia tum nec","code_information":[{"code":"0105U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.0,"maximum":4443.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1425.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":969.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3955.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4443.62,"additional_payer_notes":"APC"}]}]},{"description":"Gstr emptg 7 timed brth spec","code_information":[{"code":"0106U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.49,"maximum":4090.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":874.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3641.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4090.43,"additional_payer_notes":"APC"}]}]},{"description":"C diff tox ag detcj ia stool","code_information":[{"code":"0107U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":74.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.84,"additional_payer_notes":"APC"}]}]},{"description":"Gi barrett esoph 9 prtn bmrk","code_information":[{"code":"0108U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4950.0,"maximum":23153.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7425.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5049.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4950.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20612.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23153.62,"additional_payer_notes":"APC"}]}]},{"description":"Id aspergillus dna 4 species","code_information":[{"code":"0109U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":667.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":213.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":593.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.15,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 1+oral onc rx&sbsts","code_information":[{"code":"0110U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":126.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc colon ca kras&nras alys","code_information":[{"code":"0111U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":682.29,"maximum":3191.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1023.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":695.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":682.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2841.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3191.41,"additional_payer_notes":"APC"}]}]},{"description":"Iadi 16s&18s rrna genes","code_information":[{"code":"0112U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.13,"maximum":1665.80,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":534.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":363.25,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":356.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1482.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1665.8,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 pca3&tmprss2-erg","code_information":[{"code":"0113U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Gi barretts esoph vim&ccna1","code_information":[{"code":"0114U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.01,"maximum":9065.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2907.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1976.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8070.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9065.04,"additional_payer_notes":"APC"}]}]},{"description":"Respir iadna 18 viral&2 bact","code_information":[{"code":"0115U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.35,"maximum":1287.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":413.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":275.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1146.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1287.95,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr nzm ia 35+oral flu","code_information":[{"code":"0116U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":1154.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1028.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.97,"additional_payer_notes":"APC"}]}]},{"description":"Pain mgmt 11 endogenous anal","code_information":[{"code":"0117U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":3932.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1260.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3500.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3932.14,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj don-drv cll-fr dna","code_information":[{"code":"0118U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.25,"maximum":12878.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4129.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11464.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12878.33,"additional_payer_notes":"APC"}]}]},{"description":"Crd ceramides liq chrom plsm","code_information":[{"code":"0119U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.76,"maximum":391.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":125.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":83.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":348.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":391.79,"additional_payer_notes":"APC"}]}]},{"description":"Onc b cll lymphm mrna 58 gen","code_information":[{"code":"0120U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.21,"maximum":11741.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3765.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2560.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10452.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11741.51,"additional_payer_notes":"APC"}]}]},{"description":"Sc dis vcam-1 whole blood","code_information":[{"code":"0121U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":509.2,"maximum":2381.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":763.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":519.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":509.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2120.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2381.78,"additional_payer_notes":"APC"}]}]},{"description":"Sc dis p-selectin whl blood","code_information":[{"code":"0122U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":526.23,"maximum":2461.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":789.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":536.75,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":526.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2191.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2461.44,"additional_payer_notes":"APC"}]}]},{"description":"Mchnl fragility rbc prflg","code_information":[{"code":"0123U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":357.63,"maximum":1672.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":536.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":357.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1489.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1672.81,"additional_payer_notes":"APC"}]}]},{"description":"Hered brst ca rltd do panel","code_information":[{"code":"0129U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":6099.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1955.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5429.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6099.23,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca do mrna pnl","code_information":[{"code":"0130U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":2735.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":877.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2435.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2735.87,"additional_payer_notes":"APC"}]}]},{"description":"Hered prst8 ca rltd do 11","code_information":[{"code":"0133U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":690.29,"maximum":3228.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1035.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":704.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":690.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2874.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3228.83,"additional_payer_notes":"APC"}]}]},{"description":"Hered pan ca mrna pnl 18 gen","code_information":[{"code":"0134U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":748.39,"maximum":3500.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1122.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":763.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":748.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3116.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3500.59,"additional_payer_notes":"APC"}]}]},{"description":"Atm mrna seq alys","code_information":[{"code":"0136U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.43,"maximum":1905.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":611.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":415.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1696.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1905.75,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 mrna seq alys","code_information":[{"code":"0137U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 brca2 mrna seq alys","code_information":[{"code":"0138U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":468.33,"maximum":2190.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":702.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":468.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1950.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2190.61,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds fungi dna 15 trgt","code_information":[{"code":"0140U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.75,"maximum":733.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":235.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":652.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":733.2,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng gram pos","code_information":[{"code":"0141U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.75,"maximum":733.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":235.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":652.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":733.2,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng gram neg","code_information":[{"code":"0142U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.75,"maximum":733.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":235.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":652.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":733.2,"additional_payer_notes":"APC"}]}]},{"description":"Nfct bct fng prst dna >1000","code_information":[{"code":"0152U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2126.2,"maximum":9945.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3189.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2168.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8853.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9945.3,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 101 genes","code_information":[{"code":"0153U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":14778.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4739.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13156.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14778.19,"additional_payer_notes":"APC"}]}]},{"description":"Fgfr3 gene analysis","code_information":[{"code":"0154U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":482.14,"maximum":2255.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":723.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":491.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":482.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2007.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2255.21,"additional_payer_notes":"APC"}]}]},{"description":"Pik3ca gene analysis","code_information":[{"code":"0155U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Copy number sequence alys","code_information":[{"code":"0156U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1740.0,"maximum":8138.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2610.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1774.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1740.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7245.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8138.85,"additional_payer_notes":"APC"}]}]},{"description":"Apc mrna seq alys","code_information":[{"code":"0157U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 mrna seq alys","code_information":[{"code":"0158U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 mrna seq alys","code_information":[{"code":"0159U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 mrna seq alys","code_information":[{"code":"0160U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 mrna seq alys","code_information":[{"code":"0161U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca trgt mrna pnl","code_information":[{"code":"0162U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":486.54,"maximum":2275.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":729.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":496.27,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":486.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2026.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2275.79,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibs ia anti-cdtb&vinculin","code_information":[{"code":"0164U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.02,"maximum":523.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":168.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":112.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":466.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":523.97,"additional_payer_notes":"APC"}]}]},{"description":"Peanut allg spec asmt 64 epi","code_information":[{"code":"0165U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":463.76,"maximum":2169.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":695.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":473.04,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":463.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1931.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2169.24,"additional_payer_notes":"APC"}]}]},{"description":"Liver ds 10 biochem asy srm","code_information":[{"code":"0166U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":2354.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":755.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2096.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2354.65,"additional_payer_notes":"APC"}]}]},{"description":"Nudt15&tpmt gene com vrnt","code_information":[{"code":"0169U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.17,"maximum":2180.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":699.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":475.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1941.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2180.51,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd rna next gen seq","code_information":[{"code":"0170U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":9121.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2925.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8120.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9121.12,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl dna 23","code_information":[{"code":"0171U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1519.06,"maximum":7105.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2278.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1549.44,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1519.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6325.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7105.4,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum alys brca1 brca2","code_information":[{"code":"0172U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3030.0,"maximum":14172.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4545.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3090.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3030.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12617.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14172.82,"additional_payer_notes":"APC"}]}]},{"description":"Psyc gen alys panel 14 genes","code_information":[{"code":"0173U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.17,"maximum":2180.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":699.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":475.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1941.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2180.51,"additional_payer_notes":"APC"}]}]},{"description":"Onc solid tumor 30 prtn trgt","code_information":[{"code":"0174U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.37,"maximum":6105.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1958.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1331.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1305.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5435.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6105.87,"additional_payer_notes":"APC"}]}]},{"description":"Psyc gen alys panel 15 genes","code_information":[{"code":"0175U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":6249.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2004.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5563.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6249.56,"additional_payer_notes":"APC"}]}]},{"description":"Cdtb&vinculin igg antb ia","code_information":[{"code":"0176U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.19,"maximum":300.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":267.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":300.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca dna pik3ca 11","code_information":[{"code":"0177U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Peanut allg asmt epi clin rx","code_information":[{"code":"0178U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":459.86,"maximum":2151.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":689.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":469.06,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":459.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1914.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2151.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc nonsm cll lng ca alys 23","code_information":[{"code":"0179U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1943.21,"maximum":9089.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2914.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1982.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1943.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8091.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9089.36,"additional_payer_notes":"APC"}]}]},{"description":"Abo gnotyp abo 7 exons","code_information":[{"code":"0180U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Co gnotyp aqp1 exon 1","code_information":[{"code":"0181U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Crom gnotyp cd55 exons 1-10","code_information":[{"code":"0182U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":1409.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":452.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1254.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1409.56,"additional_payer_notes":"APC"}]}]},{"description":"Di gnotyp slc4a1 exon 19","code_information":[{"code":"0183U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Do gnotyp art4 exon 2","code_information":[{"code":"0184U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Fut1 gnotyp fut1 exon 4","code_information":[{"code":"0185U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Fut2 gnotyp fut2 exon 2","code_information":[{"code":"0186U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Fy gnotyp ackr1 exons 1-2","code_information":[{"code":"0187U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Ge gnotyp gypc exons 1-4","code_information":[{"code":"0188U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Gypa gnotyp ntrns 1 5 exon 2","code_information":[{"code":"0189U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Gypb gnotyp ntrns 1 5 seux 3","code_information":[{"code":"0190U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"In gnotyp cd44 exons 2 3 6","code_information":[{"code":"0191U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Jk gnotyp slc14a1 exon 9","code_information":[{"code":"0192U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Jr gnotyp abcg2 exons 2-26","code_information":[{"code":"0193U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Kel gnotyp kel exon 8","code_information":[{"code":"0194U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Klf1 targeted sequencing","code_information":[{"code":"0195U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":1755.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":562.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1562.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1755.23,"additional_payer_notes":"APC"}]}]},{"description":"Lu gnotyp bcam exon 3","code_information":[{"code":"0196U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Lw gnotyp icam4 exon 1","code_information":[{"code":"0197U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Rhd&rhce gntyp rhd1-10&rhce5","code_information":[{"code":"0198U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Sc gnotyp ermap exons 4 12","code_information":[{"code":"0199U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Xk gnotyp xk exons 1-3","code_information":[{"code":"0200U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Yt gnotyp ache exon 2","code_information":[{"code":"0201U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds 22 trgt sars-cov-2","code_information":[{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Ai ibd mrna xprsn prfl 17","code_information":[{"code":"0203U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Oph amd alys 3 gene variants","code_information":[{"code":"0205U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.0,"maximum":219.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":47.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":195.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":219.84,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alzheimer cell aggregj","code_information":[{"code":"0206U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2215.4,"maximum":10362.53,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3323.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2259.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2215.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9225.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10362.53,"additional_payer_notes":"APC"}]}]},{"description":"Cytog const alys interrog","code_information":[{"code":"0209U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":787.15,"maximum":3681.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":787.15,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3681.89,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis tst antb ia quan","code_information":[{"code":"0210U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.63,"maximum":87.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan-tum dna&rna gnrj seq","code_information":[{"code":"0211U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8455.0,"maximum":39548.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12682.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8624.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8455.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35207.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39548.26,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds gen dna alys proband","code_information":[{"code":"0212U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5475.2,"maximum":25610.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8212.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5584.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5475.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22799.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25610.25,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds gen dna alys ea comp","code_information":[{"code":"0213U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2709.95,"maximum":12675.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4064.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2764.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2709.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11284.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12675.79,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds xom dna alys proband","code_information":[{"code":"0214U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5224.6,"maximum":24438.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7836.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5329.09,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5224.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21755.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24438.07,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds xom dna alys ea comp","code_information":[{"code":"0215U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2574.65,"maximum":12042.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3861.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2626.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2574.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10721.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12042.93,"additional_payer_notes":"APC"}]}]},{"description":"Neuro inh ataxia dna 12 com","code_information":[{"code":"0216U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1537.02,"maximum":7189.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2305.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1567.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1537.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6400.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7189.41,"additional_payer_notes":"APC"}]}]},{"description":"Neuro inh ataxia dna 51 gene","code_information":[{"code":"0217U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2198.35,"maximum":10282.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3297.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2242.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2198.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9154.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10282.78,"additional_payer_notes":"APC"}]}]},{"description":"Neuro musc dys dmd seq alys","code_information":[{"code":"0218U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2279.0,"maximum":10660.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3418.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2324.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2279.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9489.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10660.02,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt hiv gnrj seq alys","code_information":[{"code":"0219U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":725.0,"maximum":3391.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1087.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":725.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3018.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3391.19,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca ai assmt 12 feat","code_information":[{"code":"0220U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":3303.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1059.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2940.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3303.48,"additional_payer_notes":"APC"}]}]},{"description":"Abo gnotyp next gnrj seq abo","code_information":[{"code":"0221U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Rhd&rhce gntyp next gnrj seq","code_information":[{"code":"0222U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds 22 trgt sars-cov-2","code_information":[{"code":"0223U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Antibody sars-cov-2 titer(s)","code_information":[{"code":"0224U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.43,"maximum":240.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":214.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":240.56,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds dna&rna 21 sarscov2","code_information":[{"code":"0225U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Svnt sarscov2 elisa plsm srm","code_information":[{"code":"0226U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.28,"maximum":197.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":176.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"}]}]},{"description":"Rx asy prsmv 30+rx/metablt","code_information":[{"code":"0227U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":290.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":93.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":258.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":290.66,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ma molec prfl alg","code_information":[{"code":"0228U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.03,"maximum":809.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":259.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":173.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":720.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":809.35,"additional_payer_notes":"APC"}]}]},{"description":"Bcat1 promoter mthyltn alys","code_information":[{"code":"0229U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":384.0,"maximum":1796.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":576.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":391.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":384.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1599.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1796.16,"additional_payer_notes":"APC"}]}]},{"description":"Ar full sequence analysis","code_information":[{"code":"0230U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":1409.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":452.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1254.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1409.56,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a full gene analysis","code_information":[{"code":"0231U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.27,"maximum":3958.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1269.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":863.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3523.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3958.43,"additional_payer_notes":"APC"}]}]},{"description":"Cstb full gene analysis","code_information":[{"code":"0232U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene analysis","code_information":[{"code":"0233U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 full gene analysis","code_information":[{"code":"0234U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":527.87,"maximum":2469.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":791.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":538.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":527.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2198.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2469.11,"additional_payer_notes":"APC"}]}]},{"description":"Pten full gene analysis","code_information":[{"code":"0235U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":2806.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":900.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2498.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2806.5,"additional_payer_notes":"APC"}]}]},{"description":"Smn1&smn2 full gene analysis","code_information":[{"code":"0236U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":602.7,"maximum":2819.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":904.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":614.75,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":602.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2509.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2819.13,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnlpthy gen seq pnl","code_information":[{"code":"0237U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":2735.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":877.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2435.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2735.87,"additional_payer_notes":"APC"}]}]},{"description":"Onc lnch syn gen dna seq aly","code_information":[{"code":"0238U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":2735.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":877.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2435.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2735.87,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl 311+","code_information":[{"code":"0239U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":16371.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5250.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14574.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16371.25,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl 55-74","code_information":[{"code":"0242U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5000.0,"maximum":23387.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7500.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5000.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20820.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23387.5,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe biochem assay pgf alg","code_information":[{"code":"0243U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":301.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":268.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":301.28,"additional_payer_notes":"APC"}]}]},{"description":"Onc solid orgn dna 257 genes","code_information":[{"code":"0244U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":16371.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5250.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14574.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16371.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr mut alys 10 gen&37","code_information":[{"code":"0245U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1266.07,"maximum":5922.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1899.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1291.39,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1266.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5272.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5922.04,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gnotyp 16 bld groups","code_information":[{"code":"0246U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":3367.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1080.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2998.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3367.8,"additional_payer_notes":"APC"}]}]},{"description":"Ob prtrm brth ibp4 shbg meas","code_information":[{"code":"0247U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":3508.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1125.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3123.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3508.12,"additional_payer_notes":"APC"}]}]},{"description":"Onc brn sphrd cll 12 rx pnl","code_information":[{"code":"0248U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":14190.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4550.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12633.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14190.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst alys 32 phsprtn alg","code_information":[{"code":"0249U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2219.13,"maximum":10379.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3328.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2263.51,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2219.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9240.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10379.98,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld org neo dna 505 gene","code_information":[{"code":"0250U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Hepcidin-25 elisa serum/plsm","code_information":[{"code":"0251U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Ftl aneuploidy str alys dna","code_information":[{"code":"0252U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":3550.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1138.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3160.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3550.46,"additional_payer_notes":"APC"}]}]},{"description":"Rprdtve med rna gen prfl 238","code_information":[{"code":"0253U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":14778.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4739.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13156.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14778.19,"additional_payer_notes":"APC"}]}]},{"description":"Reprdtve med alys 24 chrmsm","code_information":[{"code":"0254U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":3550.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1138.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3160.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3550.46,"additional_payer_notes":"APC"}]}]},{"description":"Andrology infertility assmt","code_information":[{"code":"0255U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.6,"maximum":147.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147.81,"additional_payer_notes":"APC"}]}]},{"description":"Tma/tmao prfl ms/ms ur alg","code_information":[{"code":"0256U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.95,"maximum":748.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":239.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":159.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":666.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":748.17,"additional_payer_notes":"APC"}]}]},{"description":"Vlcad leuk nzm actv whl bld","code_information":[{"code":"0257U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.47,"maximum":3332.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1068.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":726.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":712.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2966.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3332.58,"additional_payer_notes":"APC"}]}]},{"description":"Ai psor mrna 50-100 gen alg","code_information":[{"code":"0258U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3675.0,"maximum":17189.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5512.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3748.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15303.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17189.81,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd nuc mrs meas gfr","code_information":[{"code":"0259U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.71,"maximum":246.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":52.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":219.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":246.55,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds id opt genome mapg","code_information":[{"code":"0260U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":5910.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1895.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5261.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5910.16,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca img alys w/ai","code_information":[{"code":"0261U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2513.25,"maximum":11755.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3769.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2563.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2513.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10465.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11755.73,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum rt-pcr 7 gen","code_information":[{"code":"0262U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3200.0,"maximum":14968.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4800.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3264.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3200.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13325.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14968.0,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd meas 16 c metblt","code_information":[{"code":"0263U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":3508.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1125.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3123.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3508.12,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds id opt genome mapg","code_information":[{"code":"0264U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":5910.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1895.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5261.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5910.16,"additional_payer_notes":"APC"}]}]},{"description":"Rar do whl gn&mtcdrl dna als","code_information":[{"code":"0265U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5475.8,"maximum":25613.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8213.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5585.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5475.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22801.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25613.05,"additional_payer_notes":"APC"}]}]},{"description":"Unxpl cnst hrtbl do gn xprsn","code_information":[{"code":"0266U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3200.0,"maximum":14968.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4800.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3264.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3200.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13325.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14968.0,"additional_payer_notes":"APC"}]}]},{"description":"Rare do id opt gen mapg&seq","code_information":[{"code":"0267U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6739.33,"maximum":31523.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10108.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6739.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28063.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31523.22,"additional_payer_notes":"APC"}]}]},{"description":"Hem ahus gen seq alys 15 gen","code_information":[{"code":"0268U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":2844.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":912.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2532.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.72,"additional_payer_notes":"APC"}]}]},{"description":"Hem aut dm cgen trmbctpna 14","code_information":[{"code":"0269U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":2844.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":912.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2532.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.72,"additional_payer_notes":"APC"}]}]},{"description":"Hem cgen coagj do 20 genes","code_information":[{"code":"0270U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":2844.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":912.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2532.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.72,"additional_payer_notes":"APC"}]}]},{"description":"Hem cgen neutropenia 23 gen","code_information":[{"code":"0271U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":2844.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":912.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2532.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.72,"additional_payer_notes":"APC"}]}]},{"description":"Hem genetic bld do 51 genes","code_information":[{"code":"0272U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":2844.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":912.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2532.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.72,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen hyprfibrnlysis 8 gen","code_information":[{"code":"0273U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":2844.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":912.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2532.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.72,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen pltlt do 43 genes","code_information":[{"code":"0274U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":2844.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":912.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2532.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.72,"additional_payer_notes":"APC"}]}]},{"description":"Hem heprn nduc trmbctpna srm","code_information":[{"code":"0275U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.37,"maximum":85.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85.93,"additional_payer_notes":"APC"}]}]},{"description":"Hem inh thrombocytopenia 23","code_information":[{"code":"0276U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":11453.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3672.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10196.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11453.14,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen pltlt funcj do 31","code_information":[{"code":"0277U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":2844.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":912.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2532.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.72,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen thrombosis 12 genes","code_information":[{"code":"0278U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":2844.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":912.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2532.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2844.72,"additional_payer_notes":"APC"}]}]},{"description":"Hem vw factor&clgn iii bndg","code_information":[{"code":"0279U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":53.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"}]}]},{"description":"Hem vw factor&clgn iv bndg","code_information":[{"code":"0280U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Hem vwd propeptide ag lvl","code_information":[{"code":"0281U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gntyp 12 bld grp gen","code_information":[{"code":"0282U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":3367.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1080.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2998.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3367.8,"additional_payer_notes":"APC"}]}]},{"description":"Vw factor type 2b eval plsm","code_information":[{"code":"0283U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":86.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.07,"additional_payer_notes":"APC"}]}]},{"description":"Vw factor type 2n eval plsm","code_information":[{"code":"0284U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Onc rsps radj cll fr dna tox","code_information":[{"code":"0285U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.31,"maximum":2073.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":664.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":452.18,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":443.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1845.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2073.58,"additional_payer_notes":"APC"}]}]},{"description":"Cep72 nudt15&tpmt gene alys","code_information":[{"code":"0286U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.13,"maximum":627.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":201.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":134.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":558.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":627.39,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr dna&mrna 112 genes","code_information":[{"code":"0287U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":16839.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5400.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14990.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16839.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung mrna quan pcr 11&3","code_information":[{"code":"0288U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alzheimer mrna 24 gen","code_information":[{"code":"0289U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Pain mgmt mrna gen xprsn 36","code_information":[{"code":"0290U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Psyc mood do mrna 144 genes","code_information":[{"code":"0291U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.0,"maximum":8209.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2632.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7308.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8209.01,"additional_payer_notes":"APC"}]}]},{"description":"Psyc strs do mrna 72 genes","code_information":[{"code":"0292U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.0,"maximum":8209.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2632.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7308.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8209.01,"additional_payer_notes":"APC"}]}]},{"description":"Psyc suicidal idea mrna 54","code_information":[{"code":"0293U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst dux carc 7 proteins","code_information":[{"code":"0295U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5435.0,"maximum":25422.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8152.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5543.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5435.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22631.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25422.21,"additional_payer_notes":"APC"}]}]},{"description":"Onc orl&/orop ca 20 mlc feat","code_information":[{"code":"0296U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":9121.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2925.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8120.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9121.12,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen seq dna","code_information":[{"code":"0297U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl trns seq rna","code_information":[{"code":"0298U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen opt mapg","code_information":[{"code":"0299U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1863.22,"maximum":8715.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2794.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1900.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1863.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7758.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8715.21,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen seq&opt","code_information":[{"code":"0300U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4183.13,"maximum":19566.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6274.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4266.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4183.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17418.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19566.59,"additional_payer_notes":"APC"}]}]},{"description":"Iadna bartonella ddpcr","code_information":[{"code":"0301U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.72,"maximum":1228.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":394.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":262.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1093.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1228.87,"additional_payer_notes":"APC"}]}]},{"description":"Iadna brtnla ddpcr flwg liq","code_information":[{"code":"0302U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.37,"maximum":1690.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":542.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":361.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1504.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1690.31,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc ads whl bld hypoxic","code_information":[{"code":"0303U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2201.62,"maximum":10298.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3302.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2245.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2201.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9167.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10298.08,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc ads whl bld normoxic","code_information":[{"code":"0304U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2075.8,"maximum":9709.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3113.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2117.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2075.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8643.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9709.55,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc fnclty&dfrm shr strs","code_information":[{"code":"0305U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":662.58,"maximum":3099.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":993.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":675.83,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":662.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2759.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3099.22,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd nxt-gnrj alys 1st","code_information":[{"code":"0306U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3878.45,"maximum":18141.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5817.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3956.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3878.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16150.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18141.45,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd nxt-gnrj alys sbsq","code_information":[{"code":"0307U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":794.49,"maximum":3716.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1191.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":810.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":794.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3308.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3716.23,"additional_payer_notes":"APC"}]}]},{"description":"Crd cad alys 3 prtn plsm alg","code_information":[{"code":"0308U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":1827.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":586.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1627.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1827.73,"additional_payer_notes":"APC"}]}]},{"description":"Crd cv ds aly 4 prtn plm alg","code_information":[{"code":"0309U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":1827.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":586.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1627.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1827.73,"additional_payer_notes":"APC"}]}]},{"description":"Ped vsclts kd alys 3 bmrks","code_information":[{"code":"0310U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":1827.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":586.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1627.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1827.73,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct quan antmcrb sc","code_information":[{"code":"0311U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.08,"maximum":37.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.79,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 8 igg autoant","code_information":[{"code":"0312U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":3932.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1260.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3500.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3932.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrs dna&mrna seq 74","code_information":[{"code":"0313U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":16839.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5400.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14990.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16839.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 35 gene","code_information":[{"code":"0314U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":9121.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2925.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8120.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9121.12,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan sq cll ca mrna 40","code_information":[{"code":"0315U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8500.0,"maximum":39758.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12750.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8500.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35394.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39758.75,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi lyme ds ospa evl","code_information":[{"code":"0316U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.66,"maximum":87.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.28,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung ca 4-prb fish assay","code_information":[{"code":"0317U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2030.0,"maximum":9495.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3045.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2070.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2030.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8453.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9495.33,"additional_payer_notes":"APC"}]}]},{"description":"Ped whl gen mthyltn alys 50+","code_information":[{"code":"0318U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1770.48,"maximum":8281.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2655.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1805.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1770.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7372.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8281.42,"additional_payer_notes":"APC"}]}]},{"description":"Neph rna pretrnspl perph bld","code_information":[{"code":"0319U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2650.0,"maximum":12395.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3975.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2703.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2650.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11034.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12395.38,"additional_payer_notes":"APC"}]}]},{"description":"Neph rna psttrnspl perph bld","code_information":[{"code":"0320U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2650.0,"maximum":12395.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3975.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2703.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2650.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11034.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12395.38,"additional_payer_notes":"APC"}]}]},{"description":"Iadna gu pthgn 20bct&fng org","code_information":[{"code":"0321U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.84,"maximum":2969.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":952.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":647.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2643.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2969.46,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd meas 14 acyl carn","code_information":[{"code":"0322U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":3508.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1125.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3123.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3508.12,"additional_payer_notes":"APC"}]}]},{"description":"Iadna cns pthgn next gen seq","code_information":[{"code":"0323U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2126.2,"maximum":9945.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3189.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2168.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8853.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9945.3,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay 120+ rx&metablt","code_information":[{"code":"0328U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":535.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":171.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":476.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":535.25,"additional_payer_notes":"APC"}]}]},{"description":"Iadna vag pthgn panel 27 org","code_information":[{"code":"0330U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum gen prflg 8 dna","code_information":[{"code":"0332U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1142.06,"maximum":5341.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1713.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1164.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1142.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4755.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5341.99,"additional_payer_notes":"APC"}]}]},{"description":"Onc lvr surveilanc hcc cfdna","code_information":[{"code":"0333U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":662.32,"maximum":3098.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":993.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":675.57,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":662.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2757.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3098.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld orgn tgsa dna 84/+","code_information":[{"code":"0334U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":16371.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5250.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14574.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16371.25,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq fetal","code_information":[{"code":"0335U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5224.6,"maximum":24438.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7836.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5329.09,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5224.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21755.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24438.07,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq bld/slv","code_information":[{"code":"0336U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2574.65,"maximum":12042.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3861.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2626.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2574.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10721.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12042.93,"additional_payer_notes":"APC"}]}]},{"description":"Onc plsm cell do&myeloma id","code_information":[{"code":"0337U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":11389.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3652.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10139.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11389.71,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum crcg tum cl slct","code_information":[{"code":"0338U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":11389.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3652.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10139.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11389.71,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna hoxc6 & dlx1","code_information":[{"code":"0339U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan ca alys mrd plasma","code_information":[{"code":"0340U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3590.0,"maximum":16792.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5385.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3661.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3590.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14949.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16792.23,"additional_payer_notes":"APC"}]}]},{"description":"Ftl aneup dna seq cmpr alys","code_information":[{"code":"0341U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1900.2,"maximum":8888.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1938.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1900.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7912.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8888.19,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 xom aly 442 sncrna","code_information":[{"code":"0343U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Hep nafld semiq evl 28 lipid","code_information":[{"code":"0344U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.17,"maximum":3705.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1188.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":808.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":792.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3298.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3705.38,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genom alys pnl 15 gen","code_information":[{"code":"0345U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":6249.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2004.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5563.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6249.56,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 16 gen alys","code_information":[{"code":"0347U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":6249.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2004.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5563.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6249.56,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 25 gen alys","code_information":[{"code":"0348U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.27,"maximum":3471.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1113.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":757.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3090.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3471.97,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 27gen rx ia","code_information":[{"code":"0349U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.27,"maximum":3471.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1113.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":757.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3090.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3471.97,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 27 gen alys","code_information":[{"code":"0350U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":6249.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2004.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5563.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6249.56,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct/viral trail ip10","code_information":[{"code":"0351U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":1218.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1084.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1218.49,"additional_payer_notes":"APC"}]}]},{"description":"Apol1 risk variants","code_information":[{"code":"0355U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Onc orop 17 dna ddpcr alg","code_information":[{"code":"0356U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1800.0,"maximum":8419.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2700.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1836.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1800.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7495.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8419.5,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alys b-amyl 1-42&1-40","code_information":[{"code":"0358U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":1218.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1084.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1218.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca alys all psa","code_information":[{"code":"0359U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung elisa 7 autoant alg","code_information":[{"code":"0360U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":3932.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1260.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3500.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3932.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc pap thyr ca rna 82&10","code_information":[{"code":"0362U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":16839.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5400.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14990.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16839.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl mrna 5 gen alg","code_information":[{"code":"0363U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo gen seq alys alg","code_information":[{"code":"0364U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2007.25,"maximum":9388.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3010.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2047.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2007.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8358.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9388.91,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 prb bldr ca","code_information":[{"code":"0365U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":4195.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1345.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3735.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4195.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 prb recr bldr ca","code_information":[{"code":"0366U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":4195.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1345.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3735.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4195.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 flwg trurl rescj","code_information":[{"code":"0367U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":902.18,"maximum":4219.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1353.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":920.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":902.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3756.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4219.95,"additional_payer_notes":"APC"}]}]},{"description":"Iadna gu pthgn semiq dna16&1","code_information":[{"code":"0371U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds gu pthgn arg detcj","code_information":[{"code":"0372U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovrn bchm asy 7 prtn alg","code_information":[{"code":"0375U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":4195.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1345.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3735.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4195.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca img alys 128","code_information":[{"code":"0376U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":3303.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1059.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2940.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3303.48,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds quan advsrm/plsm lprtn","code_information":[{"code":"0377U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.58,"maximum":222.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":47.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":198.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"APC"}]}]},{"description":"Rfc1 repeat xpnsj vrnt alys","code_information":[{"code":"0378U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap sl or neo dna523&rna55","code_information":[{"code":"0379U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3288.51,"maximum":15382.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4932.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3354.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13693.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15382.01,"additional_payer_notes":"APC"}]}]},{"description":"Maple syrup ur ds mntr quan","code_information":[{"code":"0381U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.12,"maximum":206.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":44.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":183.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":206.37,"additional_payer_notes":"APC"}]}]},{"description":"Hyprphenylalninmia mntr quan","code_information":[{"code":"0382U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.64,"maximum":241.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":215.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":241.55,"additional_payer_notes":"APC"}]}]},{"description":"Tyrosinemia typ i mntr quan","code_information":[{"code":"0383U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.05,"maximum":243.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.09,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":52.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":216.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":243.46,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd rsk hi stg kdn ds","code_information":[{"code":"0384U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":3508.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1125.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3123.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3508.12,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd alg rsk dbtc kdn ds","code_information":[{"code":"0385U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":1827.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":586.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1627.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1827.73,"additional_payer_notes":"APC"}]}]},{"description":"Onc mlnma ambra1&amlo","code_information":[{"code":"0387U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":948.5,"maximum":4436.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1422.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":967.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":948.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3949.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4436.61,"additional_payer_notes":"APC"}]}]},{"description":"Onc nonsm cll lng ca 37 gen","code_information":[{"code":"0388U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":16371.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5250.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14574.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16371.25,"additional_payer_notes":"APC"}]}]},{"description":"Ped fbrl kd ifi27&mcemp1 rna","code_information":[{"code":"0389U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":328.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":292.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":328.36,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe kdr eng&rbp4 ia alg","code_information":[{"code":"0390U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":301.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":268.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":301.28,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum dna&rna 437 gen","code_information":[{"code":"0391U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":16839.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5400.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14990.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16839.0,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab genrx ia 16 genes","code_information":[{"code":"0392U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":6249.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2004.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5563.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6249.56,"additional_payer_notes":"APC"}]}]},{"description":"Neu prksn msfl ?-syncln prtn","code_information":[{"code":"0393U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":540.99,"maximum":2530.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":811.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":551.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2252.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2530.48,"additional_payer_notes":"APC"}]}]},{"description":"Pfas 16 pfas compnd lc ms/ms","code_information":[{"code":"0394U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":929.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":298.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":827.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":929.61,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng multiomics plsm alg","code_information":[{"code":"0395U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":797.45,"maximum":3730.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1196.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":813.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":797.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3320.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3730.07,"additional_payer_notes":"APC"}]}]},{"description":"Gi baret esph dna mthyln aly","code_information":[{"code":"0398U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.0,"maximum":8209.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2632.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7308.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8209.01,"additional_payer_notes":"APC"}]}]},{"description":"Neuro cere folate defncy srm","code_information":[{"code":"0399U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":1403.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":450.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1249.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1403.25,"additional_payer_notes":"APC"}]}]},{"description":"Crd c hrt ds 9 gen 12 vrnts","code_information":[{"code":"0401U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":489.68,"maximum":2290.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":734.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":499.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":489.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2039.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2290.48,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt sti mult amp prb tq","code_information":[{"code":"0402U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":667.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":213.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":593.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna 18 gen dre ur","code_information":[{"code":"0403U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst semiq meas thym kn","code_information":[{"code":"0404U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":1510.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":484.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1344.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1510.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc 59 mthltn blk mrk","code_information":[{"code":"0405U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1770.48,"maximum":8281.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2655.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1805.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1770.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7372.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8281.42,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung flow cytmtry 5 mrk","code_information":[{"code":"0406U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Neph dbtc ckd mult eclia alg","code_information":[{"code":"0407U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.0,"maximum":4443.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1425.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":969.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3955.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4443.62,"additional_payer_notes":"APC"}]}]},{"description":"Iaad blk ac wv bsnsr sarscv2","code_information":[{"code":"0408U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.13,"maximum":66.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.09,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum dna 80 & rna 36","code_information":[{"code":"0409U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc dna whl gn seq 5-","code_information":[{"code":"0410U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":5425.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1740.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4830.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5425.9,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genom alys pnl 15 gen","code_information":[{"code":"0411U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":6249.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2004.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5563.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6249.56,"additional_payer_notes":"APC"}]}]},{"description":"Beta amyloid a?42/40 imprcip","code_information":[{"code":"0412U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":3508.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1125.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3123.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3508.12,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo opt gen mapg dna","code_information":[{"code":"0413U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":5910.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1895.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5261.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5910.16,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng aug alg aly whl sld8","code_information":[{"code":"0414U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":3303.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1059.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2940.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3303.48,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds acs bld alg 5 yr score","code_information":[{"code":"0415U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":1827.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":586.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1627.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1827.73,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds alys 335 nuc genes","code_information":[{"code":"0417U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2842.53,"maximum":13295.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4263.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2899.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2842.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11836.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13295.93,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst aug alg aly whl sl8","code_information":[{"code":"0418U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":3303.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1059.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2940.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3303.48,"additional_payer_notes":"APC"}]}]},{"description":"Nrpsyc gen seq vrnt aly 13","code_information":[{"code":"0419U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":6249.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2004.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5563.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6249.56,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl mrna xprsn 6 snp","code_information":[{"code":"0420U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1328.32,"maximum":6213.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1992.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1354.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1328.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5531.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6213.22,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan solid tum alys dna","code_information":[{"code":"0422U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1943.21,"maximum":9089.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2914.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1982.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1943.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8091.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9089.36,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genomic alys pnl 26 gen","code_information":[{"code":"0423U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 xom alys 53 sncrna","code_information":[{"code":"0424U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Genom rpd seq alys ea cmprtr","code_information":[{"code":"0425U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4094.39,"maximum":19151.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6141.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4176.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4094.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17049.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19151.51,"additional_payer_notes":"APC"}]}]},{"description":"Genome ultra-rapid seq alys","code_information":[{"code":"0426U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7582.2,"maximum":35465.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11373.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7733.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31573.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35465.74,"additional_payer_notes":"APC"}]}]},{"description":"Monocyte dstrbj wdth whl bld","code_information":[{"code":"0427U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.48,"maximum":20.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"}]}]},{"description":"Hpv orop swab 14 hi-risk typ","code_information":[{"code":"0429U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Gi malabs aat calpro pncrtc","code_information":[{"code":"0430U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.54,"maximum":287.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":61.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":256.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":287.85,"additional_payer_notes":"APC"}]}]},{"description":"Gly rcptr alpha1 igg srm/csf","code_information":[{"code":"0431U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.57,"maximum":171.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":152.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171.06,"additional_payer_notes":"APC"}]}]},{"description":"Klhl11 antb sr/csf asy qual","code_information":[{"code":"0432U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.57,"maximum":171.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":152.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171.06,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 5 dna reg mrk pcr","code_information":[{"code":"0433U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs vrnt alys 25","code_information":[{"code":"0434U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc chemo rx cytox csc 14 rx","code_information":[{"code":"0435U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":14190.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4550.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12633.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14190.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng plsm alys 388 prtn","code_information":[{"code":"0436U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.24,"maximum":7036.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2256.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1534.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1504.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6263.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7036.08,"additional_payer_notes":"APC"}]}]},{"description":"Psyc anxiety do mrna 15 bmrk","code_information":[{"code":"0437U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs vrnt alys 33","code_information":[{"code":"0438U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Crd chd dna alys 5 snp 3 dna","code_information":[{"code":"0439U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":854.0,"maximum":3994.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1281.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":871.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":854.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3556.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3994.58,"additional_payer_notes":"APC"}]}]},{"description":"Crd chd dna alys 10 snp 6dna","code_information":[{"code":"0440U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":854.0,"maximum":3994.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1281.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":871.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":854.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3556.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3994.58,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct fngl/viral semiq","code_information":[{"code":"0441U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":444.08,"maximum":2077.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":666.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":452.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":444.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1849.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2077.18,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds respir nfctj mxa&crp","code_information":[{"code":"0442U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.38,"maximum":193.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":172.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":193.55,"additional_payer_notes":"APC"}]}]},{"description":"Neurflmnt lt chn ultrsens ia","code_information":[{"code":"0443U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":543.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":483.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":543.67,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld orgn neo tgsap 361","code_information":[{"code":"0444U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Abeta42 & ptau181 eclia csf","code_information":[{"code":"0445U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":1218.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1084.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1218.49,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 10 cytokine","code_information":[{"code":"0446U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":3932.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1260.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3500.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3932.14,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 11 cytokine","code_information":[{"code":"0447U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":3932.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1260.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3500.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3932.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr mthyl penk lte-qmsp","code_information":[{"code":"0452U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":898.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":288.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":799.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":898.08,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca cfdna qpcr asy","code_information":[{"code":"0453U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":898.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":288.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":799.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":898.08,"additional_payer_notes":"APC"}]}]},{"description":"U rare ds id opt genome mapg","code_information":[{"code":"0454U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":5910.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1895.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5261.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5910.16,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt sti mult amp prb ur","code_information":[{"code":"0455U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":667.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":213.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":593.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.15,"additional_payer_notes":"APC"}]}]},{"description":"Pfas 9 cmpnd lcms/ms pls/sr","code_information":[{"code":"0457U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":929.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":298.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":827.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":929.61,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca s100 a8&a9 elisa","code_information":[{"code":"0458U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":1218.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1084.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1218.49,"additional_payer_notes":"APC"}]}]},{"description":"Abeta42 & ttau eclia csf","code_information":[{"code":"0459U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":1218.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1084.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1218.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc whl bld/bucc rtpcr 24gen","code_information":[{"code":"0460U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":917.08,"maximum":4289.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1375.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":935.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3818.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4289.64,"additional_payer_notes":"APC"}]}]},{"description":"Onc rxgenom alys rtpcr 24gen","code_information":[{"code":"0461U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":917.08,"maximum":4289.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1375.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":935.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3818.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4289.64,"additional_payer_notes":"APC"}]}]},{"description":"Melatonin lvl tst slp std7/9","code_information":[{"code":"0462U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Onc crvx mrna genxprsn 14bmk","code_information":[{"code":"0463U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct scr qrtsa dna mrk","code_information":[{"code":"0464U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":591.92,"maximum":2768.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":887.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":603.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":591.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2464.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2768.71,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl carc dna qmsp 2gen","code_information":[{"code":"0465U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.01,"maximum":9065.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2907.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1976.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8070.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9065.04,"additional_payer_notes":"APC"}]}]},{"description":"Crd cad dna gwas 564856 snp","code_information":[{"code":"0466U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":345.43,"maximum":1615.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":518.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":352.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":345.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1438.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1615.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr dna ngs 60gen&aneup","code_information":[{"code":"0467U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1519.06,"maximum":7105.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2278.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1549.44,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1519.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6325.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7105.4,"additional_payer_notes":"APC"}]}]},{"description":"Hep nash mir34a5p ?2m ykl40","code_information":[{"code":"0468U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.7,"maximum":1177.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":377.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.73,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":251.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1048.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1177.33,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq ftl samp","code_information":[{"code":"0469U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1197.94,"maximum":5603.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1796.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1221.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1197.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4988.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5603.36,"additional_payer_notes":"APC"}]}]},{"description":"Onc orop detcj mrd 8 dna hpv","code_information":[{"code":"0470U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":2796.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":896.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2489.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2796.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrc ca 35 vrn kras&nras","code_information":[{"code":"0471U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Ca vi psp&sp1 antb sj?gren","code_information":[{"code":"0472U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.9,"maximum":130.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":116.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum bld/slv 648 gene","code_information":[{"code":"0473U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4500.0,"maximum":21048.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6750.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4590.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4500.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18738.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21048.75,"additional_payer_notes":"APC"}]}]},{"description":"Hered pan ca gsap 88gene ngs","code_information":[{"code":"0474U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":6099.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1955.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5429.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6099.23,"additional_payer_notes":"APC"}]}]},{"description":"Hered prst8 ca gsap 23 genes","code_information":[{"code":"0475U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":6099.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1955.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5429.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6099.23,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab psyc 14gen&cyp2d6","code_information":[{"code":"0476U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab psy 14&cyp2d6 gn-rx","code_information":[{"code":"0477U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc nsclc dna&rna dpcr 9 gen","code_information":[{"code":"0478U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":552.99,"maximum":2586.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":829.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":564.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":552.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2302.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2586.61,"additional_payer_notes":"APC"}]}]},{"description":"Tau phosphorylated ptau217","code_information":[{"code":"0479U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds csf metag ngs alys","code_information":[{"code":"0480U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2126.2,"maximum":9945.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3189.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2168.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8853.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9945.3,"additional_payer_notes":"APC"}]}]},{"description":"Idh1 idh2&tert promoter ngs","code_information":[{"code":"0481U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.24,"maximum":3153.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1011.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":687.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":674.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2807.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3153.76,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe biochem asy sfit1&pigf","code_information":[{"code":"0482U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.82,"maximum":602.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":193.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":128.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":536.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":602.56,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds ng gyra s91f pt mut","code_information":[{"code":"0483U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds mgen 23s rrna pt mut","code_information":[{"code":"0484U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum cfdna&rna ngs gm","code_information":[{"code":"0485U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3649.48,"maximum":17070.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5474.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3722.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3649.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15196.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17070.44,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan sol tum ngs cfctdna","code_information":[{"code":"0486U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1644.25,"maximum":7690.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2466.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1677.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1644.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6846.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7690.98,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum cfcdna tgsap 84","code_information":[{"code":"0487U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan/uveal mlnma cd146","code_information":[{"code":"0490U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":11389.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3652.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10139.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11389.71,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ctc slct er prtn","code_information":[{"code":"0491U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":11389.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3652.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10139.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11389.71,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ctc slctn pd-l1","code_information":[{"code":"0492U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":11389.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3652.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10139.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11389.71,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl med quan dd-cfdna ngs","code_information":[{"code":"0493U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.25,"maximum":12878.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4129.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11464.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12878.33,"additional_payer_notes":"APC"}]}]},{"description":"Rbc ag ftl rhd gene alys ngs","code_information":[{"code":"0494U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":3550.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1138.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3160.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3550.46,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alys crcg plsm prt","code_information":[{"code":"0495U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct cfdna 8/7 genes","code_information":[{"code":"0496U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":485.86,"maximum":2272.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":728.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":495.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":485.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2023.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2272.61,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna rt-pcr 6 gene","code_information":[{"code":"0497U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ngs mut detc 43gen","code_information":[{"code":"0498U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1345.31,"maximum":6292.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2017.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1372.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1345.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5602.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6292.69,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct&lng dna ngs 8gene","code_information":[{"code":"0499U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":2796.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":896.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2489.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2796.72,"additional_payer_notes":"APC"}]}]},{"description":"Autoinflam ds vexas synd dna","code_information":[{"code":"0500U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":820.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":730.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":820.43,"additional_payer_notes":"APC"}]}]},{"description":"Hpv e6/e7 mrk hi-rsk typ crv","code_information":[{"code":"0502U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alz ds ?amyl&tau prtn","code_information":[{"code":"0503U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":3508.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1125.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3123.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3508.12,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds uti id 17 path orgs","code_information":[{"code":"0504U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds vag infctj id 32orgs","code_information":[{"code":"0505U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.77,"maximum":3179.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1019.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":693.37,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":679.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2830.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3179.62,"additional_payer_notes":"APC"}]}]},{"description":"Gi barretts esophgl cell 89","code_information":[{"code":"0506U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.01,"maximum":9065.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2907.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1976.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8070.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9065.04,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovr dna whole gen w/5hmc","code_information":[{"code":"0507U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":5425.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1740.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4830.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5425.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc ca alg alys 16gen","code_information":[{"code":"0510U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":473.91,"maximum":2216.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":710.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.39,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":473.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1973.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2216.71,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum 3dmicroenvir 36+","code_information":[{"code":"0511U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":14190.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4550.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12633.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14190.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alys dgtz img msi","code_information":[{"code":"0512U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":3303.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1059.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2940.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3303.48,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alg alys msi&hrd","code_information":[{"code":"0513U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":3303.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1059.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2940.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3303.48,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibd ia quan deter adl lvl","code_information":[{"code":"0514U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":180.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.41,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibd ia quan deter ifx lvl","code_information":[{"code":"0515U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":180.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.41,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab rxgenomic gnotyp 40","code_information":[{"code":"0516U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 80+ psyactiv rx","code_information":[{"code":"0517U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":1154.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1028.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.97,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 90+ pn&mtl hlth","code_information":[{"code":"0518U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":1154.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1028.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.97,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr meds p/d/a 110+","code_information":[{"code":"0519U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":1154.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1028.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.97,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 200+ rx/sbsts","code_information":[{"code":"0520U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":1154.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1028.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.97,"additional_payer_notes":"APC"}]}]},{"description":"Rf iga&igm ccp antb sr-a ia","code_information":[{"code":"0521U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.8,"maximum":242.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":215.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":242.29,"additional_payer_notes":"APC"}]}]},{"description":"Ca vi psp&sp1 antb cl semiql","code_information":[{"code":"0522U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":1218.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1084.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1218.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc soltum dna ngs snv 22gen","code_information":[{"code":"0523U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1352.09,"maximum":6324.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2028.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1379.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1352.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5630.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6324.4,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe sflt-1/plgf ia srm/pls","code_information":[{"code":"0524U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.82,"maximum":602.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":193.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":128.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":536.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":602.56,"additional_payer_notes":"APC"}]}]},{"description":"Onc sphrd cell cul 11-rx pnl","code_information":[{"code":"0525U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":14190.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4550.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12633.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14190.88,"additional_payer_notes":"APC"}]}]},{"description":"Hsv 1&2 vzv amp prb tq pthgn","code_information":[{"code":"0527U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":667.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":213.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":593.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.15,"additional_payer_notes":"APC"}]}]},{"description":"Lrt iad 18bct/8vir&7arg rna","code_information":[{"code":"0528U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.84,"maximum":2969.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":952.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":647.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2643.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2969.46,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan-sol tum ctdna 77 gen","code_information":[{"code":"0530U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whlgen&mitochdrl dna","code_information":[{"code":"0532U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5031.2,"maximum":23533.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7546.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5131.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20950.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23533.44,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs gnotyp 16gens","code_information":[{"code":"0533U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Pfas lc-ms/ms plsm/srm quan","code_information":[{"code":"0535U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":290.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":93.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":258.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":290.66,"additional_payer_notes":"APC"}]}]},{"description":"Rbcag ftl rhd pcr alys exon4","code_information":[{"code":"0536U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":898.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":288.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":799.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":898.08,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca cfdna >2500 dmr","code_information":[{"code":"0537U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1495.0,"maximum":6992.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2242.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1524.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1495.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6225.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6992.86,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ngts ffpe 600gen","code_information":[{"code":"0538U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2989.55,"maximum":13983.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4484.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3049.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12448.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13983.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tumor cfctdna 152gen","code_information":[{"code":"0539U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3288.51,"maximum":15382.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4932.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3354.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13693.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15382.01,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med quan dd-cfdna","code_information":[{"code":"0540U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.25,"maximum":12878.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4129.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2808.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11464.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12878.33,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ngs dna 517 gens","code_information":[{"code":"0543U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2989.55,"maximum":13983.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4484.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3049.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12448.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13983.62,"additional_payer_notes":"APC"}]}]},{"description":"Achr antb id imfluor livecll","code_information":[{"code":"0545U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":176.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":157.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"}]}]},{"description":"Ldns lrp4 antb imflr livecll","code_information":[{"code":"0546U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":176.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":157.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"}]}]},{"description":"Neurflmnt lt chn cleia plsm","code_information":[{"code":"0547U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":543.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":483.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":543.67,"additional_payer_notes":"APC"}]}]},{"description":"Gfap cleia plasma","code_information":[{"code":"0548U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":543.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":483.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":543.67,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl dna mthyltd rt pcr","code_information":[{"code":"0549U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga embry te strux","code_information":[{"code":"0553U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":3550.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1138.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3160.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3550.46,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga 24chrm te bx qc","code_information":[{"code":"0554U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":3550.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1138.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3160.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3550.46,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga embryonic te qc","code_information":[{"code":"0555U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":3550.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1138.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3160.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3550.46,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds p-s dna&rna 12 trgts","code_information":[{"code":"0556U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":667.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":213.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":593.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.15,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv dna mrk vag fluid","code_information":[{"code":"0557U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":1230.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":394.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1095.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1230.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct elisa bf7 ag serum","code_information":[{"code":"0558U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":97.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.34,"additional_payer_notes":"APC"}]}]},{"description":"Onc brs quan elisa bf9ag srm","code_information":[{"code":"0559U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":97.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.34,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd gsa cfdna baseline","code_information":[{"code":"0560U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3878.45,"maximum":18141.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5817.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3956.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3878.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16150.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18141.45,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd gsa cfdna subsequent","code_information":[{"code":"0561U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":794.49,"maximum":3716.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1191.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":810.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":794.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3308.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3716.23,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum tgsa 33gens snvs","code_information":[{"code":"0562U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":2796.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":896.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2489.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2796.72,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds pthgn-sna 11vir&4bct","code_information":[{"code":"0563U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds pthgn-sna 10vir&4bct","code_information":[{"code":"0564U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc hcc ngs detc 6626epigalt","code_information":[{"code":"0565U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":5425.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1740.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4830.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5425.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng qpcr-bsd alys 13dmrs","code_information":[{"code":"0566U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq srs&lrs","code_information":[{"code":"0567U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5031.2,"maximum":23533.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7546.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5131.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20950.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23533.44,"additional_payer_notes":"APC"}]}]},{"description":"Neurol dementia ?amyl ptau","code_information":[{"code":"0568U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":4195.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1345.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3735.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4195.72,"additional_payer_notes":"APC"}]}]},{"description":"Neurol tbi alys gfap&uch-l1","code_information":[{"code":"0570U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":1218.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1084.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1218.49,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum dna80&rna10g ngs","code_information":[{"code":"0571U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med lar rtpcr 4genes","code_information":[{"code":"0575U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.0,"maximum":1777.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":570.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":387.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":380.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1582.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1777.45,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med lar quan ddcfdna","code_information":[{"code":"0576U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":15155.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4860.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13491.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15155.1,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovr serum alys 39 gps","code_information":[{"code":"0577U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":1154.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1028.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.97,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mln rna qpcr 10gen","code_information":[{"code":"0578U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Nfro dbtc ckd elisa apoa4","code_information":[{"code":"0579U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":1827.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":586.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1627.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1827.73,"additional_payer_notes":"APC"}]}]},{"description":"Bbrgdrferi antb detc 24rprtn","code_information":[{"code":"0580U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.21,"maximum":80.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.5,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl med antb nohla 39trgt","code_information":[{"code":"0581U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.8,"maximum":1523.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":488.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":325.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1356.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1523.93,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds rpd whlgen dna vrnts","code_information":[{"code":"0582U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7582.2,"maximum":35465.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11373.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7733.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31573.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35465.74,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds rpd whlgen cmptr dna","code_information":[{"code":"0583U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3791.1,"maximum":17732.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5686.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3866.92,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3791.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15786.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17732.87,"additional_payer_notes":"APC"}]}]},{"description":"Neuro csf prion prtn qual","code_information":[{"code":"0584U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":540.99,"maximum":2530.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":811.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":551.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2252.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2530.48,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so neo cfdna 521 genes","code_information":[{"code":"0585U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrna gen xprsn 216 genes","code_information":[{"code":"0586U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 60-150rx&metabl","code_information":[{"code":"0587U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":535.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":171.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":476.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":535.25,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct/vir 32genes mrna","code_information":[{"code":"0588U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Pfas24cmpnd hi-perf lc-ms/ms","code_information":[{"code":"0589U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":929.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":298.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":827.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":929.61,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca 3prtns plsm srm","code_information":[{"code":"0591U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo dna tgs 417 genes","code_information":[{"code":"0592U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds gu pthgn dna 46trgt","code_information":[{"code":"0593U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.84,"maximum":2969.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":952.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":647.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2643.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2969.46,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds tfp vctrbrn&zoonotic","code_information":[{"code":"0595U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":1230.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":394.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1095.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1230.14,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibs igg antb 18food items","code_information":[{"code":"0598U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":1403.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":450.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1249.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1403.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc ca mult ia serum","code_information":[{"code":"0599U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":4195.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1345.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3735.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4195.72,"additional_payer_notes":"APC"}]}]},{"description":"Routine venipuncture","code_information":[{"code":"36415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.34,"maximum":43.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Metabolic panel ionized ca","code_information":[{"code":"80047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":64.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.22,"additional_payer_notes":"APC"}]}]},{"description":"Metabolic panel total ca","code_information":[{"code":"80048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.46,"maximum":39.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39.57,"additional_payer_notes":"APC"}]}]},{"description":"Electrolyte panel","code_information":[{"code":"80051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.01,"maximum":32.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32.79,"additional_payer_notes":"APC"}]}]},{"description":"Comprehen metabolic panel","code_information":[{"code":"80053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.56,"maximum":49.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.39,"additional_payer_notes":"APC"}]}]},{"description":"Obstetric panel","code_information":[{"code":"80055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.81,"maximum":223.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":47.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":199.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":223.63,"additional_payer_notes":"APC"}]}]},{"description":"Lipid panel","code_information":[{"code":"80061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.39,"maximum":62.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.63,"additional_payer_notes":"APC"}]}]},{"description":"Renal function panel","code_information":[{"code":"80069","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.68,"maximum":40.60,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.6,"additional_payer_notes":"APC"}]}]},{"description":"Acute hepatitis panel","code_information":[{"code":"80074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.63,"maximum":222.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":47.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":198.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":222.79,"additional_payer_notes":"APC"}]}]},{"description":"Hepatic function panel","code_information":[{"code":"80076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.17,"maximum":38.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38.22,"additional_payer_notes":"APC"}]}]},{"description":"Obstetric panel","code_information":[{"code":"80081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.86,"maximum":350.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":74.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":311.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":350.16,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay acetaminophen","code_information":[{"code":"80143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":87.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.19,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay adalimumab","code_information":[{"code":"80145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":180.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.41,"additional_payer_notes":"APC"}]}]},{"description":"Assay of amikacin","code_information":[{"code":"80150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.08,"maximum":70.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.54,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay amiodarone","code_information":[{"code":"80151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":87.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.19,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay caffeine","code_information":[{"code":"80155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":180.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.41,"additional_payer_notes":"APC"}]}]},{"description":"Assay carbamazepine total","code_information":[{"code":"80156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.57,"maximum":68.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay carbamazepine free","code_information":[{"code":"80157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":61.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay cyclosporine","code_information":[{"code":"80158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.05,"maximum":84.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.43,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay clozapine","code_information":[{"code":"80159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.15,"maximum":94.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94.25,"additional_payer_notes":"APC"}]}]},{"description":"Asy carbamazepin 10,11-epxid","code_information":[{"code":"80161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":87.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.19,"additional_payer_notes":"APC"}]}]},{"description":"Assay of digoxin total","code_information":[{"code":"80162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.28,"maximum":62.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of digoxin free","code_information":[{"code":"80163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.28,"maximum":62.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay dipropylacetic acd tot","code_information":[{"code":"80164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":63.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63.33,"additional_payer_notes":"APC"}]}]},{"description":"Dipropylacetic acid free","code_information":[{"code":"80165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":63.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63.33,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay felbamate","code_information":[{"code":"80167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":87.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.19,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ethosuximide","code_information":[{"code":"80168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.34,"maximum":76.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.43,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay everolimus","code_information":[{"code":"80169","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":64.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.22,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gentamicin","code_information":[{"code":"80170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.38,"maximum":76.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.62,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant gabapentin","code_information":[{"code":"80171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.67,"maximum":101.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Haloperidol","code_information":[{"code":"80173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.78,"maximum":73.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":65.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73.81,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quan lamotrigine","code_information":[{"code":"80175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":61.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lidocaine","code_information":[{"code":"80176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.69,"maximum":68.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.71,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quan levetiracetam","code_information":[{"code":"80177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":61.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lithium","code_information":[{"code":"80178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.61,"maximum":30.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.92,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay salicylate","code_information":[{"code":"80179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":87.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.19,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quan mycophenolate","code_information":[{"code":"80180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.05,"maximum":84.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.43,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay flecainide","code_information":[{"code":"80181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":87.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.19,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quant oxcarbazepin","code_information":[{"code":"80183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":61.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenobarbital","code_information":[{"code":"80184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.3,"maximum":71.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenytoin total","code_information":[{"code":"80185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":61.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenytoin free","code_information":[{"code":"80186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.76,"maximum":64.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.36,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay posaconazole","code_information":[{"code":"80187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":126.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of primidone","code_information":[{"code":"80188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.59,"maximum":77.60,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.92,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77.6,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay itraconzaole","code_information":[{"code":"80189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":126.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of procainamide","code_information":[{"code":"80190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.0,"maximum":280.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":60.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":249.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":280.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay of procainamide","code_information":[{"code":"80192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.75,"maximum":78.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.35,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay leflunomide","code_information":[{"code":"80193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":180.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.41,"additional_payer_notes":"APC"}]}]},{"description":"Assay of quinidine","code_information":[{"code":"80194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.6,"maximum":68.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sirolimus","code_information":[{"code":"80195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":64.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.22,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tacrolimus","code_information":[{"code":"80197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":64.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.22,"additional_payer_notes":"APC"}]}]},{"description":"Assay of theophylline","code_information":[{"code":"80198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.14,"maximum":66.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.14,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant tiagabine","code_information":[{"code":"80199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":126.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tobramycin","code_information":[{"code":"80200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.13,"maximum":75.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75.45,"additional_payer_notes":"APC"}]}]},{"description":"Assay of topiramate","code_information":[{"code":"80201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.92,"maximum":55.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vancomycin","code_information":[{"code":"80202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":63.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63.33,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant zonisamide","code_information":[{"code":"80203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":61.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay methotrexate","code_information":[{"code":"80204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":180.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.41,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay rufinamide","code_information":[{"code":"80210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":126.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.81,"additional_payer_notes":"APC"}]}]},{"description":"Drug asy hydroxychloroquine","code_information":[{"code":"80220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":87.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.19,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay infliximab","code_information":[{"code":"80230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":180.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.41,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay lacosamide","code_information":[{"code":"80235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":126.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.81,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay vedolizumab","code_information":[{"code":"80280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":180.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.41,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay voriconazole","code_information":[{"code":"80285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":126.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.81,"additional_payer_notes":"APC"}]}]},{"description":"Quantitative assay drug","code_information":[{"code":"80299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":87.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.19,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv dir opt obs","code_information":[{"code":"80305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.6,"maximum":58.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.94,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv instrmnt","code_information":[{"code":"80306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.14,"maximum":80.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.17,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv chem anlyzr","code_information":[{"code":"80307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":290.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":93.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":258.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":290.66,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.62,"maximum":152.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.27,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":32.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":135.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152.58,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.96,"maximum":406.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":130.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":86.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":362.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":406.76,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.26,"maximum":366.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":117.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.83,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":78.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":325.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":366.06,"additional_payer_notes":"APC"}]}]},{"description":"Aldosterone suppression eval","code_information":[{"code":"80408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.5,"maximum":587.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":188.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":125.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":522.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":587.03,"additional_payer_notes":"APC"}]}]},{"description":"Calcitonin stimul panel","code_information":[{"code":"80410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.37,"maximum":375.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":80.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.93,"additional_payer_notes":"APC"}]}]},{"description":"CRH stimulation panel","code_information":[{"code":"80412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":801.62,"maximum":3749.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1202.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":817.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":801.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3338.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3749.58,"additional_payer_notes":"APC"}]}]},{"description":"Testosterone response","code_information":[{"code":"80414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.64,"maximum":241.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":215.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":241.55,"additional_payer_notes":"APC"}]}]},{"description":"Estradiol response panel","code_information":[{"code":"80415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.89,"maximum":261.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":55.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":232.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":261.43,"additional_payer_notes":"APC"}]}]},{"description":"Renin stimulation panel","code_information":[{"code":"80416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.32,"maximum":979.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":313.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.51,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":209.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":871.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":979.09,"additional_payer_notes":"APC"}]}]},{"description":"Renin stimulation panel","code_information":[{"code":"80417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.99,"maximum":205.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":43.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":183.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":205.76,"additional_payer_notes":"APC"}]}]},{"description":"Pituitary evaluation panel","code_information":[{"code":"80418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.48,"maximum":2710.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":869.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":591.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":579.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2413.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2710.52,"additional_payer_notes":"APC"}]}]},{"description":"Dexamethasone panel","code_information":[{"code":"80420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":161.88,"maximum":757.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":242.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":161.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":674.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":757.19,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance panel","code_information":[{"code":"80422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.07,"maximum":215.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":46.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":191.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":215.49,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance panel","code_information":[{"code":"80424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.5,"maximum":236.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.51,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":50.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":210.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236.21,"additional_payer_notes":"APC"}]}]},{"description":"Gonadotropin hormone panel","code_information":[{"code":"80426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.41,"maximum":694.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":148.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.19,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone panel","code_information":[{"code":"80428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.7,"maximum":311.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":66.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":277.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":311.99,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone panel","code_information":[{"code":"80430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.33,"maximum":604.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":194.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.92,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":129.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":538.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":604.94,"additional_payer_notes":"APC"}]}]},{"description":"Insulin suppression panel","code_information":[{"code":"80432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":165.61,"maximum":774.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":248.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":168.92,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":165.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":689.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":774.64,"additional_payer_notes":"APC"}]}]},{"description":"Insulin tolerance panel","code_information":[{"code":"80434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.03,"maximum":1333.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":427.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":290.73,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":285.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1186.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1333.23,"additional_payer_notes":"APC"}]}]},{"description":"Insulin tolerance panel","code_information":[{"code":"80435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.0,"maximum":481.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.06,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":103.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":428.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":481.78,"additional_payer_notes":"APC"}]}]},{"description":"Metyrapone panel","code_information":[{"code":"80436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.16,"maximum":426.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":136.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":91.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":379.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":426.4,"additional_payer_notes":"APC"}]}]},{"description":"TRH stimulation panel","code_information":[{"code":"80438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.41,"maximum":235.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":50.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":209.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":235.79,"additional_payer_notes":"APC"}]}]},{"description":"TRH stimulation panel","code_information":[{"code":"80439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.21,"maximum":314.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":67.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":279.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":314.37,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis nonauto w/scope","code_information":[{"code":"81000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.02,"maximum":18.80,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.8,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis auto w/scope","code_information":[{"code":"81001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.17,"maximum":14.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14.83,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis nonauto w/o scope","code_information":[{"code":"81002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.48,"maximum":16.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16.28,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis auto w/o scope","code_information":[{"code":"81003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.25,"maximum":10.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10.52,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis","code_information":[{"code":"81005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.17,"maximum":10.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10.15,"additional_payer_notes":"APC"}]}]},{"description":"Urine screen for bacteria","code_information":[{"code":"81007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.98,"maximum":140.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":124.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140.23,"additional_payer_notes":"APC"}]}]},{"description":"Microscopic exam of urine","code_information":[{"code":"81015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.05,"maximum":14.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis glass test","code_information":[{"code":"81020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.7,"maximum":21.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21.98,"additional_payer_notes":"APC"}]}]},{"description":"Urine pregnancy test","code_information":[{"code":"81025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.61,"maximum":40.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.27,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis volume measure","code_information":[{"code":"81050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.64,"maximum":17.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-1 genotyping","code_information":[{"code":"81105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":571.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":508.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":571.68,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-2 genotyping","code_information":[{"code":"81106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":571.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":508.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":571.68,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-3 genotyping","code_information":[{"code":"81107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":571.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":508.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":571.68,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-4 genotyping","code_information":[{"code":"81108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":571.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":508.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":571.68,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-5 genotyping","code_information":[{"code":"81109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":571.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":508.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":571.68,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-6 genotyping","code_information":[{"code":"81110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":571.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":508.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":571.68,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-9 genotyping","code_information":[{"code":"81111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":571.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":508.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":571.68,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-15 genotyping","code_information":[{"code":"81112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":571.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":508.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":571.68,"additional_payer_notes":"APC"}]}]},{"description":"Idh1 common variants","code_information":[{"code":"81120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":903.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":289.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":804.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":903.93,"additional_payer_notes":"APC"}]}]},{"description":"Idh2 common variants","code_information":[{"code":"81121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.79,"maximum":1383.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":443.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":295.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1231.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1383.56,"additional_payer_notes":"APC"}]}]},{"description":"DMD dup/delet analysis","code_information":[{"code":"81161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":279.0,"maximum":1305.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":418.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":279.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1161.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1305.02,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 seq & full dup/del","code_information":[{"code":"81162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1824.88,"maximum":8535.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2737.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1861.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1824.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7598.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8535.88,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 gene full seq alys","code_information":[{"code":"81163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":468.0,"maximum":2189.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":702.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":468.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1948.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2189.07,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 gen ful dup/del alys","code_information":[{"code":"81164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.23,"maximum":2732.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":876.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":584.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2432.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2732.74,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene full seq alys","code_information":[{"code":"81165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene full dup/del alys","code_information":[{"code":"81166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":1409.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":452.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1254.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1409.56,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene full dup/del alys","code_information":[{"code":"81167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Ccnd1/igh translocation alys","code_information":[{"code":"81168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":969.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":863.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":969.69,"additional_payer_notes":"APC"}]}]},{"description":"Abl1 gene","code_information":[{"code":"81170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":1403.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":450.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1249.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1403.25,"additional_payer_notes":"APC"}]}]},{"description":"Aff2 gene detc abnor alleles","code_information":[{"code":"81171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Aff2 gene charac alleles","code_information":[{"code":"81172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene full gene sequence","code_information":[{"code":"81173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":1409.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":452.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1254.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1409.56,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene known famil variant","code_information":[{"code":"81174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Asxl1 full gene sequence","code_information":[{"code":"81175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.5,"maximum":3164.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1014.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2817.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3164.33,"additional_payer_notes":"APC"}]}]},{"description":"Asxl1 gene target seq alys","code_information":[{"code":"81176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.9,"maximum":1131.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":362.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":241.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1007.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1131.49,"additional_payer_notes":"APC"}]}]},{"description":"Atn1 gene detc abnor alleles","code_information":[{"code":"81177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Atxn1 gene detc abnor allele","code_information":[{"code":"81178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Atxn2 gene detc abnor allele","code_information":[{"code":"81179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Atxn3 gene detc abnor allele","code_information":[{"code":"81180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Atxn7 gene detc abnor allele","code_information":[{"code":"81181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Atxn8os gen detc abnor allel","code_information":[{"code":"81182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Atxn10 gene detc abnor allel","code_information":[{"code":"81183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gen detc abnor allel","code_information":[{"code":"81184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gene full gene seq","code_information":[{"code":"81185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.27,"maximum":3958.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1269.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":863.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3523.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3958.43,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gen known famil vrnt","code_information":[{"code":"81186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Cnbp gene detc abnor allele","code_information":[{"code":"81187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene detc abnor allele","code_information":[{"code":"81188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene full gene sequence","code_information":[{"code":"81189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene known famil vrnt","code_information":[{"code":"81190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk1 translocation analysis","code_information":[{"code":"81191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":969.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":863.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":969.69,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk2 translocation analysis","code_information":[{"code":"81192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":969.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":863.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":969.69,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk3 translocation analysis","code_information":[{"code":"81193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":969.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":863.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":969.69,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk translocation analysis","code_information":[{"code":"81194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.28,"maximum":2424.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":777.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":528.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":518.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2158.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2424.25,"additional_payer_notes":"APC"}]}]},{"description":"Cytog genom-wid alys hem mal","code_information":[{"code":"81195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1863.22,"maximum":8715.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2794.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1900.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1863.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7758.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8715.21,"additional_payer_notes":"APC"}]}]},{"description":"Aspa gene","code_information":[{"code":"81200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.25,"maximum":221.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":47.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":196.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":221.01,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene full sequence","code_information":[{"code":"81201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":780.0,"maximum":3648.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1170.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":795.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3248.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3648.45,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene known fam variants","code_information":[{"code":"81202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":280.0,"maximum":1309.7,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":420.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":285.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":280.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1165.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1309.7,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene dup/delet variants","code_information":[{"code":"81203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.0,"maximum":935.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":204.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":200.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":832.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":935.5,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene charac alleles","code_information":[{"code":"81204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Bckdhb gene","code_information":[{"code":"81205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.99,"maximum":444.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":94.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":395.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":444.32,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene major bp","code_information":[{"code":"81206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.96,"maximum":766.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":245.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":163.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":682.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":766.92,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene minor bp","code_information":[{"code":"81207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.84,"maximum":677.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":217.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":144.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":603.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":677.49,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene other bp","code_information":[{"code":"81208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.62,"maximum":1003.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":321.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":214.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":893.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1003.89,"additional_payer_notes":"APC"}]}]},{"description":"Blm gene","code_information":[{"code":"81209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":183.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":163.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183.87,"additional_payer_notes":"APC"}]}]},{"description":"Braf gene","code_information":[{"code":"81210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":820.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":730.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":820.43,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 185&5385&6174 var","code_information":[{"code":"81212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":440.0,"maximum":2058.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":660.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":448.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":440.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1832.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2058.1,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene known fam variant","code_information":[{"code":"81215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":1755.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":562.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1562.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1755.23,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene full sequence","code_information":[{"code":"81216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.12,"maximum":865.90,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":770.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":865.9,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene known fam variant","code_information":[{"code":"81217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":1755.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":562.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1562.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1755.23,"additional_payer_notes":"APC"}]}]},{"description":"Cebpa gene full sequence","code_information":[{"code":"81218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.9,"maximum":1131.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":362.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":241.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1007.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1131.49,"additional_payer_notes":"APC"}]}]},{"description":"Calr gene com variants","code_information":[{"code":"81219","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.63,"maximum":568.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":182.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.06,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":121.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":506.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":568.92,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene com variants","code_information":[{"code":"81220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":556.6,"maximum":2603.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":834.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.73,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":556.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2317.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2603.5,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene known fam variants","code_information":[{"code":"81221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.22,"maximum":454.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":97.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":454.75,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene dup/delet variants","code_information":[{"code":"81222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.07,"maximum":2035.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":652.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":443.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":435.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1811.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2035.04,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene full sequence","code_information":[{"code":"81223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":499.0,"maximum":2334.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":748.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":499.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2077.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2334.07,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene intron poly t","code_information":[{"code":"81224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.75,"maximum":789.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":253.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":172.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":168.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":702.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":789.33,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2c19 gene com variants","code_information":[{"code":"81225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.36,"maximum":1362.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":437.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":297.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1213.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1362.84,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gene com variants","code_information":[{"code":"81226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":2109.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":676.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1877.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2109.13,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2c9 gene com variants","code_information":[{"code":"81227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"Cytogen micrarray copy nmbr","code_information":[{"code":"81228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":900.0,"maximum":4209.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1350.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":918.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":900.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3747.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4209.75,"additional_payer_notes":"APC"}]}]},{"description":"Cytogen m array copy no&snp","code_information":[{"code":"81229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":5425.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1740.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4830.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5425.9,"additional_payer_notes":"APC"}]}]},{"description":"Cyp3a4 gene common variants","code_information":[{"code":"81230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"Cyp3a5 gene common variants","code_information":[{"code":"81231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"Dpyd gene common variants","code_information":[{"code":"81232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"Btk gene common variants","code_information":[{"code":"81233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":820.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":730.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":820.43,"additional_payer_notes":"APC"}]}]},{"description":"Dmpk gene detc abnor allele","code_information":[{"code":"81234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Egfr gene com variants","code_information":[{"code":"81235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":324.58,"maximum":1518.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":486.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":324.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1351.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1518.22,"additional_payer_notes":"APC"}]}]},{"description":"Ezh2 gene full gene sequence","code_information":[{"code":"81236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Ezh2 gene common variants","code_information":[{"code":"81237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":820.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":730.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":820.43,"additional_payer_notes":"APC"}]}]},{"description":"F9 full gene sequence","code_information":[{"code":"81238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":2806.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":900.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2498.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2806.5,"additional_payer_notes":"APC"}]}]},{"description":"Dmpk gene charac alleles","code_information":[{"code":"81239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"F2 gene","code_information":[{"code":"81240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.69,"maximum":307.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":65.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.26,"additional_payer_notes":"APC"}]}]},{"description":"F5 gene","code_information":[{"code":"81241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.37,"maximum":343.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":305.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":343.19,"additional_payer_notes":"APC"}]}]},{"description":"Fancc gene","code_information":[{"code":"81242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.62,"maximum":171.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":36.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":152.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171.29,"additional_payer_notes":"APC"}]}]},{"description":"Fmr1 gene detection","code_information":[{"code":"81243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.04,"maximum":266.80,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.18,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":57.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":237.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":266.8,"additional_payer_notes":"APC"}]}]},{"description":"Fmr1 gene characterization","code_information":[{"code":"81244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.89,"maximum":209.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":44.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":186.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":209.97,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene","code_information":[{"code":"81245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":165.51,"maximum":774.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":248.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":168.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":165.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":689.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":774.17,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene analysis","code_information":[{"code":"81246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.0,"maximum":388.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":124.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":83.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":345.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":388.23,"additional_payer_notes":"APC"}]}]},{"description":"G6pd gene alys cmn variant","code_information":[{"code":"81247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"G6pd known familial variant","code_information":[{"code":"81248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":1755.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":562.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1562.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1755.23,"additional_payer_notes":"APC"}]}]},{"description":"G6pd full gene sequence","code_information":[{"code":"81249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":2806.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":900.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2498.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2806.5,"additional_payer_notes":"APC"}]}]},{"description":"G6pc gene","code_information":[{"code":"81250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.49,"maximum":273.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":58.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":243.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":273.59,"additional_payer_notes":"APC"}]}]},{"description":"Gba gene","code_information":[{"code":"81251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.25,"maximum":221.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":47.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":196.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":221.01,"additional_payer_notes":"APC"}]}]},{"description":"Gjb2 gene full sequence","code_information":[{"code":"81252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.12,"maximum":472.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":151.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":101.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":421.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":472.99,"additional_payer_notes":"APC"}]}]},{"description":"Gjb2 gene known fam variants","code_information":[{"code":"81253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.52,"maximum":287.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.75,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":61.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":256.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":287.76,"additional_payer_notes":"APC"}]}]},{"description":"Gjb6 gene com variants","code_information":[{"code":"81254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.0,"maximum":163.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163.71,"additional_payer_notes":"APC"}]}]},{"description":"Hexa gene","code_information":[{"code":"81255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.45,"maximum":240.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":214.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":240.66,"additional_payer_notes":"APC"}]}]},{"description":"Hfe gene","code_information":[{"code":"81256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.36,"maximum":305.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":65.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":272.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene","code_information":[{"code":"81257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.26,"maximum":478.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":153.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":102.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":478.32,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene fam vrnt","code_information":[{"code":"81258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":1755.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":562.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1562.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1755.23,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 full gene sequence","code_information":[{"code":"81259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":2806.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":900.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2498.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2806.5,"additional_payer_notes":"APC"}]}]},{"description":"Ikbkap gene","code_information":[{"code":"81260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":183.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":163.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183.87,"additional_payer_notes":"APC"}]}]},{"description":"Igh gene rearrange amp meth","code_information":[{"code":"81261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.99,"maximum":926.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":296.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":197.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":824.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":926.1,"additional_payer_notes":"APC"}]}]},{"description":"Igh gene rearrang dir probe","code_information":[{"code":"81262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.55,"maximum":320.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":102.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.92,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":68.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":285.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":320.64,"additional_payer_notes":"APC"}]}]},{"description":"Igh vari regional mutation","code_information":[{"code":"81263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":294.52,"maximum":1377.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":441.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":294.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1226.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1377.62,"additional_payer_notes":"APC"}]}]},{"description":"Igk rearrangeabn clonal pop","code_information":[{"code":"81264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":172.73,"maximum":807.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":259.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.18,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":172.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":719.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":807.94,"additional_payer_notes":"APC"}]}]},{"description":"Str markers specimen anal","code_information":[{"code":"81265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":233.07,"maximum":1090.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":349.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.73,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":233.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":970.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1090.18,"additional_payer_notes":"APC"}]}]},{"description":"Str markers spec anal addl","code_information":[{"code":"81266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.81,"maximum":1425.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":457.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":304.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1269.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1425.75,"additional_payer_notes":"APC"}]}]},{"description":"Chimerism anal no cell selec","code_information":[{"code":"81267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.46,"maximum":970.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":311.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":207.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":863.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":970.39,"additional_payer_notes":"APC"}]}]},{"description":"Chimerism anal w/cell select","code_information":[{"code":"81268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.79,"maximum":1219.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":391.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":260.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1085.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1219.85,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene dup/del vrnts","code_information":[{"code":"81269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.4,"maximum":946.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":303.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":206.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":842.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":946.73,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene","code_information":[{"code":"81270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.66,"maximum":428.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":91.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":381.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":428.74,"additional_payer_notes":"APC"}]}]},{"description":"Htt gene detc abnor alleles","code_information":[{"code":"81271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Kit gene targeted seq analys","code_information":[{"code":"81272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":1541.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":494.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1372.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1541.28,"additional_payer_notes":"APC"}]}]},{"description":"Kit gene analys d816 variant","code_information":[{"code":"81273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.87,"maximum":584.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":187.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.37,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":124.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":519.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":584.08,"additional_payer_notes":"APC"}]}]},{"description":"Htt gene charac alleles","code_information":[{"code":"81274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Kras gene variants exon 2","code_information":[{"code":"81275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":903.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":289.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":804.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":903.93,"additional_payer_notes":"APC"}]}]},{"description":"Kras gene addl variants","code_information":[{"code":"81276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":903.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":289.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":804.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":903.93,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenomic neo microra alys","code_information":[{"code":"81277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":5425.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1740.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4830.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5425.9,"additional_payer_notes":"APC"}]}]},{"description":"Igh@/bcl2 translocation alys","code_information":[{"code":"81278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":969.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":863.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":969.69,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene trgt sequence alys","code_information":[{"code":"81279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Ifnl3 gene","code_information":[{"code":"81283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.37,"maximum":343.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":305.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":343.19,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene detc abnor alleles","code_information":[{"code":"81284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene charac alleles","code_information":[{"code":"81285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene full gene sequence","code_information":[{"code":"81286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Mgmt gene methylation anal","code_information":[{"code":"81287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.64,"maximum":583.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":186.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":124.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":519.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":583.0,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene","code_information":[{"code":"81288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.32,"maximum":899.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":288.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196.17,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":192.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":800.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":899.58,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene known famil variant","code_information":[{"code":"81289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Mcoln1 gene","code_information":[{"code":"81290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":183.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":163.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183.87,"additional_payer_notes":"APC"}]}]},{"description":"Mthfr gene","code_information":[{"code":"81291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.34,"maximum":305.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":65.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":272.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":305.63,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene full seq","code_information":[{"code":"81292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":675.4,"maximum":3159.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1013.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":688.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":675.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2812.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3159.18,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene known variants","code_information":[{"code":"81293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.0,"maximum":1548.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":496.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":337.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":331.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1378.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1548.25,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene dup/delete variant","code_information":[{"code":"81294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.4,"maximum":946.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":303.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":206.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":842.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":946.73,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene full seq","code_information":[{"code":"81295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":381.7,"maximum":1785.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":572.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":381.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1589.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1785.4,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene known variants","code_information":[{"code":"81296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":337.73,"maximum":1579.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":506.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":344.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":337.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1406.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1579.73,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene dup/delete variant","code_information":[{"code":"81297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.3,"maximum":997.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":319.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.57,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":213.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":888.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":997.71,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene full seq","code_information":[{"code":"81298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":641.85,"maximum":3002.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":962.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":654.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":641.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2672.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3002.25,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene known variants","code_information":[{"code":"81299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.0,"maximum":1440.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":462.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":314.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":308.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1282.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1440.67,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene dup/delete variant","code_information":[{"code":"81300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.0,"maximum":1113.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":357.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":238.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":991.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1113.25,"additional_payer_notes":"APC"}]}]},{"description":"Microsatellite instability","code_information":[{"code":"81301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":348.56,"maximum":1630.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":522.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":355.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":348.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1451.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1630.39,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene full seq","code_information":[{"code":"81302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":527.87,"maximum":2469.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":791.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":538.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":527.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2198.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2469.11,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene known variant","code_information":[{"code":"81303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.0,"maximum":561.3,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":180.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":120.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":499.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":561.3,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene dup/delet variant","code_information":[{"code":"81304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.0,"maximum":701.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":225.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":150.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.62,"additional_payer_notes":"APC"}]}]},{"description":"Myd88 gene p.leu265pro vrnt","code_information":[{"code":"81305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":820.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":730.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":820.43,"additional_payer_notes":"APC"}]}]},{"description":"Nudt15 gene common variants","code_information":[{"code":"81306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.36,"maximum":1362.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":437.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":297.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1213.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1362.84,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 gene full gene seq","code_information":[{"code":"81307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.5,"maximum":3164.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1014.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2817.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3164.33,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 gene known famil vrnt","code_information":[{"code":"81308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":1409.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":452.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1254.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1409.56,"additional_payer_notes":"APC"}]}]},{"description":"Pik3ca gene trgt seq alys","code_information":[{"code":"81309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Npm1 gene","code_information":[{"code":"81310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.52,"maximum":1153.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":369.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":246.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1026.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1153.1,"additional_payer_notes":"APC"}]}]},{"description":"Nras gene variants exon 2&3","code_information":[{"code":"81311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.79,"maximum":1383.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":443.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":295.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1231.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1383.56,"additional_payer_notes":"APC"}]}]},{"description":"Pabpn1 gene detc abnor allel","code_information":[{"code":"81312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Pca3/klk3 antigen","code_information":[{"code":"81313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.05,"maximum":1193.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":255.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1062.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1193.0,"additional_payer_notes":"APC"}]}]},{"description":"Pdgfra gene","code_information":[{"code":"81314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":1541.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":494.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1372.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1541.28,"additional_payer_notes":"APC"}]}]},{"description":"Pml/raralpha com breakpoints","code_information":[{"code":"81315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":969.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":863.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":969.69,"additional_payer_notes":"APC"}]}]},{"description":"Pml/raralpha 1 breakpoint","code_information":[{"code":"81316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":969.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":310.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":863.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":969.69,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 gene full seq analysis","code_information":[{"code":"81317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.5,"maximum":3164.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1014.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2817.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3164.33,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 known familial variants","code_information":[{"code":"81318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.0,"maximum":1548.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":496.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":337.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":331.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1378.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1548.25,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 gene dup/delet variants","code_information":[{"code":"81319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.5,"maximum":951.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":305.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.57,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":203.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":847.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":951.87,"additional_payer_notes":"APC"}]}]},{"description":"Plcg2 gene common variants","code_information":[{"code":"81320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.36,"maximum":1362.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":437.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":297.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1213.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1362.84,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene full sequence","code_information":[{"code":"81321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":2806.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":900.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2498.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2806.5,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene known fam variant","code_information":[{"code":"81322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.6,"maximum":217.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":46.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":194.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":217.97,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene dup/delet variant","code_information":[{"code":"81323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":1403.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":450.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1249.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1403.25,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene dup/delet","code_information":[{"code":"81324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.36,"maximum":3547.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1137.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":773.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":758.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3157.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3547.23,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene full sequence","code_information":[{"code":"81325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":769.58,"maximum":3599.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1154.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":784.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":769.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3204.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3599.71,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene known fam variant","code_information":[{"code":"81326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.6,"maximum":217.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":46.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":194.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":217.97,"additional_payer_notes":"APC"}]}]},{"description":"Sept9 methylation analysis","code_information":[{"code":"81327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":898.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":288.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":799.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":898.08,"additional_payer_notes":"APC"}]}]},{"description":"Slco1b1 gene com variants","code_information":[{"code":"81328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gene dos/deletion alys","code_information":[{"code":"81329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Smpd1 gene common variants","code_information":[{"code":"81330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.0,"maximum":219.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":47.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":195.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":219.84,"additional_payer_notes":"APC"}]}]},{"description":"Snrpn/ube3a gene","code_information":[{"code":"81331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.07,"maximum":238.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.09,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":212.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":238.88,"additional_payer_notes":"APC"}]}]},{"description":"Serpina1 gene","code_information":[{"code":"81332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.65,"maximum":204.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":43.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":181.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":204.17,"additional_payer_notes":"APC"}]}]},{"description":"Tgfbi gene common variants","code_information":[{"code":"81333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Runx1 gene targeted seq alys","code_information":[{"code":"81334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":1541.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":494.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1372.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1541.28,"additional_payer_notes":"APC"}]}]},{"description":"Tpmt gene com variants","code_information":[{"code":"81335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gene full gene sequence","code_information":[{"code":"81336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":1409.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":452.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1254.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1409.56,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gen nown famil seq vrnt","code_information":[{"code":"81337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Mpl gene common variants","code_information":[{"code":"81338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.33,"maximum":703.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":225.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":150.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":625.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":703.17,"additional_payer_notes":"APC"}]}]},{"description":"Mpl gene seq alys exon 10","code_information":[{"code":"81339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Trb@ gene rearrange amplify","code_information":[{"code":"81340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":208.92,"maximum":977.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":313.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":208.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":869.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":977.22,"additional_payer_notes":"APC"}]}]},{"description":"Trb@ gene rearrange dirprobe","code_information":[{"code":"81341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.59,"maximum":231.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":49.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":206.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":231.96,"additional_payer_notes":"APC"}]}]},{"description":"Trg gene rearrangement anal","code_information":[{"code":"81342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.5,"maximum":942.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":302.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":201.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":839.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":942.52,"additional_payer_notes":"APC"}]}]},{"description":"Ppp2r2b gen detc abnor allel","code_information":[{"code":"81343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Tbp gene detc abnor alleles","code_information":[{"code":"81344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Tert gene targeted seq alys","code_information":[{"code":"81345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Tyms gene com variants","code_information":[{"code":"81346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"Sf3b1 gene common variants","code_information":[{"code":"81347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":903.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":289.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":804.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":903.93,"additional_payer_notes":"APC"}]}]},{"description":"Srsf2 gene common variants","code_information":[{"code":"81348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":820.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":263.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":730.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":820.43,"additional_payer_notes":"APC"}]}]},{"description":"Cytog alys chrml abnr lw-ps","code_information":[{"code":"81349","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1197.94,"maximum":5603.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1796.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1221.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1197.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4988.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5603.36,"additional_payer_notes":"APC"}]}]},{"description":"Ugt1a1 gene","code_information":[{"code":"81350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.0,"maximum":1094.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":351.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":234.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":974.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1094.54,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene full gene sequence","code_information":[{"code":"81351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":641.85,"maximum":3002.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":962.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":654.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":641.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2672.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3002.25,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene trgt sequence alys","code_information":[{"code":"81352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":1541.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":494.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1372.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1541.28,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene known famil vrnt","code_information":[{"code":"81353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.0,"maximum":1440.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":462.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":314.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":308.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1282.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1440.67,"additional_payer_notes":"APC"}]}]},{"description":"Cytog alys chrml abnor ogm","code_information":[{"code":"81354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":5910.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1895.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5261.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5910.16,"additional_payer_notes":"APC"}]}]},{"description":"Vkorc1 gene","code_information":[{"code":"81355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.2,"maximum":412.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":132.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":88.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":367.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":412.56,"additional_payer_notes":"APC"}]}]},{"description":"U2af1 gene common variants","code_information":[{"code":"81357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":903.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":289.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":804.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":903.93,"additional_payer_notes":"APC"}]}]},{"description":"Zrsr2 gene common variants","code_information":[{"code":"81360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":903.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":289.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":804.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":903.93,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene com variants","code_information":[{"code":"81361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":817.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":727.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":817.67,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene known fam variant","code_information":[{"code":"81362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":1755.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":562.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1562.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1755.23,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene dup/del variants","code_information":[{"code":"81363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.4,"maximum":946.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":303.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":206.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":842.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":946.73,"additional_payer_notes":"APC"}]}]},{"description":"Hbb full gene sequence","code_information":[{"code":"81364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":324.58,"maximum":1518.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":486.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":324.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1351.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1518.22,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii typing lr","code_information":[{"code":"81370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":402.12,"maximum":1880.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":603.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":410.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":402.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1674.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1880.92,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii type verify lr","code_information":[{"code":"81371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":404.52,"maximum":1892.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":606.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":412.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":404.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1684.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1892.14,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing complete lr","code_information":[{"code":"81372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.59,"maximum":1887.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":605.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":411.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":403.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1680.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1887.79,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 locus lr","code_information":[{"code":"81373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.43,"maximum":596.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":191.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":127.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":530.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":596.05,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 antigen lr","code_information":[{"code":"81374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.33,"maximum":347.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":111.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":74.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":309.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":347.68,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing ag equiv lr","code_information":[{"code":"81375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":220.74,"maximum":1032.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":331.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":220.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":919.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1032.51,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 locus lr","code_information":[{"code":"81376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":571.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":508.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":571.68,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii type 1 ag equiv lr","code_information":[{"code":"81377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.74,"maximum":443.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":142.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":94.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":394.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":443.15,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii typing hr","code_information":[{"code":"81378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":345.57,"maximum":1616.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":518.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":352.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1438.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1616.4,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing complete hr","code_information":[{"code":"81379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":335.38,"maximum":1568.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":503.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":335.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1396.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1568.74,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 locus hr","code_information":[{"code":"81380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.25,"maximum":829.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":265.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":180.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":177.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":738.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":829.09,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 allele hr","code_information":[{"code":"81381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.9,"maximum":794.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":254.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":169.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":707.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":794.71,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 loc hr","code_information":[{"code":"81382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.68,"maximum":578.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":185.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":123.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":515.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":578.51,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 allele hr","code_information":[{"code":"81383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.13,"maximum":510.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":163.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":109.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":454.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":510.46,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 1","code_information":[{"code":"81400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.96,"maximum":299.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":63.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":266.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":299.17,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 2","code_information":[{"code":"81401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":640.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":205.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":570.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":640.82,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 3","code_information":[{"code":"81402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.33,"maximum":703.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":225.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":150.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":625.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":703.17,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 4","code_information":[{"code":"81403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":866.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":866.27,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 5","code_information":[{"code":"81404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":1285.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1144.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1285.52,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 6","code_information":[{"code":"81405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":1409.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":452.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1254.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1409.56,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 7","code_information":[{"code":"81406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":1323.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":424.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1177.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1323.17,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 8","code_information":[{"code":"81407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.27,"maximum":3958.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1269.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":863.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3523.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3958.43,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 9","code_information":[{"code":"81408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2000.0,"maximum":9355.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3000.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2040.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2000.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8328.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9355.0,"additional_payer_notes":"APC"}]}]},{"description":"Aortic dysfunction/dilation","code_information":[{"code":"81410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":504.0,"maximum":2357.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":756.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":514.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":504.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2098.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2357.46,"additional_payer_notes":"APC"}]}]},{"description":"Aortic dysfunction/dilation","code_information":[{"code":"81411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1350.19,"maximum":6315.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2025.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1377.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1350.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5622.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6315.51,"additional_payer_notes":"APC"}]}]},{"description":"Ashkenazi jewish assoc dis","code_information":[{"code":"81412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":11453.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3672.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10196.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11453.14,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnnlpath inc 10 gns","code_information":[{"code":"81413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":2735.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":877.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2435.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2735.87,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnnlpath inc 2 gns","code_information":[{"code":"81414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":2735.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":877.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2435.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2735.87,"additional_payer_notes":"APC"}]}]},{"description":"Exome sequence analysis","code_information":[{"code":"81415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4780.0,"maximum":22358.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7170.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4875.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4780.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19904.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22358.45,"additional_payer_notes":"APC"}]}]},{"description":"Exome sequence analysis","code_information":[{"code":"81416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12000.0,"maximum":56130.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18000.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12240.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12000.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49969.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56130.0,"additional_payer_notes":"APC"}]}]},{"description":"Exome re-evaluation","code_information":[{"code":"81417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.0,"maximum":1496.8,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":480.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":320.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1332.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1496.8,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab gen seq alys pnl 6","code_information":[{"code":"81418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":917.08,"maximum":4289.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1375.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":935.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3818.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4289.64,"additional_payer_notes":"APC"}]}]},{"description":"Epilepsy gen seq alys panel","code_information":[{"code":"81419","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":11453.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3672.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10196.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11453.14,"additional_payer_notes":"APC"}]}]},{"description":"Fetal chrmoml aneuploidy","code_information":[{"code":"81420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":3550.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1138.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3160.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3550.46,"additional_payer_notes":"APC"}]}]},{"description":"Fetal chrmoml microdeltj","code_information":[{"code":"81422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":3550.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1138.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3160.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3550.46,"additional_payer_notes":"APC"}]}]},{"description":"Genome sequence analysis","code_information":[{"code":"81425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5031.2,"maximum":23533.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7546.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5131.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20950.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23533.44,"additional_payer_notes":"APC"}]}]},{"description":"Genome sequence analysis","code_information":[{"code":"81426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2709.95,"maximum":12675.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4064.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2764.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2709.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11284.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12675.79,"additional_payer_notes":"APC"}]}]},{"description":"Genome re-evaluation","code_information":[{"code":"81427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2337.65,"maximum":10934.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3506.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2384.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2337.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9734.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10934.36,"additional_payer_notes":"APC"}]}]},{"description":"Hearing loss sequence analys","code_information":[{"code":"81430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1625.0,"maximum":7600.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2437.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1657.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1625.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6766.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7600.94,"additional_payer_notes":"APC"}]}]},{"description":"Hearing loss dup/del analys","code_information":[{"code":"81431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.57,"maximum":3178.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1019.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":693.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":679.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2829.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3178.69,"additional_payer_notes":"APC"}]}]},{"description":"Hrdtry brst ca-rlatd dsordrs","code_information":[{"code":"81432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":6099.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1955.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5429.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6099.23,"additional_payer_notes":"APC"}]}]},{"description":"Hereditary retinal disorders","code_information":[{"code":"81434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":2796.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":896.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2489.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2796.72,"additional_payer_notes":"APC"}]}]},{"description":"Hereditary colon ca dsordrs","code_information":[{"code":"81435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":6099.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1955.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5429.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6099.23,"additional_payer_notes":"APC"}]}]},{"description":"Heredtry nurondcrn tum dsrdr","code_information":[{"code":"81437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":6099.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1955.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5429.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6099.23,"additional_payer_notes":"APC"}]}]},{"description":"Inherited cardmypthy 5 gns","code_information":[{"code":"81439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":2735.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":877.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2435.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2735.87,"additional_payer_notes":"APC"}]}]},{"description":"Mitochondrial gene","code_information":[{"code":"81440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3324.0,"maximum":15548.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4986.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3390.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3324.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13841.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15548.01,"additional_payer_notes":"APC"}]}]},{"description":"Ibmfs seq alys pnl 30 genes","code_information":[{"code":"81441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":11453.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3672.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10196.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11453.14,"additional_payer_notes":"APC"}]}]},{"description":"Noonan spectrum disorders","code_information":[{"code":"81442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2143.6,"maximum":10026.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3215.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2186.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2143.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8926.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10026.69,"additional_payer_notes":"APC"}]}]},{"description":"Genetic tstg severe inh cond","code_information":[{"code":"81443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":11453.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3672.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10196.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11453.14,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":2796.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":896.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2489.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2796.72,"additional_payer_notes":"APC"}]}]},{"description":"Hrdtry perph neurphy panel","code_information":[{"code":"81448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":2735.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":877.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2435.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2735.87,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so neo 5-50 rna alys","code_information":[{"code":"81449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":2796.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":896.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2489.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2796.72,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.53,"maximum":3552.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1139.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3162.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3552.7,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap hl neo 5-50 rna alys","code_information":[{"code":"81451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.53,"maximum":3552.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1139.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":759.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3162.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3552.7,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so/hl 51/< rna alys","code_information":[{"code":"81456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":13656.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4379.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12157.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13656.43,"additional_payer_notes":"APC"}]}]},{"description":"So neo gsap dna mcrstl ins","code_information":[{"code":"81457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":896.87,"maximum":4195.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1345.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":896.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3734.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4195.11,"additional_payer_notes":"APC"}]}]},{"description":"So gsap dna cpy nmbr&mcrstl","code_information":[{"code":"81458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1046.35,"maximum":4894.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1569.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1067.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1046.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4357.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4894.3,"additional_payer_notes":"APC"}]}]},{"description":"So neo gsap dna/dna&rna","code_information":[{"code":"81459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2989.55,"maximum":13983.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4484.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3049.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12448.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13983.62,"additional_payer_notes":"APC"}]}]},{"description":"Whole mitochondrial genome","code_information":[{"code":"81460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1287.0,"maximum":6019.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1930.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1312.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1287.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5359.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6019.94,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cll fr dna/dna&rna","code_information":[{"code":"81462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1195.83,"maximum":5593.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1793.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1219.75,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1195.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4979.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5593.49,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cl fr cpy nmbr&mcrst","code_information":[{"code":"81463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1345.31,"maximum":6292.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2017.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1372.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1345.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5602.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6292.69,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cll fr mcrstl ins","code_information":[{"code":"81464","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3288.51,"maximum":15382.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4932.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3354.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13693.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15382.01,"additional_payer_notes":"APC"}]}]},{"description":"Whole mitochondrial genome","code_information":[{"code":"81465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":936.0,"maximum":4378.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1404.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":954.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":936.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3897.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4378.14,"additional_payer_notes":"APC"}]}]},{"description":"X-linked intellectual dblt","code_information":[{"code":"81470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.0,"maximum":4275.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1371.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":932.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":914.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3805.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4275.24,"additional_payer_notes":"APC"}]}]},{"description":"X-linked intellectual dblt","code_information":[{"code":"81471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.0,"maximum":4275.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1371.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":932.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":914.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3805.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4275.24,"additional_payer_notes":"APC"}]}]},{"description":"Autoimmune rheumatoid arthr","code_information":[{"code":"81490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":3932.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1260.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3500.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3932.14,"additional_payer_notes":"APC"}]}]},{"description":"Cor artery disease mrna","code_information":[{"code":"81493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1050.0,"maximum":4911.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1575.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1071.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1050.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4372.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4911.38,"additional_payer_notes":"APC"}]}]},{"description":"Onco (ovar) two proteins","code_information":[{"code":"81500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":1218.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1084.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1218.49,"additional_payer_notes":"APC"}]}]},{"description":"Onco (ovar) five proteins","code_information":[{"code":"81503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":4195.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1345.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3735.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4195.72,"additional_payer_notes":"APC"}]}]},{"description":"Oncology tissue of origin","code_information":[{"code":"81504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":520.0,"maximum":2432.3,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":530.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":520.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2165.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2432.3,"additional_payer_notes":"APC"}]}]},{"description":"Endo assay seven anal","code_information":[{"code":"81506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.92,"maximum":322.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":286.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":322.37,"additional_payer_notes":"APC"}]}]},{"description":"Fetal aneuploidy trisom risk","code_information":[{"code":"81507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":795.0,"maximum":3718.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1192.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":810.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3310.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3718.61,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor two proteins","code_information":[{"code":"81508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.3,"maximum":253.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.39,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":54.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":226.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":253.99,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor 3 proteins","code_information":[{"code":"81509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1487.37,"maximum":6957.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2231.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1517.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1487.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6193.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6957.17,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor three anal","code_information":[{"code":"81510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.54,"maximum":259.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":55.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":231.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":259.79,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor four anal","code_information":[{"code":"81511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.5,"maximum":718.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":230.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.57,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":153.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":639.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":718.0,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor five anal","code_information":[{"code":"81512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.52,"maximum":325.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":104.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":69.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":289.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":325.18,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv rna vag flu alg","code_information":[{"code":"81513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":667.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":213.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":593.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.15,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv&vaginitis dna alg","code_information":[{"code":"81514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":1230.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":394.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1095.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1230.14,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv&vaginitis dna alg","code_information":[{"code":"81515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":1230.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":394.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1095.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1230.14,"additional_payer_notes":"APC"}]}]},{"description":"Liver ds alys 3 bmrk srm alg","code_information":[{"code":"81517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.19,"maximum":824.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":264.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":176.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":733.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":824.13,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst mrna 11 genes","code_information":[{"code":"81518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Oncology breast mrna","code_information":[{"code":"81519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 58 genes","code_information":[{"code":"81520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.21,"maximum":11741.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3765.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2560.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10452.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11741.51,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 70 genes","code_information":[{"code":"81521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 12 genes","code_information":[{"code":"81522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst mrna 70 cnt 31 gene","code_information":[{"code":"81523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Oncology colon mrna","code_information":[{"code":"81525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3116.0,"maximum":14575.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4674.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3178.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3116.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12975.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14575.09,"additional_payer_notes":"APC"}]}]},{"description":"Oncology colorectal scr","code_information":[{"code":"81528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":508.87,"maximum":2380.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":763.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":519.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":508.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2118.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2380.24,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 31 gene","code_information":[{"code":"81529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7193.0,"maximum":33645.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10789.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7336.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7193.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29952.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33645.26,"additional_payer_notes":"APC"}]}]},{"description":"Oncology gynecologic","code_information":[{"code":"81535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.46,"maximum":2710.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":869.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":591.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":579.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2412.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2710.42,"additional_payer_notes":"APC"}]}]},{"description":"Oncology gynecologic","code_information":[{"code":"81536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.56,"maximum":830.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":266.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":177.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":739.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":830.54,"additional_payer_notes":"APC"}]}]},{"description":"Oncology lung","code_information":[{"code":"81538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2871.0,"maximum":13429.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4306.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2928.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2871.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11955.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13429.1,"additional_payer_notes":"APC"}]}]},{"description":"Oncology prostate prob score","code_information":[{"code":"81539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Oncology tum unknown origin","code_information":[{"code":"81540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3750.0,"maximum":17540.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5625.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3825.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3750.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15615.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17540.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate mrna 46 genes","code_information":[{"code":"81541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate mrna 22 cnt gen","code_information":[{"code":"81542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":18115.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5809.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16127.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18115.96,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr mrna 10,196 gen alg","code_information":[{"code":"81546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":16839.0,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5400.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14990.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16839.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate 3 genes","code_information":[{"code":"81551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2030.0,"maximum":9495.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3045.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2070.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2030.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8453.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9495.33,"additional_payer_notes":"APC"}]}]},{"description":"Onc uveal mlnma mrna 15 gene","code_information":[{"code":"81552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7776.0,"maximum":36372.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11664.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7931.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7776.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32380.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36372.24,"additional_payer_notes":"APC"}]}]},{"description":"Pulm ds ipf mrna 190 gen alg","code_information":[{"code":"81554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5409.6,"maximum":25303.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8114.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5517.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5409.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22526.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25303.4,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl rej kdn mrna qpcr 139","code_information":[{"code":"81558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":15155.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4860.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13491.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15155.1,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj pd lvr&bwl cd154+cll","code_information":[{"code":"81560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":640.73,"maximum":2997.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":961.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":653.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":640.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2668.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2997.01,"additional_payer_notes":"APC"}]}]},{"description":"Cardiology hrt trnspl mrna","code_information":[{"code":"81595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":15155.1,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4860.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13491.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15155.1,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds chrnc hcv 6 assays","code_information":[{"code":"81596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.19,"maximum":337.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":108.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":72.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":300.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":337.67,"additional_payer_notes":"APC"}]}]},{"description":"Test for acetone/ketones","code_information":[{"code":"82009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.52,"maximum":21.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21.14,"additional_payer_notes":"APC"}]}]},{"description":"Acetone assay","code_information":[{"code":"82010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.17,"maximum":38.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38.22,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholinesterase assay","code_information":[{"code":"82013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.29,"maximum":57.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.49,"additional_payer_notes":"APC"}]}]},{"description":"Acylcarnitines qual","code_information":[{"code":"82016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.49,"maximum":77.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77.13,"additional_payer_notes":"APC"}]}]},{"description":"Acylcarnitines quant","code_information":[{"code":"82017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":78.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of acth","code_information":[{"code":"82024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.62,"maximum":180.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.39,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay of adp & amp","code_information":[{"code":"82030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.8,"maximum":120.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":107.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120.68,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum albumin","code_information":[{"code":"82040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":23.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine albumin","code_information":[{"code":"82042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.78,"maximum":36.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.39,"additional_payer_notes":"APC"}]}]},{"description":"Microalbumin quantitative","code_information":[{"code":"82043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.78,"maximum":27.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27.04,"additional_payer_notes":"APC"}]}]},{"description":"Microalbumin semiquant","code_information":[{"code":"82044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.23,"maximum":29.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29.14,"additional_payer_notes":"APC"}]}]},{"description":"Albumin ischemia modified","code_information":[{"code":"82045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.94,"maximum":158.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":33.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":141.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of breath ethanol","code_information":[{"code":"82075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.0,"maximum":140.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":30.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":124.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay spec xcp ur&breath ia","code_information":[{"code":"82077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aldolase","code_information":[{"code":"82085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.71,"maximum":45.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aldosterone","code_information":[{"code":"82088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.75,"maximum":190.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":40.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":169.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":190.61,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-1-antitrypsin total","code_information":[{"code":"82103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.44,"maximum":62.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.87,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-1-antitrypsin pheno","code_information":[{"code":"82104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.46,"maximum":67.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.64,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-fetoprotein serum","code_information":[{"code":"82105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.77,"maximum":78.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.44,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-fetoprotein amniotic","code_information":[{"code":"82106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.0,"maximum":79.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.52,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-Fetoprotein L3","code_information":[{"code":"82107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":301.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":268.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":301.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aluminum","code_information":[{"code":"82108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.48,"maximum":119.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":106.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.18,"additional_payer_notes":"APC"}]}]},{"description":"Amines vaginal fluid qual","code_information":[{"code":"82120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.99,"maximum":28.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28.02,"additional_payer_notes":"APC"}]}]},{"description":"Amino acid single qual","code_information":[{"code":"82127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.18,"maximum":66.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.33,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids mult qual","code_information":[{"code":"82128","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.87,"maximum":64.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.88,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids single quant","code_information":[{"code":"82131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.98,"maximum":107.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.44,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":95.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107.49,"additional_payer_notes":"APC"}]}]},{"description":"Assay aminolevulinic acid","code_information":[{"code":"82135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.45,"maximum":76.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.94,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids quant 2-5","code_information":[{"code":"82136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.61,"maximum":91.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.73,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids quan 6 or more","code_information":[{"code":"82139","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":78.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ammonia","code_information":[{"code":"82140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.57,"maximum":68.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.15,"additional_payer_notes":"APC"}]}]},{"description":"Amniotic fluid scan","code_information":[{"code":"82143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.35,"maximum":43.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of amylase","code_information":[{"code":"82150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.48,"maximum":30.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.31,"additional_payer_notes":"APC"}]}]},{"description":"Androstanediol glucuronide","code_information":[{"code":"82154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.83,"maximum":134.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":28.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":120.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134.85,"additional_payer_notes":"APC"}]}]},{"description":"Assay of androstenedione","code_information":[{"code":"82157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.28,"maximum":136.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of androsterone","code_information":[{"code":"82160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.55,"maximum":119.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.06,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":106.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.51,"additional_payer_notes":"APC"}]}]},{"description":"Assay of angiotensin II","code_information":[{"code":"82163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.52,"maximum":95.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95.98,"additional_payer_notes":"APC"}]}]},{"description":"Angiotensin I enzyme test","code_information":[{"code":"82164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.6,"maximum":68.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay anti-mullerian horm","code_information":[{"code":"82166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.62,"maximum":180.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.39,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay of apolipoprotein","code_information":[{"code":"82172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.09,"maximum":98.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.51,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":87.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay of arsenic","code_information":[{"code":"82175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.97,"maximum":88.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ascorbic acid","code_information":[{"code":"82180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.89,"maximum":46.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46.26,"additional_payer_notes":"APC"}]}]},{"description":"Atomic absorption","code_information":[{"code":"82190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.9,"maximum":74.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.37,"additional_payer_notes":"APC"}]}]},{"description":"Assay of beta-2 protein","code_information":[{"code":"82232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.18,"maximum":75.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75.68,"additional_payer_notes":"APC"}]}]},{"description":"Beta-amyloid 1-40 (abeta 40)","code_information":[{"code":"82233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":603.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":193.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":536.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":603.02,"additional_payer_notes":"APC"}]}]},{"description":"Beta-amyloid 1-42 (abeta 42)","code_information":[{"code":"82234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":603.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":193.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":536.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":603.02,"additional_payer_notes":"APC"}]}]},{"description":"Bile acids total","code_information":[{"code":"82239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.12,"maximum":80.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.08,"additional_payer_notes":"APC"}]}]},{"description":"Bile acids cholylglycine","code_information":[{"code":"82240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.58,"maximum":124.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":110.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124.33,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin total","code_information":[{"code":"82247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":23.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.48,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin direct","code_information":[{"code":"82248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":23.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.48,"additional_payer_notes":"APC"}]}]},{"description":"Fecal bilirubin test","code_information":[{"code":"82252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.56,"maximum":21.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay of biotinidase","code_information":[{"code":"82261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":78.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.91,"additional_payer_notes":"APC"}]}]},{"description":"Occult blood feces","code_information":[{"code":"82270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.38,"maximum":20.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.49,"additional_payer_notes":"APC"}]}]},{"description":"Occult blood other sources","code_information":[{"code":"82271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.32,"maximum":24.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.88,"additional_payer_notes":"APC"}]}]},{"description":"Occult bld feces 1-3 tests","code_information":[{"code":"82272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.23,"maximum":19.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay test for blood fecal","code_information":[{"code":"82274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.92,"maximum":74.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of bradykinin","code_information":[{"code":"82286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.16,"maximum":24.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cadmium","code_information":[{"code":"82300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.64,"maximum":110.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":23.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":98.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110.58,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin d 25 hydroxy","code_information":[{"code":"82306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.6,"maximum":138.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":123.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138.45,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcitonin","code_information":[{"code":"82308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.79,"maximum":125.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium","code_information":[{"code":"82310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.16,"maximum":24.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium","code_information":[{"code":"82330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.68,"maximum":63.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63.99,"additional_payer_notes":"APC"}]}]},{"description":"Calcium infusion test","code_information":[{"code":"82331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.34,"maximum":62.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.4,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium in urine","code_information":[{"code":"82340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.03,"maximum":28.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28.21,"additional_payer_notes":"APC"}]}]},{"description":"Calculus analysis qual","code_information":[{"code":"82355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.58,"maximum":54.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.17,"additional_payer_notes":"APC"}]}]},{"description":"Calculus assay quant","code_information":[{"code":"82360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":60.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.2,"additional_payer_notes":"APC"}]}]},{"description":"Calculus spectroscopy","code_information":[{"code":"82365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.9,"maximum":60.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.34,"additional_payer_notes":"APC"}]}]},{"description":"X-ray assay calculus","code_information":[{"code":"82370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.52,"maximum":58.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay c-d transfer measure","code_information":[{"code":"82373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.06,"maximum":84.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.48,"additional_payer_notes":"APC"}]}]},{"description":"Assay blood carbon dioxide","code_information":[{"code":"82374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.88,"maximum":22.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.83,"additional_payer_notes":"APC"}]}]},{"description":"Assay carboxyhb quant","code_information":[{"code":"82375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.32,"maximum":57.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay carboxyhb qual","code_information":[{"code":"82376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.07,"maximum":65.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65.81,"additional_payer_notes":"APC"}]}]},{"description":"Carcinoembryonic antigen","code_information":[{"code":"82378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.96,"maximum":88.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of carnitine","code_information":[{"code":"82379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":78.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of carotene","code_information":[{"code":"82380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.22,"maximum":43.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay urine catecholamines","code_information":[{"code":"82382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.3,"maximum":127.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":113.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay blood catecholamines","code_information":[{"code":"82383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.08,"maximum":136.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay three catecholamines","code_information":[{"code":"82384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.25,"maximum":118.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":105.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cathepsin-d","code_information":[{"code":"82387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.06,"maximum":84.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.48,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ceruloplasmin","code_information":[{"code":"82390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":50.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.24,"additional_payer_notes":"APC"}]}]},{"description":"Chemiluminescent assay","code_information":[{"code":"82397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.12,"maximum":66.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.05,"additional_payer_notes":"APC"}]}]},{"description":"Assay of chloramphenicol","code_information":[{"code":"82415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.67,"maximum":59.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood chloride","code_information":[{"code":"82435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.6,"maximum":21.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21.52,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine chloride","code_information":[{"code":"82436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.75,"maximum":26.90,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.9,"additional_payer_notes":"APC"}]}]},{"description":"Assay other fluid chlorides","code_information":[{"code":"82438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.0,"maximum":23.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.39,"additional_payer_notes":"APC"}]}]},{"description":"Test for chlorohydrocarbons","code_information":[{"code":"82441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.01,"maximum":28.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay bld/serum cholesterol","code_information":[{"code":"82465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.35,"maximum":20.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.35,"additional_payer_notes":"APC"}]}]},{"description":"Assay serum cholinesterase","code_information":[{"code":"82480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.87,"maximum":36.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay rbc cholinesterase","code_information":[{"code":"82482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.81,"maximum":45.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay chondroitin sulfate","code_information":[{"code":"82485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.65,"maximum":96.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.06,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96.59,"additional_payer_notes":"APC"}]}]},{"description":"Assay of chromium","code_information":[{"code":"82495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.28,"maximum":94.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":84.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94.86,"additional_payer_notes":"APC"}]}]},{"description":"Assay of citrate","code_information":[{"code":"82507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.8,"maximum":130.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":115.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130.03,"additional_payer_notes":"APC"}]}]},{"description":"Collagen crosslinks","code_information":[{"code":"82523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.68,"maximum":87.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.38,"additional_payer_notes":"APC"}]}]},{"description":"Assay of copper","code_information":[{"code":"82525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.41,"maximum":58.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.05,"additional_payer_notes":"APC"}]}]},{"description":"Assay of corticosterone","code_information":[{"code":"82528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.52,"maximum":105.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105.34,"additional_payer_notes":"APC"}]}]},{"description":"Cortisol free","code_information":[{"code":"82530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.71,"maximum":78.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.16,"additional_payer_notes":"APC"}]}]},{"description":"Total cortisol","code_information":[{"code":"82533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.3,"maximum":76.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.24,"additional_payer_notes":"APC"}]}]},{"description":"Assay of creatine","code_information":[{"code":"82540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.64,"maximum":21.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.73,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"}]}]},{"description":"Col chromotography qual/quan","code_information":[{"code":"82542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.09,"maximum":112.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.57,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.68,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ck (cpk)","code_information":[{"code":"82550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.51,"maximum":30.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.64,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.45,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cpk in blood","code_information":[{"code":"82552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.39,"maximum":62.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.63,"additional_payer_notes":"APC"}]}]},{"description":"Creatine mb fraction","code_information":[{"code":"82553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.55,"maximum":54.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.03,"additional_payer_notes":"APC"}]}]},{"description":"Creatine isoforms","code_information":[{"code":"82554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.87,"maximum":55.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55.52,"additional_payer_notes":"APC"}]}]},{"description":"Assay of creatinine","code_information":[{"code":"82565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.12,"maximum":23.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.95,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine creatinine","code_information":[{"code":"82570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":24.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.23,"additional_payer_notes":"APC"}]}]},{"description":"Creatinine clearance test","code_information":[{"code":"82575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.46,"maximum":44.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cryofibrinogen","code_information":[{"code":"82585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.14,"maximum":66.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cryoglobulin","code_information":[{"code":"82595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":30.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cyanide","code_information":[{"code":"82600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.4,"maximum":90.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90.74,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin B-12","code_information":[{"code":"82607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.08,"maximum":70.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.54,"additional_payer_notes":"APC"}]}]},{"description":"B-12 binding capacity","code_information":[{"code":"82608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.32,"maximum":66.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.98,"additional_payer_notes":"APC"}]}]},{"description":"Cystatin c","code_information":[{"code":"82610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.52,"maximum":86.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.63,"additional_payer_notes":"APC"}]}]},{"description":"Test for urine cystines","code_information":[{"code":"82615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.55,"maximum":44.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.67,"additional_payer_notes":"APC"}]}]},{"description":"Dehydroepiandrosterone","code_information":[{"code":"82626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.27,"maximum":118.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":105.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118.2,"additional_payer_notes":"APC"}]}]},{"description":"Dehydroepiandrosterone","code_information":[{"code":"82627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.23,"maximum":103.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":92.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103.98,"additional_payer_notes":"APC"}]}]},{"description":"Desoxycorticosterone","code_information":[{"code":"82633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.98,"maximum":144.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":30.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":129.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144.91,"additional_payer_notes":"APC"}]}]},{"description":"Deoxycortisol","code_information":[{"code":"82634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.28,"maximum":136.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of dibucaine number","code_information":[{"code":"82638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":57.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.3,"additional_payer_notes":"APC"}]}]},{"description":"Dihydrotestosterone","code_information":[{"code":"82642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.28,"maximum":136.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136.96,"additional_payer_notes":"APC"}]}]},{"description":"Vit d 1 25-dihydroxy","code_information":[{"code":"82652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.5,"maximum":180.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.27,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":38.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":160.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180.08,"additional_payer_notes":"APC"}]}]},{"description":"El-1 fecal quantitative","code_information":[{"code":"82653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.97,"maximum":107.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":95.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107.44,"additional_payer_notes":"APC"}]}]},{"description":"Pancreatic elastase fecal","code_information":[{"code":"82656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":53.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"}]}]},{"description":"Enzyme cell activity","code_information":[{"code":"82657","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.17,"maximum":103.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":92.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103.7,"additional_payer_notes":"APC"}]}]},{"description":"Enzyme cell activity ra","code_information":[{"code":"82658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.03,"maximum":205.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":44.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":183.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":205.95,"additional_payer_notes":"APC"}]}]},{"description":"Electrophoretic test","code_information":[{"code":"82664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.5,"maximum":287.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.73,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":61.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":256.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":287.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay of erythropoietin","code_information":[{"code":"82668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.79,"maximum":87.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.17,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estradiol","code_information":[{"code":"82670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.94,"maximum":130.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":116.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogens","code_information":[{"code":"82671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.3,"maximum":151.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":32.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151.08,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogen","code_information":[{"code":"82672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.7,"maximum":101.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estriol","code_information":[{"code":"82677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.18,"maximum":113.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113.1,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrone","code_information":[{"code":"82679","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.95,"maximum":116.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay dir meas fr estradiol","code_information":[{"code":"82681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.94,"maximum":130.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":116.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ethylene glycol","code_information":[{"code":"82693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.9,"maximum":69.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of etiocholanolone","code_information":[{"code":"82696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.24,"maximum":122.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":109.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122.74,"additional_payer_notes":"APC"}]}]},{"description":"Fats/lipids feces qual","code_information":[{"code":"82705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.1,"maximum":23.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.86,"additional_payer_notes":"APC"}]}]},{"description":"Fats/lipids feces quant","code_information":[{"code":"82710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.8,"maximum":78.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.58,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fecal fat","code_information":[{"code":"82715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.97,"maximum":107.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":95.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood fatty acids","code_information":[{"code":"82725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.77,"maximum":87.80,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.8,"additional_payer_notes":"APC"}]}]},{"description":"Long chain fatty acids","code_information":[{"code":"82726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.75,"maximum":92.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":82.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92.38,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ferritin","code_information":[{"code":"82728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.63,"maximum":63.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fetal fibronectin","code_information":[{"code":"82731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":301.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":268.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":301.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fluoride","code_information":[{"code":"82735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":86.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.72,"additional_payer_notes":"APC"}]}]},{"description":"Assay of folic acid serum","code_information":[{"code":"82746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.7,"maximum":68.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay of folic acid rbc","code_information":[{"code":"82747","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.65,"maximum":82.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":73.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay of semen fructose","code_information":[{"code":"82757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.34,"maximum":81.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":72.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of rbc galactokinase","code_information":[{"code":"82759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.48,"maximum":100.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of galactose","code_information":[{"code":"82760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.2,"maximum":52.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay galactose transferase","code_information":[{"code":"82775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.07,"maximum":98.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":87.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98.55,"additional_payer_notes":"APC"}]}]},{"description":"Galactose transferase test","code_information":[{"code":"82776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.74,"maximum":54.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.91,"additional_payer_notes":"APC"}]}]},{"description":"Galectin-3","code_information":[{"code":"82777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.25,"maximum":206.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":44.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":184.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":206.98,"additional_payer_notes":"APC"}]}]},{"description":"Assay iga/igd/igg/igm each","code_information":[{"code":"82784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.3,"maximum":43.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ige","code_information":[{"code":"82785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.46,"maximum":76.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.99,"additional_payer_notes":"APC"}]}]},{"description":"Igg 1 2 3 or 4 each","code_information":[{"code":"82787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.02,"maximum":37.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"}]}]},{"description":"Blood pH","code_information":[{"code":"82800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.0,"maximum":51.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51.45,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases any combination","code_information":[{"code":"82803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.07,"maximum":121.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":108.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121.94,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases w/o2 saturation","code_information":[{"code":"82805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.77,"maximum":368.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":78.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":328.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":368.45,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases o2 sat only","code_information":[{"code":"82810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.77,"maximum":45.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.7,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin-oxygen affinity","code_information":[{"code":"82820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.34,"maximum":62.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.4,"additional_payer_notes":"APC"}]}]},{"description":"Gastric analy w/ph ea spec","code_information":[{"code":"82930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.71,"maximum":31.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31.39,"additional_payer_notes":"APC"}]}]},{"description":"Gastrin test","code_information":[{"code":"82938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.69,"maximum":82.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.04,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":73.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gastrin","code_information":[{"code":"82941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.63,"maximum":82.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":73.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82.46,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glucagon","code_information":[{"code":"82943","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.29,"maximum":66.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.84,"additional_payer_notes":"APC"}]}]},{"description":"Glucose Other Fluid","code_information":[{"code":"82945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.93,"maximum":18.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance test","code_information":[{"code":"82946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.77,"maximum":83.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay glucose blood quant","code_information":[{"code":"82947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.93,"maximum":18.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"APC"}]}]},{"description":"Reagent strip/blood glucose","code_information":[{"code":"82948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.04,"maximum":23.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"}]}]},{"description":"Glucose test","code_information":[{"code":"82950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":22.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.22,"additional_payer_notes":"APC"}]}]},{"description":"Glucose tolerance test (GTT)","code_information":[{"code":"82951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":60.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.2,"additional_payer_notes":"APC"}]}]},{"description":"GTT-added samples","code_information":[{"code":"82952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.92,"maximum":18.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of g6pd enzyme","code_information":[{"code":"82955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.7,"maximum":45.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.37,"additional_payer_notes":"APC"}]}]},{"description":"Test for G6PD enzyme","code_information":[{"code":"82960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.05,"maximum":28.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28.3,"additional_payer_notes":"APC"}]}]},{"description":"Glucose blood test","code_information":[{"code":"82962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.28,"maximum":15.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glucosidase","code_information":[{"code":"82963","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.48,"maximum":100.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gdh enzyme","code_information":[{"code":"82965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.15,"maximum":61.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.51,"additional_payer_notes":"APC"}]}]},{"description":"Assay of GGT","code_information":[{"code":"82977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.2,"maximum":33.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33.68,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glutathione","code_information":[{"code":"82978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.45,"maximum":72.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.27,"additional_payer_notes":"APC"}]}]},{"description":"Assay rbc glutathione","code_information":[{"code":"82979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":44.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glycated protein","code_information":[{"code":"82985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.76,"maximum":78.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gonadotropin (fsh)","code_information":[{"code":"83001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.58,"maximum":86.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gonadotropin (lh)","code_information":[{"code":"83002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.52,"maximum":86.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay growth hormone (hgh)","code_information":[{"code":"83003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.67,"maximum":77.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77.97,"additional_payer_notes":"APC"}]}]},{"description":"Growth stimulation gene 2","code_information":[{"code":"83006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.6,"maximum":353.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":113.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":75.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":314.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":353.62,"additional_payer_notes":"APC"}]}]},{"description":"H pylori (c-13) blood","code_information":[{"code":"83009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.36,"maximum":315.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":101.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":67.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":280.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":315.08,"additional_payer_notes":"APC"}]}]},{"description":"Assay of haptoglobin quant","code_information":[{"code":"83010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.58,"maximum":58.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of haptoglobins","code_information":[{"code":"83012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.89,"maximum":125.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125.78,"additional_payer_notes":"APC"}]}]},{"description":"H pylori (c-13) breath","code_information":[{"code":"83013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.36,"maximum":315.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":101.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":67.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":280.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":315.08,"additional_payer_notes":"APC"}]}]},{"description":"H pylori drug admin","code_information":[{"code":"83014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.86,"maximum":36.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.77,"additional_payer_notes":"APC"}]}]},{"description":"Heavy metal qual any anal","code_information":[{"code":"83015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.94,"maximum":97.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":87.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.95,"additional_payer_notes":"APC"}]}]},{"description":"Heavy metal quant each nes","code_information":[{"code":"83018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.96,"maximum":102.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102.72,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin electrophoresis","code_information":[{"code":"83020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":60.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.2,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin chromotography","code_information":[{"code":"83021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.06,"maximum":84.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.48,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin copper sulfate","code_information":[{"code":"83026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.01,"maximum":18.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.09,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"}]}]},{"description":"Fetal hemoglobin chemical","code_information":[{"code":"83030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":50.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.24,"additional_payer_notes":"APC"}]}]},{"description":"Fetal hemoglobin assay qual","code_information":[{"code":"83033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.0,"maximum":37.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.42,"additional_payer_notes":"APC"}]}]},{"description":"Glycosylated hemoglobin test","code_information":[{"code":"83036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.71,"maximum":45.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.42,"additional_payer_notes":"APC"}]}]},{"description":"Glycosylated hb home device","code_information":[{"code":"83037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.71,"maximum":45.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.42,"additional_payer_notes":"APC"}]}]},{"description":"Blood methemoglobin test","code_information":[{"code":"83045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.49,"maximum":30.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.36,"additional_payer_notes":"APC"}]}]},{"description":"Blood methemoglobin assay","code_information":[{"code":"83050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.2,"maximum":38.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay of plasma hemoglobin","code_information":[{"code":"83051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.31,"maximum":34.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"}]}]},{"description":"Blood sulfhemoglobin assay","code_information":[{"code":"83060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.8,"maximum":41.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of hemoglobin heat","code_information":[{"code":"83065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.0,"maximum":42.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.18,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42.1,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin stability screen","code_information":[{"code":"83068","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.47,"maximum":44.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine hemoglobin","code_information":[{"code":"83069","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.95,"maximum":18.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"}]}]},{"description":"Assay of hemosiderin qual","code_information":[{"code":"83070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":22.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.22,"additional_payer_notes":"APC"}]}]},{"description":"Assay of b hexosaminidase","code_information":[{"code":"83080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":78.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of histamine","code_information":[{"code":"83088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.53,"maximum":138.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":122.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Homocystine","code_information":[{"code":"83090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.92,"maximum":83.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of homovanillic acid","code_information":[{"code":"83150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.41,"maximum":104.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":93.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of corticosteroids 17","code_information":[{"code":"83491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":83.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of 5-hiaa","code_information":[{"code":"83497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.9,"maximum":60.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone 17-d","code_information":[{"code":"83498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.17,"maximum":127.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":113.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay free hydroxyproline","code_information":[{"code":"83500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.65,"maximum":105.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":94.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105.95,"additional_payer_notes":"APC"}]}]},{"description":"Assay total hydroxyproline","code_information":[{"code":"83505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.3,"maximum":113.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":101.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113.66,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay nonantibody","code_information":[{"code":"83516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":53.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay dipstick","code_information":[{"code":"83518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.64,"maximum":45.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.83,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.09,"additional_payer_notes":"APC"}]}]},{"description":"Ria nonantibody","code_information":[{"code":"83519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":86.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.07,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay quant nos nonab","code_information":[{"code":"83520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Ig light chains free each","code_information":[{"code":"83521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of insulin","code_information":[{"code":"83525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.43,"maximum":53.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.46,"additional_payer_notes":"APC"}]}]},{"description":"Assay of insulin","code_information":[{"code":"83527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.95,"maximum":60.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of intrinsic factor","code_information":[{"code":"83528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.82,"maximum":92.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":82.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92.71,"additional_payer_notes":"APC"}]}]},{"description":"Asay of interleukin-6 (il-6)","code_information":[{"code":"83529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of iron","code_information":[{"code":"83540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":30.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"}]}]},{"description":"Iron binding test","code_information":[{"code":"83550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.74,"maximum":40.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"}]}]},{"description":"Assay of idh enzyme","code_information":[{"code":"83570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.85,"maximum":41.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41.4,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ketogenic steroids","code_information":[{"code":"83582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.47,"maximum":72.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay 17- ketosteroids","code_information":[{"code":"83586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.8,"maximum":59.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.87,"additional_payer_notes":"APC"}]}]},{"description":"Fractionation ketosteroids","code_information":[{"code":"83593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.5,"maximum":133.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":118.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lactic acid","code_information":[{"code":"83605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.57,"maximum":54.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.12,"additional_payer_notes":"APC"}]}]},{"description":"Lactate (LD) (LDH) enzyme","code_information":[{"code":"83615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.04,"maximum":28.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ldh enzymes","code_information":[{"code":"83625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.79,"maximum":59.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.83,"additional_payer_notes":"APC"}]}]},{"description":"Lactoferrin fecal (qual)","code_information":[{"code":"83630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.7,"maximum":92.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.09,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":82.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92.15,"additional_payer_notes":"APC"}]}]},{"description":"Lactoferrin fecal (quant)","code_information":[{"code":"83631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.63,"maximum":91.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.82,"additional_payer_notes":"APC"}]}]},{"description":"Placental lactogen","code_information":[{"code":"83632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.22,"maximum":94.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":84.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94.58,"additional_payer_notes":"APC"}]}]},{"description":"Test urine for lactose","code_information":[{"code":"83633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.25,"maximum":52.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52.62,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lead","code_information":[{"code":"83655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":56.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.64,"additional_payer_notes":"APC"}]}]},{"description":"L/s ratio fetal lung","code_information":[{"code":"83661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.99,"maximum":102.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102.86,"additional_payer_notes":"APC"}]}]},{"description":"Foam stability fetal lung","code_information":[{"code":"83662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.91,"maximum":88.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88.45,"additional_payer_notes":"APC"}]}]},{"description":"Fluoro polarize fetal lung","code_information":[{"code":"83663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.91,"maximum":88.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88.45,"additional_payer_notes":"APC"}]}]},{"description":"Lamellar bdy fetal lung","code_information":[{"code":"83664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.32,"maximum":90.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90.37,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lap enzyme","code_information":[{"code":"83670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.81,"maximum":45.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipase","code_information":[{"code":"83690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.89,"maximum":32.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipoprotein(a)","code_information":[{"code":"83695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.32,"maximum":66.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.98,"additional_payer_notes":"APC"}]}]},{"description":"Assay Lipoprotein Pla2","code_information":[{"code":"83698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.31,"maximum":216.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":46.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":192.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":216.62,"additional_payer_notes":"APC"}]}]},{"description":"Lipopro bld electrophoretic","code_information":[{"code":"83700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.26,"maximum":52.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52.67,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprotein bld hr fraction","code_information":[{"code":"83701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.86,"maximum":158.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":141.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158.38,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprotein bld quan part","code_information":[{"code":"83704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.19,"maximum":159.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":142.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipoprotein","code_information":[{"code":"83718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.19,"maximum":38.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood lipoprotein","code_information":[{"code":"83719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.75,"maximum":59.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood lipoprotein","code_information":[{"code":"83721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.5,"maximum":49.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.11,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprtn dir meas sd ldl chl","code_information":[{"code":"83722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.19,"maximum":159.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":142.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lrh hormone","code_information":[{"code":"83727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.19,"maximum":80.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.41,"additional_payer_notes":"APC"}]}]},{"description":"Assay of magnesium","code_information":[{"code":"83735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.7,"maximum":31.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.83,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay malate dehydrogenase","code_information":[{"code":"83775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.37,"maximum":34.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of manganese","code_information":[{"code":"83785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.65,"maximum":124.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.18,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":110.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"}]}]},{"description":"Mass spectrometry qual/quan","code_information":[{"code":"83789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.11,"maximum":112.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.59,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.77,"additional_payer_notes":"APC"}]}]},{"description":"Assay of mercury","code_information":[{"code":"83825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.26,"maximum":76.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.59,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.06,"additional_payer_notes":"APC"}]}]},{"description":"Assay of metanephrines","code_information":[{"code":"83835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.94,"maximum":79.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.24,"additional_payer_notes":"APC"}]}]},{"description":"Assay of methemalbumin","code_information":[{"code":"83857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":50.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.24,"additional_payer_notes":"APC"}]}]},{"description":"Microfluid analy tears","code_information":[{"code":"83861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.48,"maximum":105.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":93.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105.15,"additional_payer_notes":"APC"}]}]},{"description":"Mucopolysaccharides","code_information":[{"code":"83864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.5,"maximum":133.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":118.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay synovial fluid mucin","code_information":[{"code":"83872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.86,"maximum":27.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27.41,"additional_payer_notes":"APC"}]}]},{"description":"Assay of csf protein","code_information":[{"code":"83873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.2,"maximum":80.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"}]}]},{"description":"Assay of myoglobin","code_information":[{"code":"83874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.92,"maximum":60.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.43,"additional_payer_notes":"APC"}]}]},{"description":"Assay myeloperoxidase","code_information":[{"code":"83876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.86,"maximum":237.90,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":211.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237.9,"additional_payer_notes":"APC"}]}]},{"description":"Assay of natriuretic peptide","code_information":[{"code":"83880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.26,"maximum":183.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":39.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":163.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay nephelometry not spec","code_information":[{"code":"83883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.6,"maximum":63.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63.61,"additional_payer_notes":"APC"}]}]},{"description":"Assay neurflmnt light chain","code_information":[{"code":"83884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":543.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":483.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":543.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay of nickel","code_information":[{"code":"83885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.51,"maximum":114.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":102.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay of nucleotidase","code_information":[{"code":"83915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.15,"maximum":52.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.15,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52.15,"additional_payer_notes":"APC"}]}]},{"description":"Oligoclonal bands","code_information":[{"code":"83916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.39,"maximum":128.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":114.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128.12,"additional_payer_notes":"APC"}]}]},{"description":"Organic acids total quant","code_information":[{"code":"83918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.6,"maximum":110.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":23.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":98.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110.39,"additional_payer_notes":"APC"}]}]},{"description":"Organic acids qual each","code_information":[{"code":"83919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.45,"maximum":76.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.94,"additional_payer_notes":"APC"}]}]},{"description":"Organic acid single quant","code_information":[{"code":"83921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.21,"maximum":99.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":88.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99.21,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood osmolality","code_information":[{"code":"83930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.61,"maximum":30.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine osmolality","code_information":[{"code":"83935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.82,"maximum":31.90,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31.9,"additional_payer_notes":"APC"}]}]},{"description":"Assay of osteocalcin","code_information":[{"code":"83937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.85,"maximum":139.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":124.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139.62,"additional_payer_notes":"APC"}]}]},{"description":"Assay of oxalate","code_information":[{"code":"83945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.45,"maximum":67.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.59,"additional_payer_notes":"APC"}]}]},{"description":"Oncoprotein her-2/neu","code_information":[{"code":"83950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":301.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":268.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":301.28,"additional_payer_notes":"APC"}]}]},{"description":"Oncoprotein dcp","code_information":[{"code":"83951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":301.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":268.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":301.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of parathormone","code_information":[{"code":"83970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.28,"maximum":193.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":41.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":171.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":193.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay ph body fluid nos","code_information":[{"code":"83986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.58,"maximum":16.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled breath condensate","code_information":[{"code":"83987","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.58,"maximum":16.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay for calprotectin fecal","code_information":[{"code":"83993","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.63,"maximum":91.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood pku","code_information":[{"code":"84030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.5,"maximum":25.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenylketones","code_information":[{"code":"84035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.98,"maximum":18.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"}]}]},{"description":"Assay acid phosphatase","code_information":[{"code":"84060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.64,"maximum":35.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay prostate phosphatase","code_information":[{"code":"84066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.66,"maximum":45.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.18,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatase","code_information":[{"code":"84075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":24.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatase","code_information":[{"code":"84078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.26,"maximum":38.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatases","code_information":[{"code":"84080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.78,"maximum":69.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay phosphatidylglycerol","code_information":[{"code":"84081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.52,"maximum":77.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77.27,"additional_payer_notes":"APC"}]}]},{"description":"Assay of rbc pg6d enzyme","code_information":[{"code":"84085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":44.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay phosphohexose enzymes","code_information":[{"code":"84087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.73,"maximum":50.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.19,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phosphorus","code_information":[{"code":"84100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.74,"maximum":22.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine phosphorus","code_information":[{"code":"84105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.78,"maximum":27.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27.04,"additional_payer_notes":"APC"}]}]},{"description":"Test for porphobilinogen","code_information":[{"code":"84106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.82,"maximum":27.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"APC"}]}]},{"description":"Assay of porphobilinogen","code_information":[{"code":"84110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.44,"maximum":39.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39.48,"additional_payer_notes":"APC"}]}]},{"description":"Eval amniotic fluid protein","code_information":[{"code":"84112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.11,"maximum":458.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":147.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":98.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":408.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":458.91,"additional_payer_notes":"APC"}]}]},{"description":"Test urine for porphyrins","code_information":[{"code":"84119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.36,"maximum":62.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.49,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine porphyrins","code_information":[{"code":"84120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.71,"maximum":68.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces porphyrins","code_information":[{"code":"84126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.11,"maximum":182.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":39.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":162.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":182.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum potassium","code_information":[{"code":"84132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.76,"maximum":22.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine potassium","code_information":[{"code":"84133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.73,"maximum":22.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prealbumin","code_information":[{"code":"84134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.59,"maximum":68.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.24,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnanediol","code_information":[{"code":"84135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.27,"maximum":99.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":88.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99.49,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnanetriol","code_information":[{"code":"84138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.05,"maximum":98.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":87.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98.46,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnenolone","code_information":[{"code":"84140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.67,"maximum":96.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96.68,"additional_payer_notes":"APC"}]}]},{"description":"Assay of 17-hydroxypregneno","code_information":[{"code":"84143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.81,"maximum":106.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.27,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":94.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone","code_information":[{"code":"84144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.86,"maximum":97.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.57,"additional_payer_notes":"APC"}]}]},{"description":"Procalcitonin (PCT)","code_information":[{"code":"84145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.22,"maximum":127.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":113.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127.32,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prolactin","code_information":[{"code":"84146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.38,"maximum":90.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prostaglandin","code_information":[{"code":"84150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.77,"maximum":195.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":41.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.38,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa complexed","code_information":[{"code":"84152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.39,"maximum":86.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa total","code_information":[{"code":"84153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.39,"maximum":86.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa free","code_information":[{"code":"84154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.39,"maximum":86.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein serum","code_information":[{"code":"84155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.67,"maximum":17.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein urine","code_information":[{"code":"84156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.67,"maximum":17.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein other","code_information":[{"code":"84157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.0,"maximum":18.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein any source","code_information":[{"code":"84160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.61,"maximum":26.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"APC"}]}]},{"description":"Pappa serum","code_information":[{"code":"84163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":70.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.4,"additional_payer_notes":"APC"}]}]},{"description":"Protein e-phoresis serum","code_information":[{"code":"84165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":50.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.24,"additional_payer_notes":"APC"}]}]},{"description":"Protein e-phoresis/urine/csf","code_information":[{"code":"84166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.83,"maximum":83.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.4,"additional_payer_notes":"APC"}]}]},{"description":"Western blot test","code_information":[{"code":"84181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.03,"maximum":79.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.37,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.66,"additional_payer_notes":"APC"}]}]},{"description":"Protein western blot test","code_information":[{"code":"84182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.21,"maximum":136.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay RBC protoporphyrin","code_information":[{"code":"84202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.35,"maximum":67.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.64,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.12,"additional_payer_notes":"APC"}]}]},{"description":"Test RBC protoporphyrin","code_information":[{"code":"84203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.74,"maximum":45.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay of proinsulin","code_information":[{"code":"84206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.69,"maximum":124.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-6","code_information":[{"code":"84207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.1,"maximum":131.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42.15,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":28.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":117.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pyruvate","code_information":[{"code":"84210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.48,"maximum":67.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pyruvate kinase","code_information":[{"code":"84220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":44.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of quinine","code_information":[{"code":"84228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.63,"maximum":54.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.4,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogen","code_information":[{"code":"84233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.88,"maximum":411.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":131.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89.64,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":87.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":365.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":411.06,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone","code_information":[{"code":"84234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.88,"maximum":303.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":97.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.18,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":64.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":270.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":303.48,"additional_payer_notes":"APC"}]}]},{"description":"Assay of endocrine hormone","code_information":[{"code":"84235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.23,"maximum":333.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":106.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":71.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":296.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":333.18,"additional_payer_notes":"APC"}]}]},{"description":"Assay nonendocrine receptor","code_information":[{"code":"84238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.57,"maximum":171.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":152.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171.06,"additional_payer_notes":"APC"}]}]},{"description":"Assay of renin","code_information":[{"code":"84244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.99,"maximum":102.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102.86,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-2","code_information":[{"code":"84252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.24,"maximum":94.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":84.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay of selenium","code_information":[{"code":"84255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.53,"maximum":119.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.04,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":106.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serotonin","code_information":[{"code":"84260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.98,"maximum":144.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":30.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":129.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sex hormone globul","code_information":[{"code":"84270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.73,"maximum":101.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sialic acid","code_information":[{"code":"84275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.44,"maximum":62.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.87,"additional_payer_notes":"APC"}]}]},{"description":"Assay of silica","code_information":[{"code":"84285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.21,"maximum":117.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":104.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum sodium","code_information":[{"code":"84295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.81,"maximum":22.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine sodium","code_information":[{"code":"84300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.06,"maximum":23.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sweat sodium","code_information":[{"code":"84302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.86,"maximum":22.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of somatomedin","code_information":[{"code":"84305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.26,"maximum":99.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":88.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay of somatostatin","code_information":[{"code":"84307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.28,"maximum":85.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85.5,"additional_payer_notes":"APC"}]}]},{"description":"Spectrophotometry","code_information":[{"code":"84311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.1,"maximum":37.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.15,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.89,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid specific gravity","code_information":[{"code":"84315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.28,"maximum":15.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15.34,"additional_payer_notes":"APC"}]}]},{"description":"Chromatogram assay sugars","code_information":[{"code":"84375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":182.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":162.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"}]}]},{"description":"Sugars single qual","code_information":[{"code":"84376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.5,"maximum":25.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25.73,"additional_payer_notes":"APC"}]}]},{"description":"Sugars multiple qual","code_information":[{"code":"84377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.5,"maximum":25.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25.73,"additional_payer_notes":"APC"}]}]},{"description":"Sugars single quant","code_information":[{"code":"84378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":53.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"}]}]},{"description":"Sugars multiple quant","code_information":[{"code":"84379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":53.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine sulfate","code_information":[{"code":"84392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.49,"maximum":25.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25.68,"additional_payer_notes":"APC"}]}]},{"description":"Tau phosphorylated ea","code_information":[{"code":"84393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":603.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":193.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":536.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":603.02,"additional_payer_notes":"APC"}]}]},{"description":"Total tau","code_information":[{"code":"84394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":603.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":193.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":536.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":603.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay of free testosterone","code_information":[{"code":"84402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.47,"maximum":119.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":106.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of total testosterone","code_information":[{"code":"84403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.81,"maximum":120.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":107.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120.73,"additional_payer_notes":"APC"}]}]},{"description":"Testosterone bioavailable","code_information":[{"code":"84410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.28,"maximum":239.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":213.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":239.86,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-1","code_information":[{"code":"84425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.23,"maximum":99.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":88.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thiocyanate","code_information":[{"code":"84430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.63,"maximum":54.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.4,"additional_payer_notes":"APC"}]}]},{"description":"Thromboxane urine","code_information":[{"code":"84431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.11,"maximum":164.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroglobulin","code_information":[{"code":"84432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.06,"maximum":75.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75.12,"additional_payer_notes":"APC"}]}]},{"description":"Asy thiopurin s-mthyltrnsfrs","code_information":[{"code":"84433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.17,"maximum":103.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":92.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay of total thyroxine","code_information":[{"code":"84436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.87,"maximum":32.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay of neonatal thyroxine","code_information":[{"code":"84437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":30.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of free thyroxine","code_information":[{"code":"84439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.02,"maximum":42.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42.19,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroid activity","code_information":[{"code":"84442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.78,"maximum":69.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay thyroid stim hormone","code_information":[{"code":"84443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.8,"maximum":78.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.58,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tsi globulin","code_information":[{"code":"84445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.86,"maximum":237.90,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":211.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237.9,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin e","code_information":[{"code":"84446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.18,"maximum":66.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay of transcortin","code_information":[{"code":"84449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.0,"maximum":84.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.2,"additional_payer_notes":"APC"}]}]},{"description":"Transferase (AST) (SGOT)","code_information":[{"code":"84450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":24.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.23,"additional_payer_notes":"APC"}]}]},{"description":"Alanine amino (ALT) (SGPT)","code_information":[{"code":"84460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.3,"maximum":24.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of transferrin","code_information":[{"code":"84466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.76,"maximum":59.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.68,"additional_payer_notes":"APC"}]}]},{"description":"Assay of triglycerides","code_information":[{"code":"84478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.74,"maximum":26.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroid (t3 or t4)","code_information":[{"code":"84479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":30.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay triiodothyronine (t3)","code_information":[{"code":"84480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.18,"maximum":66.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.33,"additional_payer_notes":"APC"}]}]},{"description":"Free assay (FT-3)","code_information":[{"code":"84481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.94,"maximum":79.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.24,"additional_payer_notes":"APC"}]}]},{"description":"T3 reverse","code_information":[{"code":"84482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.76,"maximum":73.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":65.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73.72,"additional_payer_notes":"APC"}]}]},{"description":"Assay of troponin quant","code_information":[{"code":"84484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.47,"maximum":58.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay duodenal fluid trypsin","code_information":[{"code":"84485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.2,"maximum":33.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33.68,"additional_payer_notes":"APC"}]}]},{"description":"Test feces for trypsin","code_information":[{"code":"84488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.3,"maximum":34.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces for trypsin","code_information":[{"code":"84490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.93,"maximum":46.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46.45,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tyrosine","code_information":[{"code":"84510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.63,"maximum":49.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.72,"additional_payer_notes":"APC"}]}]},{"description":"Assay of troponin qual","code_information":[{"code":"84512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.09,"maximum":47.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urea nitrogen","code_information":[{"code":"84520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.95,"maximum":18.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"}]}]},{"description":"Urea nitrogen semi-quant","code_information":[{"code":"84525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.13,"maximum":24.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.0,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine/urea-n","code_information":[{"code":"84540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.56,"maximum":26.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.01,"additional_payer_notes":"APC"}]}]},{"description":"Urea-N clearance test","code_information":[{"code":"84545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.2,"maximum":33.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33.68,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood/uric acid","code_information":[{"code":"84550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.52,"maximum":21.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine/uric acid","code_information":[{"code":"84560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.08,"maximum":23.76,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces/urobilinogen","code_information":[{"code":"84577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.8,"maximum":78.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":69.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.58,"additional_payer_notes":"APC"}]}]},{"description":"Test urine urobilinogen","code_information":[{"code":"84578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.47,"maximum":20.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine urobilinogen","code_information":[{"code":"84580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.55,"maximum":44.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine urobilinogen","code_information":[{"code":"84583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.05,"maximum":28.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine vma","code_information":[{"code":"84585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.5,"maximum":72.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vip","code_information":[{"code":"84586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.33,"maximum":165.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.04,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":147.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vasopressin","code_information":[{"code":"84588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.94,"maximum":158.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":33.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":141.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin a","code_information":[{"code":"84590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.61,"maximum":54.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Nos Vitamin","code_information":[{"code":"84591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.06,"maximum":79.80,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.8,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin k","code_information":[{"code":"84597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.72,"maximum":64.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.18,"additional_payer_notes":"APC"}]}]},{"description":"Assay of volatiles","code_information":[{"code":"84600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.11,"maximum":80.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.03,"additional_payer_notes":"APC"}]}]},{"description":"Xylose tolerance test","code_information":[{"code":"84620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.91,"maximum":60.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of zinc","code_information":[{"code":"84630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.39,"maximum":53.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of c-peptide","code_information":[{"code":"84681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":97.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.34,"additional_payer_notes":"APC"}]}]},{"description":"Chorionic gonadotropin test","code_information":[{"code":"84702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":70.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.4,"additional_payer_notes":"APC"}]}]},{"description":"Chorionic gonadotropin assay","code_information":[{"code":"84703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.52,"maximum":35.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35.17,"additional_payer_notes":"APC"}]}]},{"description":"Hcg free betachain test","code_information":[{"code":"84704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.29,"maximum":71.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.52,"additional_payer_notes":"APC"}]}]},{"description":"Ovulation tests","code_information":[{"code":"84830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.7,"maximum":59.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.4,"additional_payer_notes":"APC"}]}]},{"description":"Bleeding time test","code_information":[{"code":"85002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.82,"maximum":22.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.55,"additional_payer_notes":"APC"}]}]},{"description":"Automated diff wbc count","code_information":[{"code":"85004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":30.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"}]}]},{"description":"Bl smear w/diff wbc count","code_information":[{"code":"85007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.8,"maximum":17.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17.77,"additional_payer_notes":"APC"}]}]},{"description":"Bl smear w/o diff wbc count","code_information":[{"code":"85008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.43,"maximum":16.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16.04,"additional_payer_notes":"APC"}]}]},{"description":"Manual diff wbc count b-coat","code_information":[{"code":"85009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.07,"maximum":23.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.71,"additional_payer_notes":"APC"}]}]},{"description":"Spun microhematocrit","code_information":[{"code":"85013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.0,"maximum":32.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32.74,"additional_payer_notes":"APC"}]}]},{"description":"Hematocrit","code_information":[{"code":"85014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.37,"maximum":11.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11.09,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin","code_information":[{"code":"85018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.37,"maximum":11.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11.09,"additional_payer_notes":"APC"}]}]},{"description":"Complete cbc w/auto diff wbc","code_information":[{"code":"85025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.77,"maximum":36.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.34,"additional_payer_notes":"APC"}]}]},{"description":"Complete cbc automated","code_information":[{"code":"85027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":30.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"}]}]},{"description":"Manual cell count each","code_information":[{"code":"85032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.31,"maximum":20.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"APC"}]}]},{"description":"Automated rbc count","code_information":[{"code":"85041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.02,"maximum":14.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"}]}]},{"description":"Manual reticulocyte count","code_information":[{"code":"85044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.31,"maximum":20.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"APC"}]}]},{"description":"Automated reticulocyte count","code_information":[{"code":"85045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.99,"maximum":18.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"APC"}]}]},{"description":"Reticyte/hgb concentrate","code_information":[{"code":"85046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.57,"maximum":26.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.05,"additional_payer_notes":"APC"}]}]},{"description":"Automated leukocyte count","code_information":[{"code":"85048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.54,"maximum":11.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.59,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"}]}]},{"description":"Automated platelet count","code_information":[{"code":"85049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.48,"maximum":20.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"}]}]},{"description":"Reticulated platelet assay","code_information":[{"code":"85055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.74,"maximum":167.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":148.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167.17,"additional_payer_notes":"APC"}]}]},{"description":"Chromogenic substrate assay","code_information":[{"code":"85130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.89,"maximum":55.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55.62,"additional_payer_notes":"APC"}]}]},{"description":"Blood clot retraction","code_information":[{"code":"85170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.3,"maximum":76.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.24,"additional_payer_notes":"APC"}]}]},{"description":"Blood clot lysis time","code_information":[{"code":"85175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.37,"maximum":95.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":84.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95.28,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor ii prothrom spec","code_information":[{"code":"85210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.98,"maximum":60.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.71,"additional_payer_notes":"APC"}]}]},{"description":"Blooc clot factor v test","code_information":[{"code":"85220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.65,"maximum":82.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":73.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82.56,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor vii proconvertin","code_information":[{"code":"85230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":83.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.73,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii ahg 1 stage","code_information":[{"code":"85240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":83.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.73,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii reltd antgn","code_information":[{"code":"85244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.42,"maximum":95.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.83,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95.51,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii vw ristoctn","code_information":[{"code":"85245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.94,"maximum":107.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":95.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107.3,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii vw antigen","code_information":[{"code":"85246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.94,"maximum":107.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":95.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107.3,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii multimetric","code_information":[{"code":"85247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.94,"maximum":107.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":95.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107.3,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor ix ptc/chrstmas","code_information":[{"code":"85250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.04,"maximum":89.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":79.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89.06,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor x stuart-power","code_information":[{"code":"85260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":83.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.73,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xi pta","code_information":[{"code":"85270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":83.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.73,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xii hageman","code_information":[{"code":"85280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":90.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90.51,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xiii fibrin stab","code_information":[{"code":"85290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.34,"maximum":76.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.43,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xiii fibrin scrn","code_information":[{"code":"85291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.11,"maximum":42.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42.61,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor fletcher fact","code_information":[{"code":"85292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.93,"maximum":88.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88.55,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor wght kininogen","code_information":[{"code":"85293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.93,"maximum":88.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88.55,"additional_payer_notes":"APC"}]}]},{"description":"Antithrombin iii activity","code_information":[{"code":"85300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.85,"maximum":55.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55.43,"additional_payer_notes":"APC"}]}]},{"description":"Antithrombin iii antigen","code_information":[{"code":"85301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.81,"maximum":50.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":45.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.56,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot c antigen","code_information":[{"code":"85302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.01,"maximum":56.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.18,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot c activity","code_information":[{"code":"85303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.84,"maximum":64.74,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.74,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot s total","code_information":[{"code":"85305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.61,"maximum":54.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.31,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot s free","code_information":[{"code":"85306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.32,"maximum":71.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.66,"additional_payer_notes":"APC"}]}]},{"description":"Assay Activated Protein C","code_information":[{"code":"85307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.32,"maximum":71.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.66,"additional_payer_notes":"APC"}]}]},{"description":"Factor inhibitor test","code_information":[{"code":"85335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":60.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.2,"additional_payer_notes":"APC"}]}]},{"description":"Thrombomodulin","code_information":[{"code":"85337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":80.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.78,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time lee & white","code_information":[{"code":"85345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.69,"maximum":21.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21.94,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time activated","code_information":[{"code":"85347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.28,"maximum":20.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.37,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time otr method","code_information":[{"code":"85348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.49,"maximum":21.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21.0,"additional_payer_notes":"APC"}]}]},{"description":"Euglobulin lysis","code_information":[{"code":"85360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.41,"maximum":39.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradation products","code_information":[{"code":"85362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.89,"maximum":32.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.03,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32.23,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen test","code_information":[{"code":"85366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.46,"maximum":376.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":80.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":335.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":376.35,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen test","code_information":[{"code":"85370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.43,"maximum":58.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.14,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degrade semiquant","code_information":[{"code":"85378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.72,"maximum":45.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.47,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradation quant","code_information":[{"code":"85379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":47.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47.62,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradj d-dimer","code_information":[{"code":"85380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":47.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47.62,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen activity","code_information":[{"code":"85384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.72,"maximum":45.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.47,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen antigen","code_information":[{"code":"85385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.46,"maximum":67.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.64,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolysins screen i&r","code_information":[{"code":"85390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.48,"maximum":72.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.41,"additional_payer_notes":"APC"}]}]},{"description":"Clotting funct activity","code_information":[{"code":"85397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.86,"maximum":144.35,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":30.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":128.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144.35,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasmin","code_information":[{"code":"85400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.71,"maximum":36.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic antiplasmin","code_information":[{"code":"85410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.71,"maximum":36.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.19,"maximum":80.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.41,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.53,"maximum":30.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.54,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":47.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47.62,"additional_payer_notes":"APC"}]}]},{"description":"Heinz bodies direct","code_information":[{"code":"85441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.2,"maximum":19.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"}]}]},{"description":"Heinz bodies induced","code_information":[{"code":"85445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.82,"maximum":31.90,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31.9,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin fetal","code_information":[{"code":"85460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.73,"maximum":36.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.16,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin fetal","code_information":[{"code":"85461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.36,"maximum":43.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43.78,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysin acid","code_information":[{"code":"85475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.87,"maximum":41.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41.49,"additional_payer_notes":"APC"}]}]},{"description":"Heparin assay","code_information":[{"code":"85520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.09,"maximum":61.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.23,"additional_payer_notes":"APC"}]}]},{"description":"Heparin neutralization","code_information":[{"code":"85525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.84,"maximum":55.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55.38,"additional_payer_notes":"APC"}]}]},{"description":"Heparin-protamine tolerance","code_information":[{"code":"85530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.09,"maximum":61.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.23,"additional_payer_notes":"APC"}]}]},{"description":"Iron Stain Peripheral Blood","code_information":[{"code":"85536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.88,"maximum":32.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32.18,"additional_payer_notes":"APC"}]}]},{"description":"Wbc alkaline phosphatase","code_information":[{"code":"85540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.6,"maximum":40.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.23,"additional_payer_notes":"APC"}]}]},{"description":"RBC mechanical fragility","code_information":[{"code":"85547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.6,"maximum":40.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.23,"additional_payer_notes":"APC"}]}]},{"description":"Muramidase","code_information":[{"code":"85549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.75,"maximum":87.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":78.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.7,"additional_payer_notes":"APC"}]}]},{"description":"RBC osmotic fragility","code_information":[{"code":"85555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.47,"maximum":34.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34.94,"additional_payer_notes":"APC"}]}]},{"description":"RBC osmotic fragility","code_information":[{"code":"85557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.36,"maximum":62.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.49,"additional_payer_notes":"APC"}]}]},{"description":"Blood platelet aggregation","code_information":[{"code":"85576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.91,"maximum":116.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116.52,"additional_payer_notes":"APC"}]}]},{"description":"Phospholipid pltlt neutraliz","code_information":[{"code":"85597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":84.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.1,"additional_payer_notes":"APC"}]}]},{"description":"Hexagnal phosph pltlt neutrl","code_information":[{"code":"85598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":84.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.1,"additional_payer_notes":"APC"}]}]},{"description":"Prothrombin time","code_information":[{"code":"85610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.29,"maximum":20.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"}]}]},{"description":"Prothrombin test","code_information":[{"code":"85611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.94,"maximum":18.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.43,"additional_payer_notes":"APC"}]}]},{"description":"Viper venom prothrombin time","code_information":[{"code":"85612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.49,"maximum":81.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":72.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81.81,"additional_payer_notes":"APC"}]}]},{"description":"Russell viper venom diluted","code_information":[{"code":"85613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.58,"maximum":44.81,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.81,"additional_payer_notes":"APC"}]}]},{"description":"Reptilase test","code_information":[{"code":"85635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.85,"maximum":46.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46.07,"additional_payer_notes":"APC"}]}]},{"description":"Rbc sed rate nonautomated","code_information":[{"code":"85651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":19.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"}]}]},{"description":"Rbc sed rate automated","code_information":[{"code":"85652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.7,"maximum":12.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.75,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":2.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12.63,"additional_payer_notes":"APC"}]}]},{"description":"RBC sickle cell test","code_information":[{"code":"85660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.51,"maximum":25.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25.77,"additional_payer_notes":"APC"}]}]},{"description":"Thrombin time plasma","code_information":[{"code":"85670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.77,"maximum":26.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.99,"additional_payer_notes":"APC"}]}]},{"description":"Thrombin time titer","code_information":[{"code":"85675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.85,"maximum":32.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32.04,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin inhibition","code_information":[{"code":"85705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.63,"maximum":45.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.04,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin time partial","code_information":[{"code":"85730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.01,"maximum":28.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28.11,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin time partial","code_information":[{"code":"85732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":30.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"}]}]},{"description":"Blood viscosity examination","code_information":[{"code":"85810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.67,"maximum":54.59,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.59,"additional_payer_notes":"APC"}]}]},{"description":"Agglutinins febrile antigen","code_information":[{"code":"86000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.98,"maximum":32.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32.65,"additional_payer_notes":"APC"}]}]},{"description":"Allergen Specific Igg","code_information":[{"code":"86001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.82,"maximum":36.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.58,"additional_payer_notes":"APC"}]}]},{"description":"Allergen specific IgE","code_information":[{"code":"86003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.22,"maximum":24.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.42,"additional_payer_notes":"APC"}]}]},{"description":"Allergen specific IgE","code_information":[{"code":"86005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.97,"maximum":37.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.28,"additional_payer_notes":"APC"}]}]},{"description":"Allg spec ige recomb ea","code_information":[{"code":"86008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.93,"maximum":83.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.87,"additional_payer_notes":"APC"}]}]},{"description":"Actin antibody each","code_information":[{"code":"86015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"WBC antibody identification","code_information":[{"code":"86021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":70.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.4,"additional_payer_notes":"APC"}]}]},{"description":"Platelet antibodies","code_information":[{"code":"86022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.37,"maximum":85.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85.93,"additional_payer_notes":"APC"}]}]},{"description":"Immunoglobulin assay","code_information":[{"code":"86023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.46,"maximum":58.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.28,"additional_payer_notes":"APC"}]}]},{"description":"Anca screen each antibody","code_information":[{"code":"86036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Anca titer each antibody","code_information":[{"code":"86037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Antinuclear antibodies","code_information":[{"code":"86038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.09,"maximum":56.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.55,"additional_payer_notes":"APC"}]}]},{"description":"Antinuclear antibodies (ANA)","code_information":[{"code":"86039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.16,"maximum":52.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52.2,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr bndng antb","code_information":[{"code":"86041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":86.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.07,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr blckg antb","code_information":[{"code":"86042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":86.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.07,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr modlg antb","code_information":[{"code":"86043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Aquaporin-4 antb elisa","code_information":[{"code":"86051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":53.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"}]}]},{"description":"Aquaporin-4 antb cba each","code_information":[{"code":"86052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Aqaprn-4 antb flo cytmtry ea","code_information":[{"code":"86053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":176.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":157.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"}]}]},{"description":"Antistreptolysin o titer","code_information":[{"code":"86060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.3,"maximum":34.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34.15,"additional_payer_notes":"APC"}]}]},{"description":"Antistreptolysin o screen","code_information":[{"code":"86063","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.77,"maximum":26.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.99,"additional_payer_notes":"APC"}]}]},{"description":"C-reactive protein","code_information":[{"code":"86140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":24.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.23,"additional_payer_notes":"APC"}]}]},{"description":"C-reactive protein hs","code_information":[{"code":"86141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.95,"maximum":60.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.57,"additional_payer_notes":"APC"}]}]},{"description":"Beta-2 glycoprotein antibody","code_information":[{"code":"86146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.45,"maximum":119.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":105.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.04,"additional_payer_notes":"APC"}]}]},{"description":"Cardiolipin antibody ea ig","code_information":[{"code":"86147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.45,"maximum":119.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":105.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.04,"additional_payer_notes":"APC"}]}]},{"description":"Anti-phospholipid antibody","code_information":[{"code":"86148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.07,"maximum":75.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75.17,"additional_payer_notes":"APC"}]}]},{"description":"Cell enumeration & id","code_information":[{"code":"86152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.78,"maximum":1173.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":376.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":255.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":250.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1044.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1173.02,"additional_payer_notes":"APC"}]}]},{"description":"Chemotaxis assay","code_information":[{"code":"86155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.99,"maximum":74.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.79,"additional_payer_notes":"APC"}]}]},{"description":"Cold agglutinin screen","code_information":[{"code":"86156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.07,"maximum":37.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.75,"additional_payer_notes":"APC"}]}]},{"description":"Cold agglutinin titer","code_information":[{"code":"86157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.06,"maximum":37.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.7,"additional_payer_notes":"APC"}]}]},{"description":"Complement antigen","code_information":[{"code":"86160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.0,"maximum":56.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.13,"additional_payer_notes":"APC"}]}]},{"description":"Complement/function activity","code_information":[{"code":"86161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.0,"maximum":56.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.13,"additional_payer_notes":"APC"}]}]},{"description":"Complement total (ch50)","code_information":[{"code":"86162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.32,"maximum":95.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":84.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95.05,"additional_payer_notes":"APC"}]}]},{"description":"Complement fixation each","code_information":[{"code":"86171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.01,"maximum":46.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46.82,"additional_payer_notes":"APC"}]}]},{"description":"Ccp antibody","code_information":[{"code":"86200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.95,"maximum":60.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.57,"additional_payer_notes":"APC"}]}]},{"description":"Deoxyribonuclease antibody","code_information":[{"code":"86215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":61.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"}]}]},{"description":"Dna antibody native","code_information":[{"code":"86225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.74,"maximum":64.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.27,"additional_payer_notes":"APC"}]}]},{"description":"Dna antibody single strand","code_information":[{"code":"86226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":56.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.64,"additional_payer_notes":"APC"}]}]},{"description":"Ema each ig class","code_information":[{"code":"86231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.09,"maximum":56.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.55,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear antigen antibody","code_information":[{"code":"86235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.93,"maximum":83.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83.87,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescent antibody screen","code_information":[{"code":"86255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescent antibody titer","code_information":[{"code":"86256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Dgp antibody each ig class","code_information":[{"code":"86258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone antibody","code_information":[{"code":"86277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.74,"maximum":73.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":65.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73.62,"additional_payer_notes":"APC"}]}]},{"description":"Hemagglutination inhibition","code_information":[{"code":"86280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.19,"maximum":38.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38.31,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor qual","code_information":[{"code":"86294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.57,"maximum":119.60,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":106.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.6,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 15-3","code_information":[{"code":"86300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":97.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.34,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 19-9","code_information":[{"code":"86301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":97.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.34,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 125","code_information":[{"code":"86304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":97.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.34,"additional_payer_notes":"APC"}]}]},{"description":"Human epididymis protein 4","code_information":[{"code":"86305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":97.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.34,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody screen","code_information":[{"code":"86308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":24.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.23,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody titer","code_information":[{"code":"86309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":30.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody absrbj","code_information":[{"code":"86310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.37,"maximum":34.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34.47,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor other","code_information":[{"code":"86316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":97.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":86.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97.34,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay infectious agent","code_information":[{"code":"86317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.99,"maximum":70.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.12,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay infectious agent","code_information":[{"code":"86318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.09,"maximum":84.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.62,"additional_payer_notes":"APC"}]}]},{"description":"Serum immunoelectrophoresis","code_information":[{"code":"86320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.92,"maximum":139.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":124.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139.95,"additional_payer_notes":"APC"}]}]},{"description":"Other immunoelectrophoresis","code_information":[{"code":"86325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.13,"maximum":108.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.59,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":23.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108.19,"additional_payer_notes":"APC"}]}]},{"description":"Ia nfct ab sarscov2 covid19","code_information":[{"code":"86328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.28,"maximum":211.80,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":45.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":188.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":211.8,"additional_payer_notes":"APC"}]}]},{"description":"Immunodiffusion nes","code_information":[{"code":"86329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.05,"maximum":65.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65.72,"additional_payer_notes":"APC"}]}]},{"description":"Immunodiffusion ouchterlony","code_information":[{"code":"86331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Immune complex assay","code_information":[{"code":"86332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.37,"maximum":113.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":101.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113.99,"additional_payer_notes":"APC"}]}]},{"description":"Immunofix e-phoresis serum","code_information":[{"code":"86334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.34,"maximum":104.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":93.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104.5,"additional_payer_notes":"APC"}]}]},{"description":"Immunfix e-phorsis/urine/csf","code_information":[{"code":"86335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.35,"maximum":137.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137.28,"additional_payer_notes":"APC"}]}]},{"description":"Inhibin A","code_information":[{"code":"86336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.59,"maximum":72.92,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.92,"additional_payer_notes":"APC"}]}]},{"description":"Insulin antibodies","code_information":[{"code":"86337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.41,"maximum":100.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100.15,"additional_payer_notes":"APC"}]}]},{"description":"Intrinsic factor antibody","code_information":[{"code":"86340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.08,"maximum":70.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.54,"additional_payer_notes":"APC"}]}]},{"description":"Islet cell antibody","code_information":[{"code":"86341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.57,"maximum":110.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.04,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":98.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110.25,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte histamine release","code_information":[{"code":"86343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.46,"maximum":58.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.28,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte phagocytosis","code_information":[{"code":"86344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.39,"maximum":48.60,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.6,"additional_payer_notes":"APC"}]}]},{"description":"Cell function assay w/stim","code_information":[{"code":"86352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.86,"maximum":635.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":203.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":135.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":565.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":635.49,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocyte transformation","code_information":[{"code":"86353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.03,"maximum":229.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":49.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":204.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":229.34,"additional_payer_notes":"APC"}]}]},{"description":"B cells total count","code_information":[{"code":"86355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":176.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":157.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"}]}]},{"description":"Mononuclear cell antigen","code_information":[{"code":"86356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.78,"maximum":125.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125.26,"additional_payer_notes":"APC"}]}]},{"description":"Nk cells total count","code_information":[{"code":"86357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":176.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":157.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"}]}]},{"description":"T cells total count","code_information":[{"code":"86359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":176.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":157.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"}]}]},{"description":"T cell absolute count/ratio","code_information":[{"code":"86360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.98,"maximum":219.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.92,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":46.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":195.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"}]}]},{"description":"T cell absolute count","code_information":[{"code":"86361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.78,"maximum":125.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125.26,"additional_payer_notes":"APC"}]}]},{"description":"Mog-igg1 antb cba each","code_information":[{"code":"86362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Mog-igg1 antb flo cytmtry ea","code_information":[{"code":"86363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":176.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":157.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"}]}]},{"description":"Tiss trnsgltmnase ea ig clas","code_information":[{"code":"86364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":53.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-specific kinase antb","code_information":[{"code":"86366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":86.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.07,"additional_payer_notes":"APC"}]}]},{"description":"Stem cells total count","code_information":[{"code":"86367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.78,"maximum":363.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":116.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":77.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":323.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":363.82,"additional_payer_notes":"APC"}]}]},{"description":"Microsomal antibody each","code_information":[{"code":"86376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.55,"maximum":68.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.06,"additional_payer_notes":"APC"}]}]},{"description":"Mitochondrial antibody each","code_information":[{"code":"86381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.45,"maximum":119.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":105.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119.04,"additional_payer_notes":"APC"}]}]},{"description":"Neutralization test viral","code_information":[{"code":"86382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.91,"maximum":79.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.25,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.1,"additional_payer_notes":"APC"}]}]},{"description":"Nitroblue tetrazolium dye","code_information":[{"code":"86384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.61,"maximum":63.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63.66,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear matrix protein 22","code_information":[{"code":"86386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.78,"maximum":101.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101.88,"additional_payer_notes":"APC"}]}]},{"description":"Particle agglut antbdy scrn","code_information":[{"code":"86403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.54,"maximum":53.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.98,"additional_payer_notes":"APC"}]}]},{"description":"Particle agglut antbdy titr","code_information":[{"code":"86406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.64,"maximum":49.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.77,"additional_payer_notes":"APC"}]}]},{"description":"Neutrlzg antb sarscov2 scr","code_information":[{"code":"86408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.13,"maximum":197.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":175.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197.06,"additional_payer_notes":"APC"}]}]},{"description":"Neutrlzg antb sarscov2 titer","code_information":[{"code":"86409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.61,"maximum":372.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":119.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":79.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":331.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":372.38,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 antb quantitative","code_information":[{"code":"86413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.43,"maximum":240.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":214.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":240.56,"additional_payer_notes":"APC"}]}]},{"description":"Rheumatoid factor test qual","code_information":[{"code":"86430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.14,"maximum":28.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28.72,"additional_payer_notes":"APC"}]}]},{"description":"Rheumatoid factor quant","code_information":[{"code":"86431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.67,"maximum":26.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.52,"additional_payer_notes":"APC"}]}]},{"description":"Tb test cell immun measure","code_information":[{"code":"86480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.98,"maximum":289.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":258.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":289.91,"additional_payer_notes":"APC"}]}]},{"description":"Tb ag response t-cell susp","code_information":[{"code":"86481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.0,"maximum":467.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":150.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":100.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":416.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":467.75,"additional_payer_notes":"APC"}]}]},{"description":"Strptcs pneum antb serot ia","code_information":[{"code":"86581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.03,"maximum":430.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":138.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":92.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":383.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":430.47,"additional_payer_notes":"APC"}]}]},{"description":"Streptokinase antibody","code_information":[{"code":"86590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.66,"maximum":59.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.22,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis test non-trep qual","code_information":[{"code":"86592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":19.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis test non-trep quant","code_information":[{"code":"86593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.4,"maximum":20.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.58,"additional_payer_notes":"APC"}]}]},{"description":"Voltage-gtd ca chnl antb ea","code_information":[{"code":"86596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Antinomyces antibody","code_information":[{"code":"86602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":47.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47.62,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus antibody","code_information":[{"code":"86603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":60.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.2,"additional_payer_notes":"APC"}]}]},{"description":"Aspergillus antibody","code_information":[{"code":"86606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":70.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.4,"additional_payer_notes":"APC"}]}]},{"description":"Bacterium antibody","code_information":[{"code":"86609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":60.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.25,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella Antibody","code_information":[{"code":"86611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":47.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47.62,"additional_payer_notes":"APC"}]}]},{"description":"Blastomyces antibody","code_information":[{"code":"86612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.9,"maximum":60.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.34,"additional_payer_notes":"APC"}]}]},{"description":"Bordetella antibody","code_information":[{"code":"86615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Lyme disease antibody","code_information":[{"code":"86617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.49,"maximum":72.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.45,"additional_payer_notes":"APC"}]}]},{"description":"Lyme disease antibody","code_information":[{"code":"86618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.03,"maximum":79.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.37,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.66,"additional_payer_notes":"APC"}]}]},{"description":"Borrelia antibody","code_information":[{"code":"86619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.38,"maximum":62.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.58,"additional_payer_notes":"APC"}]}]},{"description":"Brucella antibody","code_information":[{"code":"86622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.93,"maximum":41.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41.77,"additional_payer_notes":"APC"}]}]},{"description":"Campylobacter antibody","code_information":[{"code":"86625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.12,"maximum":61.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.37,"additional_payer_notes":"APC"}]}]},{"description":"Candida antibody","code_information":[{"code":"86628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.01,"maximum":56.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.18,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia antibody","code_information":[{"code":"86631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.82,"maximum":55.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.06,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55.29,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia igm antibody","code_information":[{"code":"86632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.68,"maximum":59.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.31,"additional_payer_notes":"APC"}]}]},{"description":"Coccidioides antibody","code_information":[{"code":"86635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.47,"maximum":53.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.65,"additional_payer_notes":"APC"}]}]},{"description":"Q fever antibody","code_information":[{"code":"86638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.12,"maximum":56.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.69,"additional_payer_notes":"APC"}]}]},{"description":"Cryptococcus antibody","code_information":[{"code":"86641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.41,"maximum":67.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.4,"additional_payer_notes":"APC"}]}]},{"description":"CMV antibody","code_information":[{"code":"86644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":67.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.31,"additional_payer_notes":"APC"}]}]},{"description":"Cmv antibody igm","code_information":[{"code":"86645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":78.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.82,"additional_payer_notes":"APC"}]}]},{"description":"Diphtheria antibody","code_information":[{"code":"86648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.21,"maximum":71.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.51,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.14,"additional_payer_notes":"APC"}]}]},{"description":"Encephalitis californ antbdy","code_information":[{"code":"86651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis east eqne anbdy","code_information":[{"code":"86652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis st louis antbody","code_information":[{"code":"86653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis west eqne antbdy","code_information":[{"code":"86654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus antibody","code_information":[{"code":"86658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.03,"maximum":60.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr antibody","code_information":[{"code":"86663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.12,"maximum":61.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.37,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr nuclear antigen","code_information":[{"code":"86664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.29,"maximum":71.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.52,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr capsid vca","code_information":[{"code":"86665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.14,"maximum":84.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.85,"additional_payer_notes":"APC"}]}]},{"description":"Ehrlichia Antibody","code_information":[{"code":"86666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":47.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47.62,"additional_payer_notes":"APC"}]}]},{"description":"Francisella tularensis","code_information":[{"code":"86668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.16,"maximum":66.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.44,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.23,"additional_payer_notes":"APC"}]}]},{"description":"Fungus nes antibody","code_information":[{"code":"86671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":57.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.3,"additional_payer_notes":"APC"}]}]},{"description":"Giardia lamblia antibody","code_information":[{"code":"86674","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.72,"maximum":68.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.85,"additional_payer_notes":"APC"}]}]},{"description":"Helicobacter pylori antibody","code_information":[{"code":"86677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":78.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.82,"additional_payer_notes":"APC"}]}]},{"description":"Helminth antibody","code_information":[{"code":"86682","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.01,"maximum":60.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.85,"additional_payer_notes":"APC"}]}]},{"description":"Hemophilus influenza antibdy","code_information":[{"code":"86684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.84,"maximum":74.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":65.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.09,"additional_payer_notes":"APC"}]}]},{"description":"Htlv-i antibody","code_information":[{"code":"86687","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.09,"maximum":42.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.27,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42.52,"additional_payer_notes":"APC"}]}]},{"description":"Htlv-ii antibody","code_information":[{"code":"86688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.0,"maximum":65.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65.48,"additional_payer_notes":"APC"}]}]},{"description":"Htlv/hiv confirmj antibody","code_information":[{"code":"86689","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":90.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90.51,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis delta agent antbdy","code_information":[{"code":"86692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.16,"maximum":80.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":71.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80.27,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex nes antbdy","code_information":[{"code":"86694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":67.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.31,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex type 1 test","code_information":[{"code":"86695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex type 2 test","code_information":[{"code":"86696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":90.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90.51,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasma antibody","code_information":[{"code":"86698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.79,"maximum":64.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.5,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1antibody","code_information":[{"code":"86701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.89,"maximum":41.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.07,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41.58,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 antibody","code_information":[{"code":"86702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.52,"maximum":63.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63.24,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1/hiv-2 1 result antbdy","code_information":[{"code":"86703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.71,"maximum":64.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.13,"additional_payer_notes":"APC"}]}]},{"description":"Hep b core antibody total","code_information":[{"code":"86704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Hep b core antibody igm","code_information":[{"code":"86705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.77,"maximum":55.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55.05,"additional_payer_notes":"APC"}]}]},{"description":"Hep b surface antibody","code_information":[{"code":"86706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":50.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.24,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis be antibody","code_information":[{"code":"86707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.57,"maximum":54.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.12,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis a antibody","code_information":[{"code":"86708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.39,"maximum":57.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.64,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.95,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis a igm antibody","code_information":[{"code":"86709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.26,"maximum":52.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52.67,"additional_payer_notes":"APC"}]}]},{"description":"Influenza virus antibody","code_information":[{"code":"86710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.55,"maximum":63.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"}]}]},{"description":"John cunningham antibody","code_information":[{"code":"86711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.89,"maximum":79.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.0,"additional_payer_notes":"APC"}]}]},{"description":"Legionella antibody","code_information":[{"code":"86713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.3,"maximum":71.57,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.57,"additional_payer_notes":"APC"}]}]},{"description":"Leishmania antibody","code_information":[{"code":"86717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":57.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.3,"additional_payer_notes":"APC"}]}]},{"description":"Leptospira antibody","code_information":[{"code":"86720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.2,"maximum":75.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75.78,"additional_payer_notes":"APC"}]}]},{"description":"Listeria monocytogenes","code_information":[{"code":"86723","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Lymph choriomeningitis ab","code_information":[{"code":"86727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":60.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.2,"additional_payer_notes":"APC"}]}]},{"description":"Mucormycosis antibody","code_information":[{"code":"86732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.0,"maximum":70.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.16,"additional_payer_notes":"APC"}]}]},{"description":"Mumps antibody","code_information":[{"code":"86735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.05,"maximum":61.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.04,"additional_payer_notes":"APC"}]}]},{"description":"Mycoplasma antibody","code_information":[{"code":"86738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.24,"maximum":61.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.93,"additional_payer_notes":"APC"}]}]},{"description":"Neisseria meningitidis","code_information":[{"code":"86741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Nocardia antibody","code_information":[{"code":"86744","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.99,"maximum":74.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.79,"additional_payer_notes":"APC"}]}]},{"description":"Parvovirus antibody","code_information":[{"code":"86747","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.03,"maximum":70.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.3,"additional_payer_notes":"APC"}]}]},{"description":"Malaria antibody","code_information":[{"code":"86750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Protozoa antibody nos","code_information":[{"code":"86753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.39,"maximum":57.95,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.64,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.95,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory virus antibody","code_information":[{"code":"86756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.89,"maximum":74.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.33,"additional_payer_notes":"APC"}]}]},{"description":"Rickettsia Antibody","code_information":[{"code":"86757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":90.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90.51,"additional_payer_notes":"APC"}]}]},{"description":"Rotavirus antibody","code_information":[{"code":"86759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.23,"maximum":85.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85.27,"additional_payer_notes":"APC"}]}]},{"description":"Rubella antibody","code_information":[{"code":"86762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":67.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.31,"additional_payer_notes":"APC"}]}]},{"description":"Rubeola antibody","code_information":[{"code":"86765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":60.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.25,"additional_payer_notes":"APC"}]}]},{"description":"Salmonella antibody","code_information":[{"code":"86768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid-19 antibody","code_information":[{"code":"86769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.13,"maximum":197.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":175.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197.06,"additional_payer_notes":"APC"}]}]},{"description":"Shigella antibody","code_information":[{"code":"86771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.48,"maximum":114.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":101.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114.51,"additional_payer_notes":"APC"}]}]},{"description":"Tetanus antibody","code_information":[{"code":"86774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.8,"maximum":69.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69.23,"additional_payer_notes":"APC"}]}]},{"description":"Toxoplasma antibody","code_information":[{"code":"86777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":67.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.31,"additional_payer_notes":"APC"}]}]},{"description":"Toxoplasma antibody igm","code_information":[{"code":"86778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.41,"maximum":67.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.4,"additional_payer_notes":"APC"}]}]},{"description":"Treponema pallidum","code_information":[{"code":"86780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.24,"maximum":61.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.93,"additional_payer_notes":"APC"}]}]},{"description":"Trichinella antibody","code_information":[{"code":"86784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.56,"maximum":58.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.75,"additional_payer_notes":"APC"}]}]},{"description":"Varicella-zoster antibody","code_information":[{"code":"86787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":60.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.25,"additional_payer_notes":"APC"}]}]},{"description":"West nile virus ab igm","code_information":[{"code":"86788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":78.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.82,"additional_payer_notes":"APC"}]}]},{"description":"West Nile Virus Antibody","code_information":[{"code":"86789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":67.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.31,"additional_payer_notes":"APC"}]}]},{"description":"Virus antibody nos","code_information":[{"code":"86790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":60.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60.25,"additional_payer_notes":"APC"}]}]},{"description":"Yersinia antibody","code_information":[{"code":"86793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":61.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.7,"additional_payer_notes":"APC"}]}]},{"description":"Zika virus igm antibody","code_information":[{"code":"86794","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":78.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.82,"additional_payer_notes":"APC"}]}]},{"description":"Thyroglobulin antibody","code_information":[{"code":"86800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.91,"maximum":74.42,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.42,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c ab test","code_information":[{"code":"86803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.27,"maximum":66.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.75,"additional_payer_notes":"APC"}]}]},{"description":"Hep c ab test confirm","code_information":[{"code":"86804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.49,"maximum":72.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.45,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocytotoxicity assay","code_information":[{"code":"86805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":189.51,"maximum":886.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":284.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":189.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":789.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":886.43,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocytotoxicity assay","code_information":[{"code":"86806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.59,"maximum":222.60,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":47.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":198.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":222.6,"additional_payer_notes":"APC"}]}]},{"description":"Cytotoxic antibody screening","code_information":[{"code":"86807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.65,"maximum":367.89,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":117.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":78.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":327.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":367.89,"additional_payer_notes":"APC"}]}]},{"description":"Cytotoxic antibody screening","code_information":[{"code":"86808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.68,"maximum":138.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.27,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":123.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138.83,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing a b or c","code_information":[{"code":"86812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.81,"maximum":120.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":107.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120.73,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing a b or c","code_information":[{"code":"86813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.0,"maximum":271.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":58.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":241.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.3,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing dr/dq","code_information":[{"code":"86816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.17,"maximum":141.12,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":30.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":125.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141.12,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing dr/dq","code_information":[{"code":"86817","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.14,"maximum":496.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":106.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":496.47,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocyte culture mixed","code_information":[{"code":"86821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.56,"maximum":171.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":36.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":152.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171.01,"additional_payer_notes":"APC"}]}]},{"description":"Hla x-math non-cytotoxic","code_information":[{"code":"86825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.49,"maximum":512.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":164.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":109.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":455.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":512.14,"additional_payer_notes":"APC"}]}]},{"description":"Hla x-match noncytotoxc addl","code_information":[{"code":"86826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.53,"maximum":170.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.26,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":152.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170.87,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i&ii antibody qual","code_information":[{"code":"86828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.19,"maximum":300.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":267.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":300.25,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i/ii antibody qual","code_information":[{"code":"86829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.19,"maximum":300.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":267.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":300.25,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i phenotype qual","code_information":[{"code":"86830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.52,"maximum":446.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":143.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":95.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":397.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":446.79,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii phenotype qual","code_information":[{"code":"86831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.88,"maximum":382.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":122.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":81.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":340.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":382.99,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i high defin qual","code_information":[{"code":"86832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":323.75,"maximum":1514.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":485.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":330.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":323.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1348.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1514.34,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii high defin qual","code_information":[{"code":"86833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.8,"maximum":1523.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":488.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":325.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1356.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1523.93,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i semiquant panel","code_information":[{"code":"86834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":357.56,"maximum":1672.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":536.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":357.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1488.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1672.49,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii semiquant panel","code_information":[{"code":"86835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":1510.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":484.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1344.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1510.65,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysins/agglutinins auto","code_information":[{"code":"86940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.77,"maximum":41.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41.02,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysins/agglutinins","code_information":[{"code":"86941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":56.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.64,"additional_payer_notes":"APC"}]}]},{"description":"Small animal inoculation","code_information":[{"code":"87003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.84,"maximum":78.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.77,"additional_payer_notes":"APC"}]}]},{"description":"Specimen infect agnt concntj","code_information":[{"code":"87015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.68,"maximum":31.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31.25,"additional_payer_notes":"APC"}]}]},{"description":"Blood culture for bacteria","code_information":[{"code":"87040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.32,"maximum":48.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.27,"additional_payer_notes":"APC"}]}]},{"description":"Feces culture aerobic bact","code_information":[{"code":"87045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":44.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.16,"additional_payer_notes":"APC"}]}]},{"description":"Stool cultr aerobic bact ea","code_information":[{"code":"87046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":44.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.16,"additional_payer_notes":"APC"}]}]},{"description":"Culture othr specimn aerobic","code_information":[{"code":"87070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.62,"maximum":40.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.32,"additional_payer_notes":"APC"}]}]},{"description":"Culture aerobic quant other","code_information":[{"code":"87071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.89,"maximum":46.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":41.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46.26,"additional_payer_notes":"APC"}]}]},{"description":"Culture Bacteria Anaerobic","code_information":[{"code":"87073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.66,"maximum":45.18,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.18,"additional_payer_notes":"APC"}]}]},{"description":"Cultr bacteria except blood","code_information":[{"code":"87075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.47,"maximum":44.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44.3,"additional_payer_notes":"APC"}]}]},{"description":"Culture anaerobe ident each","code_information":[{"code":"87076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.08,"maximum":37.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.79,"additional_payer_notes":"APC"}]}]},{"description":"Culture Aerobic Identify","code_information":[{"code":"87077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.08,"maximum":37.79,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.79,"additional_payer_notes":"APC"}]}]},{"description":"Culture screen only","code_information":[{"code":"87081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.63,"maximum":31.01,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31.01,"additional_payer_notes":"APC"}]}]},{"description":"Culture of specimen by kit","code_information":[{"code":"87084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.07,"maximum":126.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.61,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.62,"additional_payer_notes":"APC"}]}]},{"description":"Urine culture/colony count","code_information":[{"code":"87086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.07,"maximum":37.75,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.75,"additional_payer_notes":"APC"}]}]},{"description":"Urine bacteria culture","code_information":[{"code":"87088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.09,"maximum":37.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.84,"additional_payer_notes":"APC"}]}]},{"description":"Skin fungi culture","code_information":[{"code":"87101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.71,"maximum":36.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"}]}]},{"description":"Fungus isolation culture","code_information":[{"code":"87102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.41,"maximum":39.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"}]}]},{"description":"Blood fungus culture","code_information":[{"code":"87103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.46,"maximum":95.70,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.69,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95.7,"additional_payer_notes":"APC"}]}]},{"description":"Fungi identification yeast","code_information":[{"code":"87106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.32,"maximum":48.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.27,"additional_payer_notes":"APC"}]}]},{"description":"Fungi identification mold","code_information":[{"code":"87107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.32,"maximum":48.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.27,"additional_payer_notes":"APC"}]}]},{"description":"Mycoplasma","code_information":[{"code":"87109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.39,"maximum":71.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.99,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia culture","code_information":[{"code":"87110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.6,"maximum":91.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.68,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria culture","code_information":[{"code":"87116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.8,"maximum":50.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.52,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteric identification","code_information":[{"code":"87118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.61,"maximum":68.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.34,"additional_payer_notes":"APC"}]}]},{"description":"Culture type immunofluoresc","code_information":[{"code":"87140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.57,"maximum":26.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.68,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.05,"additional_payer_notes":"APC"}]}]},{"description":"Culture typing glc/hplc","code_information":[{"code":"87143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.52,"maximum":58.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.56,"additional_payer_notes":"APC"}]}]},{"description":"Culture type immunologic","code_information":[{"code":"87147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":24.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.23,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna direct probe","code_information":[{"code":"87149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna amplified probe","code_information":[{"code":"87150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Culture Type Pulse Field Gel","code_information":[{"code":"87152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.74,"maximum":36.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.2,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna sequencing","code_information":[{"code":"87153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.36,"maximum":539.60,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":173.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":115.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":480.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":539.6,"additional_payer_notes":"APC"}]}]},{"description":"Cul typ id bld pthgn 6+ trgt","code_information":[{"code":"87154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.06,"maximum":1019.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":327.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":218.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":908.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1019.98,"additional_payer_notes":"APC"}]}]},{"description":"Culture typing added method","code_information":[{"code":"87158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.74,"maximum":36.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.89,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.2,"additional_payer_notes":"APC"}]}]},{"description":"Dark field examination","code_information":[{"code":"87164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":50.24,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50.24,"additional_payer_notes":"APC"}]}]},{"description":"Dark field examination","code_information":[{"code":"87166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.3,"maximum":52.86,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52.86,"additional_payer_notes":"APC"}]}]},{"description":"Macroscopic Exam Arthropod","code_information":[{"code":"87168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":19.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"}]}]},{"description":"Macroscopic exam parasite","code_information":[{"code":"87169","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.31,"maximum":20.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"APC"}]}]},{"description":"Pinworm Exam","code_information":[{"code":"87172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":19.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"}]}]},{"description":"Tissue homogenization cultr","code_information":[{"code":"87176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.88,"maximum":27.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27.5,"additional_payer_notes":"APC"}]}]},{"description":"Ova and parasites smears","code_information":[{"code":"87177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.9,"maximum":41.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.08,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41.63,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible diffuse","code_information":[{"code":"87181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":22.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.22,"additional_payer_notes":"APC"}]}]},{"description":"Sc std carbapenem resist gen","code_information":[{"code":"87183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible disk","code_information":[{"code":"87184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.48,"maximum":34.99,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34.99,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible enzyme","code_information":[{"code":"87185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":22.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.22,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible mic","code_information":[{"code":"87186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.65,"maximum":40.46,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.46,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible mlc","code_information":[{"code":"87187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.17,"maximum":187.90,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":40.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":167.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":187.9,"additional_payer_notes":"APC"}]}]},{"description":"Microbe suscept macrobroth","code_information":[{"code":"87188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.64,"maximum":31.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.77,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31.06,"additional_payer_notes":"APC"}]}]},{"description":"Microbe suscept mycobacteri","code_information":[{"code":"87190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.31,"maximum":34.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"}]}]},{"description":"Bactericidal level serum","code_information":[{"code":"87197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.02,"maximum":70.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.26,"additional_payer_notes":"APC"}]}]},{"description":"Smear gram stain","code_information":[{"code":"87205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":19.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"}]}]},{"description":"Smear fluorescent/acid stai","code_information":[{"code":"87206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.39,"maximum":25.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25.21,"additional_payer_notes":"APC"}]}]},{"description":"Smear special stain","code_information":[{"code":"87207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.99,"maximum":28.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.11,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28.02,"additional_payer_notes":"APC"}]}]},{"description":"Smear complex stain","code_information":[{"code":"87209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":84.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.1,"additional_payer_notes":"APC"}]}]},{"description":"Smear wet mount saline/ink","code_information":[{"code":"87210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.82,"maximum":27.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam for fungi","code_information":[{"code":"87220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":19.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"}]}]},{"description":"Assay toxin or antitoxin","code_information":[{"code":"87230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.74,"maximum":92.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":82.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92.33,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculate eggs/animal","code_information":[{"code":"87250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.56,"maximum":91.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.49,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculation tissue","code_information":[{"code":"87252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.07,"maximum":121.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":108.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121.94,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculate tissue addl","code_information":[{"code":"87253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.2,"maximum":94.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":84.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94.49,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculation shell via","code_information":[{"code":"87254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.56,"maximum":91.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.49,"additional_payer_notes":"APC"}]}]},{"description":"Genet virus isolate hsv","code_information":[{"code":"87255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.86,"maximum":158.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":141.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158.38,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus ag if","code_information":[{"code":"87260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.43,"maximum":67.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.5,"additional_payer_notes":"APC"}]}]},{"description":"Pertussis ag if","code_information":[{"code":"87265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus antibody dfa","code_information":[{"code":"87267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":62.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.77,"additional_payer_notes":"APC"}]}]},{"description":"Giardia ag if","code_information":[{"code":"87269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.61,"maximum":63.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":56.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63.66,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia trachomatis ag if","code_information":[{"code":"87270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Cytomegalovirus dfa","code_information":[{"code":"87271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":62.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.77,"additional_payer_notes":"APC"}]}]},{"description":"Cryptosporidium ag if","code_information":[{"code":"87272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex 2 ag if","code_information":[{"code":"87273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex 1 ag if","code_information":[{"code":"87274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Influenza b ag if","code_information":[{"code":"87275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":57.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.3,"additional_payer_notes":"APC"}]}]},{"description":"Influenza a ag if","code_information":[{"code":"87276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.07,"maximum":75.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75.17,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumophilia ag if","code_information":[{"code":"87278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.6,"maximum":72.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.97,"additional_payer_notes":"APC"}]}]},{"description":"Parainfluenza ag if","code_information":[{"code":"87279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.43,"maximum":76.85,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.85,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory syncytial ag if","code_information":[{"code":"87280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":62.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.77,"additional_payer_notes":"APC"}]}]},{"description":"Pneumocystis carinii ag if","code_information":[{"code":"87281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Rubeola ag if","code_information":[{"code":"87283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.8,"maximum":284.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":60.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":253.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":284.39,"additional_payer_notes":"APC"}]}]},{"description":"Treponema pallidum ag if","code_information":[{"code":"87285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.18,"maximum":56.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.97,"additional_payer_notes":"APC"}]}]},{"description":"Varicella zoster ag if","code_information":[{"code":"87290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":62.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.77,"additional_payer_notes":"APC"}]}]},{"description":"Antibody detection nos if","code_information":[{"code":"87299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.1,"maximum":75.31,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.15,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":67.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75.31,"additional_payer_notes":"APC"}]}]},{"description":"Ag detection polyval if","code_information":[{"code":"87300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus ag ia","code_information":[{"code":"87301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Aspergillus ag ia","code_information":[{"code":"87305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach ag ia","code_information":[{"code":"87320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.0,"maximum":70.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70.16,"additional_payer_notes":"APC"}]}]},{"description":"Clostridium ag ia","code_information":[{"code":"87324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Cryptococcus neoform ag ia","code_information":[{"code":"87327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":62.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62.77,"additional_payer_notes":"APC"}]}]},{"description":"Cryptosporidium ag ia","code_information":[{"code":"87328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.82,"maximum":64.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64.64,"additional_payer_notes":"APC"}]}]},{"description":"Giardia ag ia","code_information":[{"code":"87329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Cytomegalovirus ag ia","code_information":[{"code":"87332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"E coli 0157 ag ia","code_information":[{"code":"87335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.66,"maximum":59.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.22,"additional_payer_notes":"APC"}]}]},{"description":"Entamoeb hist dispr ag ia","code_information":[{"code":"87336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":74.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.84,"additional_payer_notes":"APC"}]}]},{"description":"Entamoeb hist group ag ia","code_information":[{"code":"87337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Hpylori stool ia","code_information":[{"code":"87338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.38,"maximum":67.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67.26,"additional_payer_notes":"APC"}]}]},{"description":"H pylori ag ia","code_information":[{"code":"87339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":74.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.84,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag ia","code_information":[{"code":"87340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.33,"maximum":48.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.32,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag ia","code_information":[{"code":"87341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.33,"maximum":48.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.32,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis be ag ia","code_information":[{"code":"87350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":53.93,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.93,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis delta ag ia","code_information":[{"code":"87380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.36,"maximum":85.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85.88,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasma capsul ag ia","code_information":[{"code":"87385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":61.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":55.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 ag w/hiv-1 & hiv-2 ab","code_information":[{"code":"87389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":112.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.63,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 ag ia","code_information":[{"code":"87390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.06,"maximum":112.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.54,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 ag ia","code_information":[{"code":"87391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.9,"maximum":102.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102.44,"additional_payer_notes":"APC"}]}]},{"description":"Influenza a/b ag ia","code_information":[{"code":"87400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.13,"maximum":66.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.09,"additional_payer_notes":"APC"}]}]},{"description":"Resp syncytial ag ia","code_information":[{"code":"87420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.91,"maximum":65.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":57.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65.06,"additional_payer_notes":"APC"}]}]},{"description":"Rotavirus ag ia","code_information":[{"code":"87425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Coronavirus ag ia","code_information":[{"code":"87426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.33,"maximum":165.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.04,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":147.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165.26,"additional_payer_notes":"APC"}]}]},{"description":"Shiga-like toxin ag ia","code_information":[{"code":"87427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov & inf vir a&b ag ia","code_information":[{"code":"87428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.29,"maximum":328.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":70.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":292.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":328.78,"additional_payer_notes":"APC"}]}]},{"description":"Strep a ag ia","code_information":[{"code":"87430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.81,"maximum":78.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78.63,"additional_payer_notes":"APC"}]}]},{"description":"Ag detect nos ia mult","code_information":[{"code":"87449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Ag detect polyval ia mult","code_information":[{"code":"87451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.51,"maximum":49.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.16,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag quan","code_information":[{"code":"87467","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.32,"maximum":118.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.83,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":105.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118.43,"additional_payer_notes":"APC"}]}]},{"description":"Anaplsma phgcytophlm amp prb","code_information":[{"code":"87468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Babesia microti amp prb","code_information":[{"code":"87469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella dna amp probe","code_information":[{"code":"87471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella dna quant","code_information":[{"code":"87472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"Lyme dis dna dir probe","code_information":[{"code":"87475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"Lyme dis dna amp probe","code_information":[{"code":"87476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Borrelia miyamotoi amp prb","code_information":[{"code":"87478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna dir probe","code_information":[{"code":"87480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna amp probe","code_information":[{"code":"87481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna quant","code_information":[{"code":"87482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.74,"maximum":260.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":55.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":232.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"}]}]},{"description":"Cns dna amp probe type 12-25","code_information":[{"code":"87483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Ehrlicha chaffeensis amp prb","code_information":[{"code":"87484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna dir probe","code_information":[{"code":"87485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna amp probe","code_information":[{"code":"87486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna quant","code_information":[{"code":"87487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna dir probe","code_information":[{"code":"87490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.75,"maximum":106.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":94.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106.41,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna amp probe","code_information":[{"code":"87491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna quant","code_information":[{"code":"87492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.47,"maximum":250.11,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":53.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":222.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":250.11,"additional_payer_notes":"APC"}]}]},{"description":"C diff amplified probe","code_information":[{"code":"87493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.27,"maximum":174.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":37.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":155.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174.33,"additional_payer_notes":"APC"}]}]},{"description":"Chlmy trch&neisra gonor mult","code_information":[{"code":"87494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.18,"maximum":328.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":70.18,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":292.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":328.27,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna dir probe","code_information":[{"code":"87495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.03,"maximum":140.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":30.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":125.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140.47,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna amp probe","code_information":[{"code":"87496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna quant","code_information":[{"code":"87497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus probe&revrs trns","code_information":[{"code":"87498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Vanomycin dna amp probe","code_information":[{"code":"87500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp prob 1+","code_information":[{"code":"87501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":240.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":213.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":240.0,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp probe","code_information":[{"code":"87502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.8,"maximum":448.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":143.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":95.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":398.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":448.1,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp prob addl","code_information":[{"code":"87503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.22,"maximum":136.68,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":121.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136.68,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agent detection gi","code_information":[{"code":"87505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.29,"maximum":600.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":192.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":128.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":534.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":600.08,"additional_payer_notes":"APC"}]}]},{"description":"Iadna-dna/rna probe tq 6-11","code_information":[{"code":"87506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":1230.14,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":394.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1095.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1230.14,"additional_payer_notes":"APC"}]}]},{"description":"Iadna-dna/rna probe tq 12-25","code_information":[{"code":"87507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna dir probe","code_information":[{"code":"87510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna amp probe","code_information":[{"code":"87511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna quant","code_information":[{"code":"87512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":195.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.33,"additional_payer_notes":"APC"}]}]},{"description":"H pylri clrthmcn rst amp prb","code_information":[{"code":"87513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b dna amp probe","code_information":[{"code":"87516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b dna quant","code_information":[{"code":"87517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c rna dir probe","code_information":[{"code":"87520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.22,"maximum":146.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":31.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":130.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":146.03,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c probe&rvrs trnsc","code_information":[{"code":"87521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c revrs trnscrpj","code_information":[{"code":"87522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis d quantification","code_information":[{"code":"87523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna dir probe","code_information":[{"code":"87525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.8,"maximum":139.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.4,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":29.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":124.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139.39,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna amp probe","code_information":[{"code":"87526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.26,"maximum":183.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58.89,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":39.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":163.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183.64,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna quant","code_information":[{"code":"87527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":195.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.33,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna dir probe","code_information":[{"code":"87528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna amp probe","code_information":[{"code":"87529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna quant","code_information":[{"code":"87530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna dir probe","code_information":[{"code":"87531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.0,"maximum":271.30,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.16,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":58.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":241.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.3,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna amp probe","code_information":[{"code":"87532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna quant","code_information":[{"code":"87533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":195.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.33,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 dna dir probe","code_information":[{"code":"87534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.92,"maximum":102.53,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102.53,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 probe&reverse trnscrpj","code_information":[{"code":"87535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 quant&revrse trnscrpj","code_information":[{"code":"87536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.1,"maximum":398.06,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.8,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":85.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":354.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":398.06,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 dna dir probe","code_information":[{"code":"87537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.92,"maximum":102.53,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102.53,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 probe&revrse trnscripj","code_information":[{"code":"87538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 quant&revrse trnscripj","code_information":[{"code":"87539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.62,"maximum":274.20,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":58.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":244.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":274.2,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna dir prob","code_information":[{"code":"87540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna amp prob","code_information":[{"code":"87541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna quant","code_information":[{"code":"87542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":195.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.33,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna dir probe","code_information":[{"code":"87550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna amp probe","code_information":[{"code":"87551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.24,"maximum":225.64,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":48.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":200.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":225.64,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna quant","code_information":[{"code":"87552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna dir probe","code_information":[{"code":"87555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.88,"maximum":125.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125.73,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna amp probe","code_information":[{"code":"87556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.68,"maximum":194.96,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.51,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":41.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.96,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna quant","code_information":[{"code":"87557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna dir prob","code_information":[{"code":"87560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.29,"maximum":127.65,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":113.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna amp prob","code_information":[{"code":"87561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna quant","code_information":[{"code":"87562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"M. genitalium amp probe","code_information":[{"code":"87563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Mtb rifampin rst amp prb tq","code_information":[{"code":"87564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.77,"maximum":359.09,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":115.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":76.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":319.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":359.09,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna dir probe","code_information":[{"code":"87580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna amp probe","code_information":[{"code":"87581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna quant","code_information":[{"code":"87582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":302.62,"maximum":1415.51,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":453.93,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":308.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":302.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1260.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1415.51,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna dir prob","code_information":[{"code":"87590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.88,"maximum":125.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.32,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":111.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125.73,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna amp prob","code_information":[{"code":"87591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna quant","code_information":[{"code":"87592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"Orthopoxvirus amp prb each","code_information":[{"code":"87593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":240.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":213.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":240.0,"additional_payer_notes":"APC"}]}]},{"description":"Pneumcysts jirovecii amp prb","code_information":[{"code":"87594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hpv low-risk types","code_information":[{"code":"87623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hpv high-risk types","code_information":[{"code":"87624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Hpv types 16 & 18 only","code_information":[{"code":"87625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.55,"maximum":189.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":40.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":168.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":189.67,"additional_payer_notes":"APC"}]}]},{"description":"Hpv sep hi-rsk typ&pool rslt","code_information":[{"code":"87626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":328.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":292.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":328.36,"additional_payer_notes":"APC"}]}]},{"description":"Jt spc pthgn&rx rsist gen26+","code_information":[{"code":"87627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.77,"maximum":3179.62,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1019.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":693.37,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":679.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2830.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3179.62,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 3-5 targets","code_information":[{"code":"87631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":667.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":213.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":593.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.15,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 6-11 targets","code_information":[{"code":"87632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.06,"maximum":1019.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":327.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.42,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":218.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":908.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1019.98,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 12-25 targets","code_information":[{"code":"87633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":1949.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.49,"additional_payer_notes":"APC"}]}]},{"description":"Rsv dna/rna amp probe","code_information":[{"code":"87634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":328.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":292.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":328.36,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid-19 amp prb","code_information":[{"code":"87635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":240.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":213.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":240.0,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2 & inf a&b amp prb","code_information":[{"code":"87636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":667.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":213.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":593.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.15,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2&inf a&b&rsv amp prb","code_information":[{"code":"87637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":667.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":213.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":593.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":667.15,"additional_payer_notes":"APC"}]}]},{"description":"Staph a dna amp probe","code_information":[{"code":"87640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Mr-staph dna amp probe","code_information":[{"code":"87641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna dir probe","code_information":[{"code":"87650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna amp probe","code_information":[{"code":"87651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna quant","code_information":[{"code":"87652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":195.33,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195.33,"additional_payer_notes":"APC"}]}]},{"description":"Strep b dna amp probe","code_information":[{"code":"87653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas vagin dir probe","code_information":[{"code":"87660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":93.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.78,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas vaginalis amplif","code_information":[{"code":"87661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Zika virus dna/rna amp probe","code_information":[{"code":"87662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":240.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":213.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":240.0,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna dir","code_information":[{"code":"87797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.03,"maximum":140.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":30.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":125.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140.47,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna amp","code_information":[{"code":"87798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna quant","code_information":[{"code":"87799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":200.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":178.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200.38,"additional_payer_notes":"APC"}]}]},{"description":"Detect agnt mult dna direc","code_information":[{"code":"87800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.67,"maximum":204.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":43.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":181.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":204.27,"additional_payer_notes":"APC"}]}]},{"description":"Detect agnt mult dna ampli","code_information":[{"code":"87801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":328.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":292.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":328.36,"additional_payer_notes":"APC"}]}]},{"description":"Strep b assay w/optic","code_information":[{"code":"87802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.73,"maximum":59.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59.54,"additional_payer_notes":"APC"}]}]},{"description":"Clostridium toxin a w/optic","code_information":[{"code":"87803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":74.84,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.84,"additional_payer_notes":"APC"}]}]},{"description":"Influenza assay w/optic","code_information":[{"code":"87804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.55,"maximum":77.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77.41,"additional_payer_notes":"APC"}]}]},{"description":"Hiv antigen w/hiv antibodies","code_information":[{"code":"87806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.77,"maximum":153.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49.16,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":32.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":136.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153.28,"additional_payer_notes":"APC"}]}]},{"description":"Rsv assay w/optic","code_information":[{"code":"87807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.1,"maximum":61.28,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.28,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas assay w/optic","code_information":[{"code":"87808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.29,"maximum":71.52,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":63.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71.52,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus assay w/optic","code_information":[{"code":"87809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.76,"maximum":101.78,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach assay w/optic","code_information":[{"code":"87810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.29,"maximum":165.07,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165.07,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid19 w/optic","code_information":[{"code":"87811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.38,"maximum":193.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":172.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":193.55,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2&inf typ a&b w/optic","code_information":[{"code":"87812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.48,"maximum":348.38,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":111.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":74.48,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":310.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":348.38,"additional_payer_notes":"APC"}]}]},{"description":"N. gonorrhoeae assay w/optic","code_information":[{"code":"87850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.56,"maximum":114.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":102.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114.88,"additional_payer_notes":"APC"}]}]},{"description":"Strep a assay w/optic","code_information":[{"code":"87880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.53,"maximum":77.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.8,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77.32,"additional_payer_notes":"APC"}]}]},{"description":"Agent nos assay w/optic","code_information":[{"code":"87899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.07,"maximum":75.17,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.1,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75.17,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype infect agent drug","code_information":[{"code":"87900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.35,"maximum":609.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":195.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":130.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":542.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":609.71,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna hiv reverse t","code_information":[{"code":"87901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":1204.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":386.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1072.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1204.22,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna/rna hep c","code_information":[{"code":"87902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":1204.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":386.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1072.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1204.22,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype dna hiv w/culture","code_information":[{"code":"87903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":488.66,"maximum":2285.71,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":732.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.43,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":488.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2034.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2285.71,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype dna hiv w/clt add","code_information":[{"code":"87904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.07,"maximum":121.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":108.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121.94,"additional_payer_notes":"APC"}]}]},{"description":"Sialidase enzyme assay","code_information":[{"code":"87905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.22,"maximum":57.16,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.16,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna/rna hiv","code_information":[{"code":"87906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.73,"maximum":602.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":193.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":128.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":536.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":602.13,"additional_payer_notes":"APC"}]}]},{"description":"Genotype cytomegalovirus","code_information":[{"code":"87910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":1204.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":386.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1072.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1204.22,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna hepatitis b","code_information":[{"code":"87912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":1204.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":386.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1072.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1204.22,"additional_payer_notes":"APC"}]}]},{"description":"Sex chromatin identification","code_information":[{"code":"88130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":84.10,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":74.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.1,"additional_payer_notes":"APC"}]}]},{"description":"Sex chromatin identification","code_information":[{"code":"88140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.99,"maximum":37.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.15,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.37,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v thin layer","code_information":[{"code":"88142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.26,"maximum":94.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":84.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94.77,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v thin layer redo","code_information":[{"code":"88143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.04,"maximum":107.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":23.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":95.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107.77,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v automated","code_information":[{"code":"88147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.56,"maximum":236.49,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.57,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":50.56,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":210.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236.49,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto rescreen","code_information":[{"code":"88148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":86.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.72,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v manual","code_information":[{"code":"88150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":86.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.72,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto redo","code_information":[{"code":"88152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.64,"maximum":129.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":115.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129.29,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v redo","code_information":[{"code":"88153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.03,"maximum":112.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.04,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.4,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v index add-on","code_information":[{"code":"88155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.65,"maximum":68.53,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.94,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":14.65,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":61.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68.53,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v manual","code_information":[{"code":"88164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":86.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.72,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v redo","code_information":[{"code":"88165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.22,"maximum":197.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.06,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":175.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197.48,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v auto redo","code_information":[{"code":"88166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":86.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.72,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v select","code_information":[{"code":"88167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":86.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.72,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto in fluid","code_information":[{"code":"88174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.37,"maximum":118.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":105.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118.67,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto fluid redo","code_information":[{"code":"88175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.61,"maximum":124.47,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":110.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124.47,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture lymphocyte","code_information":[{"code":"88230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.49,"maximum":544.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.82,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":116.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":544.88,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture skin/biopsy","code_information":[{"code":"88233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.73,"maximum":658.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":211.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.54,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":140.73,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":586.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":658.26,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture placenta","code_information":[{"code":"88235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.3,"maximum":703.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":225.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.31,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":150.3,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":625.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":703.03,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture bone marrow","code_information":[{"code":"88237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.75,"maximum":672.39,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.62,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":143.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":598.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":672.39,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture tumor","code_information":[{"code":"88239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":147.52,"maximum":690.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":221.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.47,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":147.52,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":614.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":690.02,"additional_payer_notes":"APC"}]}]},{"description":"Cell cryopreserve/storage","code_information":[{"code":"88240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.07,"maximum":61.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":13.07,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61.13,"additional_payer_notes":"APC"}]}]},{"description":"Frozen cell preparation","code_information":[{"code":"88241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.09,"maximum":56.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.55,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 20-25","code_information":[{"code":"88245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.17,"maximum":810.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":259.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":810.0,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 50-100","code_information":[{"code":"88248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.17,"maximum":810.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":259.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":810.0,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 100","code_information":[{"code":"88249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.17,"maximum":810.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":259.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":810.0,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 5","code_information":[{"code":"88261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.34,"maximum":1236.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.51,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":264.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1100.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1236.45,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 15-20","code_information":[{"code":"88262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.49,"maximum":586.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":188.24,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":125.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":522.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":586.98,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 45","code_information":[{"code":"88263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.29,"maximum":702.98,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":225.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":150.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":625.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":702.98,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 20-25","code_information":[{"code":"88264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.61,"maximum":676.41,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":216.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":144.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":602.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":676.41,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analys placenta","code_information":[{"code":"88267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.57,"maximum":882.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":282.86,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":188.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":785.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":882.04,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analys amniotic","code_information":[{"code":"88269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.66,"maximum":812.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":260.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.13,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":173.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":723.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":812.29,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics dna probe","code_information":[{"code":"88271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.42,"maximum":100.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32.13,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100.19,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 3-5","code_information":[{"code":"88272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.7,"maximum":190.37,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.51,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":169.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 10-30","code_information":[{"code":"88273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.81,"maximum":162.82,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.51,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":34.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":144.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":162.82,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 25-99","code_information":[{"code":"88274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.38,"maximum":198.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.23,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":42.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":176.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":198.23,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 100-300","code_information":[{"code":"88275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.19,"maximum":239.44,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.78,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.21,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.19,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":213.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":239.44,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome karyotype study","code_information":[{"code":"88280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.47,"maximum":156.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50.2,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.14,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":33.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":139.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156.56,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome banding study","code_information":[{"code":"88283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.6,"maximum":320.88,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":102.9,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.97,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":68.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":285.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":320.88,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome count additional","code_information":[{"code":"88285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.91,"maximum":125.87,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.45,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125.87,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome study additional","code_information":[{"code":"88289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.43,"maximum":161.05,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":34.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161.05,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin total transcut","code_information":[{"code":"88720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":23.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.48,"additional_payer_notes":"APC"}]}]},{"description":"Hgb quant transcutaneous","code_information":[{"code":"88738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":23.48,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.48,"additional_payer_notes":"APC"}]}]},{"description":"Transcutaneous carboxyhb","code_information":[{"code":"88740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.37,"maximum":43.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43.83,"additional_payer_notes":"APC"}]}]},{"description":"Transcutaneous methb","code_information":[{"code":"88741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.37,"maximum":43.83,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43.83,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid cell count","code_information":[{"code":"89050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.72,"maximum":22.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.72,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.08,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid cell count","code_information":[{"code":"89051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.6,"maximum":26.19,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.6,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26.19,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte assessment fecal","code_information":[{"code":"89055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":19.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"}]}]},{"description":"Exam synovial fluid crystals","code_information":[{"code":"89060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.33,"maximum":34.29,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.33,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34.29,"additional_payer_notes":"APC"}]}]},{"description":"Specimen fat stain","code_information":[{"code":"89125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.88,"maximum":27.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.82,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27.5,"additional_payer_notes":"APC"}]}]},{"description":"Exam feces for meat fibers","code_information":[{"code":"89160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.85,"maximum":22.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.28,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.85,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22.69,"additional_payer_notes":"APC"}]}]},{"description":"Nasal smear for eosinophils","code_information":[{"code":"89190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.79,"maximum":27.08,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.68,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.79,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27.08,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis w/huhner","code_information":[{"code":"89300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.84,"maximum":46.03,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.76,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46.03,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis w/count","code_information":[{"code":"89310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.61,"maximum":40.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.78,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40.27,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal vol/count/mot","code_information":[{"code":"89320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.31,"maximum":57.58,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.58,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal sperm detection","code_information":[{"code":"89321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":56.36,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.36,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal strict criteria","code_information":[{"code":"89322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.5,"maximum":72.50,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.25,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":64.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72.5,"additional_payer_notes":"APC"}]}]},{"description":"Sperm antibody test","code_information":[{"code":"89325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.67,"maximum":49.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.67,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.91,"additional_payer_notes":"APC"}]}]},{"description":"Sperm evaluation test","code_information":[{"code":"89329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.59,"maximum":91.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.63,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation cervical mucus","code_information":[{"code":"89330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.38,"maximum":48.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.55,"additional_payer_notes":"APC"}]}]},{"description":"Retrograde ejaculation anal","code_information":[{"code":"89331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.59,"maximum":91.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.98,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.63,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis","code_information":[{"code":"G0027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.5,"maximum":30.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.63,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.4,"additional_payer_notes":"APC"}]}]},{"description":"PSA Screening","code_information":[{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.31,"maximum":90.32,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.7,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":80.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90.32,"additional_payer_notes":"APC"}]}]},{"description":"Screen cerv/vag thin layer","code_information":[{"code":"G0123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.26,"maximum":94.77,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.39,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":84.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94.77,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.05,"maximum":126.53,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.58,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.59,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":27.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.53,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.97,"maximum":205.67,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.85,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":183.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":205.67,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.49,"maximum":123.91,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.02,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":26.49,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":110.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123.91,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto, automated sys","code_information":[{"code":"G0147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":86.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.72,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto, autosys, rescr","code_information":[{"code":"G0148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.94,"maximum":149.40,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47.91,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.58,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":31.94,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":133.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149.4,"additional_payer_notes":"APC"}]}]},{"description":"CBC/diffwbc w/o platelet","code_information":[{"code":"G0306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.77,"maximum":36.34,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.66,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":32.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36.34,"additional_payer_notes":"APC"}]}]},{"description":"CBC without platelet","code_information":[{"code":"G0307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":30.26,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30.26,"additional_payer_notes":"APC"}]}]},{"description":"Fecal blood scrn immunoassay","code_information":[{"code":"G0328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.05,"maximum":84.43,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84.43,"additional_payer_notes":"APC"}]}]},{"description":"EIA HIV-1/HIV-2 screen","code_information":[{"code":"G0432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.57,"maximum":91.54,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29.36,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.96,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91.54,"additional_payer_notes":"APC"}]}]},{"description":"ELISA HIV-1/HIV-2 screen","code_information":[{"code":"G0433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.29,"maximum":85.55,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.44,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":76.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85.55,"additional_payer_notes":"APC"}]}]},{"description":"Oral hiv-1/hiv-2 screen","code_information":[{"code":"G0435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":56.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"}]}]},{"description":"Hep c screen high risk/other","code_information":[{"code":"G0472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.35,"maximum":216.80,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69.53,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":46.35,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":193.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":216.8,"additional_payer_notes":"APC"}]}]},{"description":"Hiv combination assay","code_information":[{"code":"G0475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":112.63,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36.12,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112.63,"additional_payer_notes":"APC"}]}]},{"description":"Hpv combo assay ca screen","code_information":[{"code":"G0476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 1-7 classes","code_information":[{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":535.25,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":171.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":476.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":535.25,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 8-14 classes","code_information":[{"code":"G0481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.59,"maximum":732.45,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":234.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.72,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":156.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":652.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":732.45,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 15-21 classes","code_information":[{"code":"G0482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":929.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":298.11,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":827.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":929.61,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 22+ classes","code_information":[{"code":"G0483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":1154.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1028.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1154.97,"additional_payer_notes":"APC"}]}]},{"description":"Hepb screen high risk indiv","code_information":[{"code":"G0499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.27,"maximum":132.23,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.84,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":28.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":117.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132.23,"additional_payer_notes":"APC"}]}]},{"description":"Screening Hep C detect","code_information":[{"code":"G0567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def simple all cl","code_information":[{"code":"G0659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":290.66,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":93.21,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":258.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":290.66,"additional_payer_notes":"APC"}]}]},{"description":"Cephalin floculation test","code_information":[{"code":"P2028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":23.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"}]}]},{"description":"Congo red blood test","code_information":[{"code":"P2029","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":23.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"}]}]},{"description":"Blood thymol turbidity","code_information":[{"code":"P2033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":23.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"}]}]},{"description":"Blood mucoprotein","code_information":[{"code":"P2038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":23.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"}]}]},{"description":"Screen pap by tech w md supv","code_information":[{"code":"P3000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":86.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.72,"additional_payer_notes":"APC"}]}]},{"description":"Catheterize for urine spec","code_information":[{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.34,"maximum":43.69,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Wet mounts/ w preparations","code_information":[{"code":"Q0111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":86.72,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86.72,"additional_payer_notes":"APC"}]}]},{"description":"Potassium hydroxide preps","code_information":[{"code":"Q0112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.83,"maximum":27.27,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8.75,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27.27,"additional_payer_notes":"APC"}]}]},{"description":"Pinworm examinations","code_information":[{"code":"Q0113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":19.97,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"}]}]},{"description":"Fern test","code_information":[{"code":"Q0114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.74,"maximum":45.56,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":40.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45.56,"additional_payer_notes":"APC"}]}]},{"description":"Post-coital mucous exam","code_information":[{"code":"Q0115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.0,"maximum":116.94,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.5,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":104.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116.94,"additional_payer_notes":"APC"}]}]},{"description":"2019 nCoV diagnostic P","code_information":[{"code":"U0001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.92,"maximum":168.02,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53.88,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":35.92,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":149.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168.02,"additional_payer_notes":"APC"}]}]},{"description":"COVID-19 lab test non-CDC","code_information":[{"code":"U0002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":240.00,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.96,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":213.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":240.0,"additional_payer_notes":"APC"}]}]},{"description":"Breath tst attain/anal c-14","code_information":[{"code":"78267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.06,"maximum":51.73,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.59,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51.73,"additional_payer_notes":"APC"}]}]},{"description":"Breath test analysis c-14","code_information":[{"code":"78268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.41,"maximum":441.60,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":141.62,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.3,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":94.41,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":393.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":441.6,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrna 5 gen rsk urthl ca","code_information":[{"code":"0012M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrna 5 gen recr urthl ca","code_information":[{"code":"0013M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":3554.9,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1140.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3164.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3554.9,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl 83+","code_information":[{"code":"0326U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5000.0,"maximum":23387.5,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7500.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.0,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":5000.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20820.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23387.5,"additional_payer_notes":"APC"}]}]},{"description":"Ftl aneuploidy trsmy dna seq","code_information":[{"code":"0327U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":795.0,"maximum":3718.61,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1192.5,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":810.9,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3310.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3718.61,"additional_payer_notes":"APC"}]}]},{"description":"Onc neo xome&trns seq alys","code_information":[{"code":"0329U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3437.98,"maximum":16081.15,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5156.97,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.74,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":3437.98,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14316.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16081.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo opt gen mapping","code_information":[{"code":"0331U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1863.22,"maximum":8715.21,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2794.83,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1900.48,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":1863.22,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7758.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8715.21,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt gntyp alys sarscov2","code_information":[{"code":"87913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":1204.22,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":386.17,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1072.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1204.22,"additional_payer_notes":"APC"}]}]},{"description":"Ven blood coll snf/hha","code_information":[{"code":"G0471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.34,"maximum":53.04,"payers_information":[{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.01,"additional_payer_notes":"Laboratory"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"},{"payer_name":"Amerihealth Caritas","plan_name":"Next Exchange","methodology":"fee schedule","standard_charge_dollar":11.34,"additional_payer_notes":"Laboratory"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.04,"additional_payer_notes":"APC"}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"J0666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1.47,"maximum":6.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"APC"}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.30,"maximum":1.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":0.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1.42,"additional_payer_notes":"APC"}]}]},{"description":"Synvisc or Synvisc-One","code_information":[{"code":"J7325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.95,"maximum":37.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.19,"additional_payer_notes":"APC"}]}]},{"description":"Albumin (human), 25%, 50ml","code_information":[{"code":"P9047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.08,"maximum":248.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":221.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":248.27,"additional_payer_notes":"APC"}]}]},{"description":"Antihemophilic viii/vwf comp","code_information":[{"code":"J7186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1.24,"maximum":5.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"}]}]},{"description":"Degarelix injection","code_information":[{"code":"J9155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.45,"maximum":20.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6.67,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"}]}]},{"description":"Injection, pertuzumab, 1 mg","code_information":[{"code":"J9306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.02,"maximum":79.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":70.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79.6,"additional_payer_notes":"APC"}]}]},{"description":"Inj pembrolizumab","code_information":[{"code":"J9271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.29,"maximum":282.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.29,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":251.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":282.01,"additional_payer_notes":"APC"}]}]},{"description":"Epoetin alfa, non-esrd","code_information":[{"code":"J0885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.54,"maximum":39.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.54,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":35.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39.96,"additional_payer_notes":"APC"}]}]},{"description":"Paclitaxel protein bound","code_information":[{"code":"J9264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.54,"maximum":49.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.31,"additional_payer_notes":"APC"}]}]},{"description":"Inj tbo filgrastim 1 microg","code_information":[{"code":"J1447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.28,"maximum":1.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":0.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1.31,"additional_payer_notes":"APC"}]}]},{"description":"Injection, dalbavancin","code_information":[{"code":"J0875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.61,"maximum":73.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":65.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73.03,"additional_payer_notes":"APC"}]}]},{"description":"Rem mlt day uroflow setup","code_information":[{"code":"0811T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr impl ivc snr set-up","code_information":[{"code":"0982T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr s-scl eeg sys setup","code_information":[{"code":"1008T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr physiol param setup","code_information":[{"code":"99453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Trans care mgmt 14 day disch","code_information":[{"code":"99495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Trans care mgmt 7 day disch","code_information":[{"code":"99496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Periodic oral evaluation","code_information":[{"code":"D0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Limit oral eval problm focus","code_information":[{"code":"D0140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensve oral evaluation","code_information":[{"code":"D0150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Extensv oral eval prob focus","code_information":[{"code":"D0160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Re-eval,est pt,problem focus","code_information":[{"code":"D0170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Re-eval post-op visit","code_information":[{"code":"D0171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Comp periodontal evaluation","code_information":[{"code":"D0180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Assessment of a patient","code_information":[{"code":"D0191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Dental prophylaxis adult","code_information":[{"code":"D1110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Gingival irrigation per quad","code_information":[{"code":"D4921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Initial foot exam pt lops","code_information":[{"code":"G0245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Followup eval of foot pt lop","code_information":[{"code":"G0246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Demonstrate use home inr mon","code_information":[{"code":"G0248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Initial preventive exam","code_information":[{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Hospital outpt clinic visit","code_information":[{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Supply of digital device","code_information":[{"code":"G0552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Monthly tx for dmht 20mins","code_information":[{"code":"G0553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.49,"additional_payer_notes":"APC"}]}]},{"description":"Opps service,sched team conf","code_information":[{"code":"G0175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":465.33,"maximum":2176.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":465.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":698.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":474.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1937.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2176.59,"additional_payer_notes":"APC"}]}]},{"description":"Direct refer hospital observ","code_information":[{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":664.14,"maximum":3106.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":664.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":996.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":677.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2765.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3106.5,"additional_payer_notes":"APC"}]}]},{"description":"Trauma Respons w/hosp criti","code_information":[{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1486.46,"maximum":6952.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1486.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2229.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1516.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6189.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6952.94,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl impltbl glucose sensor","code_information":[{"code":"0447T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Esw integ wnd hlg 1st wnd","code_information":[{"code":"0512T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Coms ther 1st appl<=50 sq cm","code_information":[{"code":"0906T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Acne surgery","code_information":[{"code":"10040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Skin tissue procedure","code_information":[{"code":"17999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Dermatological procedure","code_information":[{"code":"96999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Wound(s) care non-selective","code_information":[{"code":"97602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Low frequency non-thermal us","code_information":[{"code":"97610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Routine footcare pt w lops","code_information":[{"code":"G0247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":223.75,"maximum":1046.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":223.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":335.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":931.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1046.58,"additional_payer_notes":"APC"}]}]},{"description":"Slctv nzmtc dbrdmt t/a/l 1st","code_information":[{"code":"0973T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Slctv nzmtc dbrdmt s/n/hf 1","code_information":[{"code":"0975T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Fna w/o image","code_information":[{"code":"10021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body","code_information":[{"code":"10120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Hair trnspl 1-15 punch grfts","code_information":[{"code":"15775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Hair trnspl >15 punch grafts","code_information":[{"code":"15776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel face epiderm","code_information":[{"code":"15788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel nonfacial","code_information":[{"code":"15793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Injection(s) spider veins","code_information":[{"code":"36468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wnd tx <=50 sq cm","code_information":[{"code":"97607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wound tx >50 cm","code_information":[{"code":"97608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":453.35,"maximum":2120.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":453.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":680.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1887.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2120.53,"additional_payer_notes":"APC"}]}]},{"description":"Dstrj neurofibroma xtnsv","code_information":[{"code":"0419T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":824.22,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Dstrj neurofibroma xtnsv","code_information":[{"code":"0420T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":824.22,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Fxjl abl lsr 1st 100 sq cm","code_information":[{"code":"0479T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":824.22,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel face dermal","code_information":[{"code":"15789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":824.22,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel nonfacial","code_information":[{"code":"15792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":824.22,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Hair removal by electrolysis","code_information":[{"code":"17380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":824.22,"maximum":3855.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1236.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3432.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3855.27,"additional_payer_notes":"APC"}]}]},{"description":"Reloc skin pocket pls gen","code_information":[{"code":"0416T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pg wcs lv battery only","code_information":[{"code":"0862T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pg wcs lv trnsmtr only","code_information":[{"code":"0863T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj skin pocket ccm-d pg","code_information":[{"code":"0925T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Hrv skn cll ssp agrft 1st 25","code_information":[{"code":"15011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"App skn cl ssp agrft t/a/l 1","code_information":[{"code":"15015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"App skn cll ssp f/n/g/hf 1st","code_information":[{"code":"15017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of forehead wrinkles","code_information":[{"code":"15824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Suction lipectomy upr extrem","code_information":[{"code":"15878","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Dermal filler injection(s)","code_information":[{"code":"G0429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Autologous PRP for ulcers","code_information":[{"code":"G0460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.98,"maximum":10762.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3451.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2347.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9581.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.81,"additional_payer_notes":"APC"}]}]},{"description":"Adrc ther prtl rc tear","code_information":[{"code":"0717T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3951.97,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Adrc ther prtl rc tear njx","code_information":[{"code":"0718T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3951.97,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of neck wrinkles","code_information":[{"code":"15825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3951.97,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of brow wrinkles","code_information":[{"code":"15826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3951.97,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of face wrinkles","code_information":[{"code":"15828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3951.97,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of skin wrinkles","code_information":[{"code":"15829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3951.97,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Suction lipectomy head&neck","code_information":[{"code":"15876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3951.97,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Suction lipectomy trunk","code_information":[{"code":"15877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3951.97,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Suction lipectomy lwr extrem","code_information":[{"code":"15879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3951.97,"maximum":18485.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3951.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5927.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4031.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16456.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18485.35,"additional_payer_notes":"APC"}]}]},{"description":"Hbot, full body chamber, 30m","code_information":[{"code":"G0277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.46,"maximum":717.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":230.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":639.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":717.82,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/us gdn 1st les","code_information":[{"code":"10005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/fluor gdn 1st les","code_information":[{"code":"10007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/ct gdn 1st les","code_information":[{"code":"10009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/mr gdn 1st les","code_information":[{"code":"10011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Guide cathet fluid drainage","code_information":[{"code":"10030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev soft tiss 1st imag","code_information":[{"code":"10035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Removal of pressure sore","code_information":[{"code":"15999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Liver surgery procedure","code_information":[{"code":"47399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Pancreas surgery procedure","code_information":[{"code":"48999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"I&d absc intraoral soft tiss","code_information":[{"code":"D7510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Incision/drain abscess intra","code_information":[{"code":"D7511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"I&d abscess extraoral","code_information":[{"code":"D7520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Incision/drain abscess extra","code_information":[{"code":"D7521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.71,"maximum":3693.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1184.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":805.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3288.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3693.87,"additional_payer_notes":"APC"}]}]},{"description":"Abltj b9 thyr ndul perq lasr","code_information":[{"code":"0673T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.87,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Rmv/rplc magnet coil assem","code_information":[{"code":"0959T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.87,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body","code_information":[{"code":"10121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.87,"maximum":8615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1841.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2762.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1878.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7669.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8615.33,"additional_payer_notes":"APC"}]}]},{"description":"Abltj mal brst tum perq crtx","code_information":[{"code":"0581T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4366.50,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Ablt b9 brst tum perq lsr ea","code_information":[{"code":"0970T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4366.50,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Ablt mal brst tum pq lsr uni","code_information":[{"code":"0971T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4366.50,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Removal of Breast Tissue","code_information":[{"code":"19300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4366.50,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Correct inverted nipple(s)","code_information":[{"code":"19355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4366.50,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Breast surgery procedure","code_information":[{"code":"19499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4366.50,"maximum":20424.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6549.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18182.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20424.31,"additional_payer_notes":"APC"}]}]},{"description":"Lymphovenous bypass per xtr","code_information":[{"code":"1019T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7405.13,"maximum":34637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30835.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34637.51,"additional_payer_notes":"APC"}]}]},{"description":"Casting/strapping procedure","code_information":[{"code":"29799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":181.22,"maximum":847.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":754.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":847.66,"additional_payer_notes":"APC"}]}]},{"description":"Extracorp shockwv tx hi enrg","code_information":[{"code":"0101T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Musculoskeletal surgery","code_information":[{"code":"20999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Spine surgery procedure","code_information":[{"code":"22899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Abdomen surgery procedure","code_information":[{"code":"22999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder surgery procedure","code_information":[{"code":"23929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Upper arm/elbow surgery","code_information":[{"code":"24999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Forearm or wrist surgery","code_information":[{"code":"25999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Hand/finger surgery","code_information":[{"code":"26989","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Pelvis/hip joint surgery","code_information":[{"code":"27299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Leg surgery procedure","code_information":[{"code":"27599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Leg/ankle surgery procedure","code_information":[{"code":"27899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Foot/toes surgery procedure","code_information":[{"code":"28899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Arthroscopy of joint","code_information":[{"code":"29999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.08,"maximum":1286.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":412.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1145.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1286.71,"additional_payer_notes":"APC"}]}]},{"description":"Rev s-sclp eltr ra rcvr&tlmt","code_information":[{"code":"0957T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1793.24,"maximum":8387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1793.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2689.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1829.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7467.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8387.86,"additional_payer_notes":"APC"}]}]},{"description":"Extracorp shockwv tx anesth","code_information":[{"code":"0102T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3648.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl sinus tarsi implant","code_information":[{"code":"0510T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3648.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Njx b1 sub mtrl sbchdrl dfct","code_information":[{"code":"0707T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3648.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Njx b1 sub mtrl hw fixj aug","code_information":[{"code":"0869T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3648.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Rmv s-sclp eltr ra rcvr&tlmt","code_information":[{"code":"0958T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3648.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair stern/nuss w/o scope","code_information":[{"code":"21742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3648.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Repair sternum/nuss w/scope","code_information":[{"code":"21743","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3648.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Arthrp ntrcrpl/crp/mtcrp ssp","code_information":[{"code":"25448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3648.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Tmj arthroscopy disc reposit","code_information":[{"code":"D7874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3648.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Open tx post pelvic fxcture","code_information":[{"code":"G0415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3648.94,"maximum":17067.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3648.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5473.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3721.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15194.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17067.93,"additional_payer_notes":"APC"}]}]},{"description":"Perq sacral augmt unilat inj","code_information":[{"code":"0200T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Perq sacral augmt bilat inj","code_information":[{"code":"0201T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt lumb","code_information":[{"code":"0221T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Perq lamot/lam crv/thrc","code_information":[{"code":"0274T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Extraosseous joint stblztion","code_information":[{"code":"0335T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rinsj sinus tarsi implt","code_information":[{"code":"0511T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Osteot hum xtrnl lngth dev","code_information":[{"code":"0594T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Osteot femur imed lngth dev","code_information":[{"code":"27458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Osteot tibia imed lngth dev","code_information":[{"code":"27713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Dcmprn prq rmv lig flv 1lmbr","code_information":[{"code":"62330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Ndsc dcmprn 1 ntrspc lumbar","code_information":[{"code":"62380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Pild/placebo control clin tr","code_information":[{"code":"G0276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Open tx iliac spine uni/bil","code_information":[{"code":"G0412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic ring fracture uni/bil","code_information":[{"code":"G0413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic ring fx treat int fix","code_information":[{"code":"G0414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8092.15,"maximum":37851.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12138.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8253.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33696.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37851.03,"additional_payer_notes":"APC"}]}]},{"description":"Post vert arthrplst 1 lumbar","code_information":[{"code":"0202T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt cerv","code_information":[{"code":"0219T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt thor","code_information":[{"code":"0220T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Perq njx algc fluor lmbr 1st","code_information":[{"code":"0627T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Perq njx algc ct lmbr 1st","code_information":[{"code":"0629T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Xenograft impltj artclr surf","code_information":[{"code":"0737T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Arthrp 1st crp/mtcrpl prostc","code_information":[{"code":"1003T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Revision of upper arm","code_information":[{"code":"24940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"U/s trtmt, not leiomyomata","code_information":[{"code":"C9734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Spine/lumbar disk surgery","code_information":[{"code":"C9757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Arthro/shoul surg; w/spacer","code_information":[{"code":"C9781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14317.73,"maximum":66971.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21476.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14604.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":59620.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66971.18,"additional_payer_notes":"APC"}]}]},{"description":"Vrt bdy tethering ant","code_information":[{"code":"0656T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19553.76,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Vrt bdy tethering ant 8+ seg","code_information":[{"code":"0657T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19553.76,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Revj rplcmt/rmvl vrt tethrg","code_information":[{"code":"0790T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19553.76,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Ant thrc vrt body tethrg <7","code_information":[{"code":"22836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19553.76,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Ant thrc vrt body tethrg 8+","code_information":[{"code":"22837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19553.76,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Rev rplc/rmv thrc vrt tethrg","code_information":[{"code":"22838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19553.76,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Imp extar knee shck absrb","code_information":[{"code":"C8003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19553.76,"maximum":91462.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19553.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19944.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81423.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91462.7,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy for treatment","code_information":[{"code":"31527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.86,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.86,"maximum":19448.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4157.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6236.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4241.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17313.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.4,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21089","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Cranio/maxillofacial surgery","code_information":[{"code":"21299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Head surgery procedure","code_information":[{"code":"21499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Neck/chest surgery procedure","code_information":[{"code":"21899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Nasal surgery procedure","code_information":[{"code":"30999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Sinus surgery procedure","code_information":[{"code":"31299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Larynx surgery procedure","code_information":[{"code":"31599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Lip surgery procedure","code_information":[{"code":"40799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Mouth surgery procedure","code_information":[{"code":"40899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Tongue and mouth surgery","code_information":[{"code":"41599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Dental surgery procedure","code_information":[{"code":"41899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Palate/uvula surgery","code_information":[{"code":"42299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Salivary surgery procedure","code_information":[{"code":"42699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Throat surgery procedure","code_information":[{"code":"42999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Outer ear surgery procedure","code_information":[{"code":"69399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Middle ear surgery procedure","code_information":[{"code":"69799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Inner ear surgery procedure","code_information":[{"code":"69949","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Temporal bone surgery","code_information":[{"code":"69979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Unspecified periodontal proc","code_information":[{"code":"D4999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.14,"maximum":1235.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":396.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1099.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1235.49,"additional_payer_notes":"APC"}]}]},{"description":"Preparation palate mold","code_information":[{"code":"42280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":601.46,"maximum":2813.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":902.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2504.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2813.33,"additional_payer_notes":"APC"}]}]},{"description":"Tmpst auto tube dlvr sys","code_information":[{"code":"0583T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Insert nasal septal button","code_information":[{"code":"30220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum flap","code_information":[{"code":"41821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of gum lesion","code_information":[{"code":"41850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Gum graft","code_information":[{"code":"41870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Insert palate implants","code_information":[{"code":"C9727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Ana crown exp 1-3 per quad","code_information":[{"code":"D4231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Gngvl flap w rootplan 1-3 th","code_information":[{"code":"D4241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Apically positioned flap","code_information":[{"code":"D4245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Guided tiss regen resorble","code_information":[{"code":"D4266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Guided tiss regen nonresorb","code_information":[{"code":"D4267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Pedicle soft tissue graft pr","code_information":[{"code":"D4270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Auto tissue graft 1st tooth","code_information":[{"code":"D4273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Non-auto graft 1st tooth","code_information":[{"code":"D4275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Con tissue w dble ped graft","code_information":[{"code":"D4276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Soft tissue graft firsttooth","code_information":[{"code":"D4277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Rem imp tooth w mucoper flp","code_information":[{"code":"D7210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Coronectomy","code_information":[{"code":"D7251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Alveoplasty w/ extraction","code_information":[{"code":"D7310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Alveoloplasty w/extract 1-3","code_information":[{"code":"D7311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Alveoplasty w/o extraction","code_information":[{"code":"D7320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Alveoloplasty not w/extracts","code_information":[{"code":"D7321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Rad exc lesion up to 1.25 cm","code_information":[{"code":"D7410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision benign lesion>1.25c","code_information":[{"code":"D7411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision benign lesion compl","code_information":[{"code":"D7412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision malig lesion<=1.25c","code_information":[{"code":"D7413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision malig lesion>1.25cm","code_information":[{"code":"D7414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"Excision malig les complicat","code_information":[{"code":"D7415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1730.33,"maximum":8093.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1730.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2595.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1764.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7205.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.62,"additional_payer_notes":"APC"}]}]},{"description":"I&cust prep jaw xpnsj 1arch","code_information":[{"code":"0964T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"I&cst prp jw xpn dl arch non","code_information":[{"code":"0965T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"I&cst prp jw xpn dl arch fxd","code_information":[{"code":"0966T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Excision gum each quadrant","code_information":[{"code":"41820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Eardrum revision","code_information":[{"code":"69450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Gingivectomy/plasty 4 or mor","code_information":[{"code":"D4210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Gingivectomy/plasty 1 to 3","code_information":[{"code":"D4211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Gingivectomy/plasty rest","code_information":[{"code":"D4212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Ana crown exp 4 or> per quad","code_information":[{"code":"D4230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Gingival flap proc w/ planin","code_information":[{"code":"D4240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Osseous surg 1 to 3 teeth","code_information":[{"code":"D4261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Malig tumor exc to 1.25 cm","code_information":[{"code":"D7440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Malig tumor > 1.25 cm","code_information":[{"code":"D7441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Rem odontogen cyst to 1.25cm","code_information":[{"code":"D7450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Rem odontogen cyst > 1.25 cm","code_information":[{"code":"D7451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Rem exostosis any site","code_information":[{"code":"D7471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Closd rductn splint alveolus","code_information":[{"code":"D7670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Alveolus clsd reduc stblz te","code_information":[{"code":"D7771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Facility svs dental rehab","code_information":[{"code":"G0330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3697.41,"maximum":17294.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5546.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3771.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15396.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17294.63,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Reinnervate larynx","code_information":[{"code":"31590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repair windpipe opening","code_information":[{"code":"31614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Revise middle ear bone","code_information":[{"code":"69661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Osseous surgery 4 or more","code_information":[{"code":"D4260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Vestibuloplasty ridge extens","code_information":[{"code":"D7340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Vestibuloplasty exten graft","code_information":[{"code":"D7350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Surg reduct osseoustuberosit","code_information":[{"code":"D7485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Alveolus open reduction","code_information":[{"code":"D7671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Open reduc compd alveolus fx","code_information":[{"code":"D7770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Mandible graft","code_information":[{"code":"D7950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6601.81,"maximum":30879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9902.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27490.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30879.96,"additional_payer_notes":"APC"}]}]},{"description":"Repos car modulj tranvns elt","code_information":[{"code":"0415T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.57,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Rpos prv ccm-d trnsvns eltrd","code_information":[{"code":"0924T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.57,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Active thrc irrigation spx","code_information":[{"code":"1021T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.57,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Chest surgery procedure","code_information":[{"code":"32999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.57,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac surgery procedure","code_information":[{"code":"33999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.57,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Vascular endoscopy procedure","code_information":[{"code":"37501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.57,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Vascular surgery procedure","code_information":[{"code":"37799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.57,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray arm/leg","code_information":[{"code":"75801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.57,"maximum":3272.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.24,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray arms/legs","code_information":[{"code":"75803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.50,"maximum":8211.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2633.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1790.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7310.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8211.36,"additional_payer_notes":"APC"}]}]},{"description":"Ev cath dir chem abltj w/img","code_information":[{"code":"0524T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3521.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv 2chmbr ldls pm cmpl","code_information":[{"code":"0798T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3521.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl 2chmbr ldls pm ra","code_information":[{"code":"0799T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3521.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl 2chmbr ldls pm rv","code_information":[{"code":"0800T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3521.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv 1chmbr ldls pm ra","code_information":[{"code":"0824T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3521.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray trunk","code_information":[{"code":"75805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3521.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray trunk","code_information":[{"code":"75807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3521.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray spleen/liver","code_information":[{"code":"75810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3521.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Follow-up angiography","code_information":[{"code":"75898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3521.23,"maximum":16470.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5281.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14662.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.56,"additional_payer_notes":"APC"}]}]},{"description":"Insj bioprostc vlv fem vn","code_information":[{"code":"0744T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6205.53,"maximum":29026.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6329.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25840.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29026.36,"additional_payer_notes":"APC"}]}]},{"description":"Tcat impl wrls l atr prs snr","code_information":[{"code":"0933T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3615.41,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"R hrt cath chd nml nt cnj","code_information":[{"code":"93593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3615.41,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"R hrt cath chd abnl nt cnj","code_information":[{"code":"93594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3615.41,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"L hrt cath chd nm/abn nt cnj","code_information":[{"code":"93595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3615.41,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt cath chd nml nt cnj","code_information":[{"code":"93596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3615.41,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt cath chd abnl nt cnj","code_information":[{"code":"93597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3615.41,"maximum":16911.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3615.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5423.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15054.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16911.08,"additional_payer_notes":"APC"}]}]},{"description":"Trnscth renal symp denrv unl","code_information":[{"code":"0338T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6347.25,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Trnscth renal symp denrv bil","code_information":[{"code":"0339T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6347.25,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl/dblk icar mas perq","code_information":[{"code":"0644T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6347.25,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt angio sf 1st","code_information":[{"code":"37254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6347.25,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt angio cplx 1","code_information":[{"code":"37256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6347.25,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc fpvt angio sf 1","code_information":[{"code":"37263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6347.25,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt angio cplx 1","code_information":[{"code":"37265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6347.25,"maximum":29689.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9520.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26430.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29689.25,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc renal art","code_information":[{"code":"0234T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc abd aorta","code_information":[{"code":"0236T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc brchiocph","code_information":[{"code":"0237T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Ev fempop artl revsc","code_information":[{"code":"0505T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Prq tcat ther rx ntrac balo1","code_information":[{"code":"0913T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt stent sf 1st","code_information":[{"code":"37258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt st cplx 1st","code_information":[{"code":"37260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt stent sf 1st","code_information":[{"code":"37267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc fpvt st cplx 1st","code_information":[{"code":"37269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc tpvt angio sf 1st","code_information":[{"code":"37280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc tpvt angio cplx 1","code_information":[{"code":"37282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc imvt angio sf 1","code_information":[{"code":"37296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc imvt angio cplx 1","code_information":[{"code":"37298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Prq trl rvs ch occ ant&rtrgr","code_information":[{"code":"92945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Sim ang w/prs cath rad emb","code_information":[{"code":"C8004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Perc drug-el cor stent sing","code_information":[{"code":"C9600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Perc d-e cor revasc t cabg s","code_information":[{"code":"C9604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Revasc intravasc lithotripsy","code_information":[{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotrip tibi/perone","code_information":[{"code":"C9772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Blind cor sinus reducer impl","code_information":[{"code":"C9783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12874.11,"maximum":60218.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12874.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19311.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":53609.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60218.65,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc iliac art","code_information":[{"code":"0238T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Perq tcat us abltj nrv p-art","code_information":[{"code":"0632T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Tcat impltj c sins rdctj dev","code_information":[{"code":"0645T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Prq tcat thrm ablt nrv p-art","code_information":[{"code":"0793T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Tcat impl wrls ivc snr","code_information":[{"code":"0981T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt athrc sf 1st","code_information":[{"code":"37271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt athrc cplx 1","code_information":[{"code":"37273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc fpvt st athrc sf 1","code_information":[{"code":"37275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc fpvt st athr cpx 1","code_information":[{"code":"37277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc tpvt st sf 1st","code_information":[{"code":"37284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc tpvt st cplx 1st","code_information":[{"code":"37286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc tpvt athrc sf 1st","code_information":[{"code":"37288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc tpvt athrc cplx 1","code_information":[{"code":"37290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc tpvt st athrc sf 1","code_information":[{"code":"37292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc tpvt st athr cpx 1","code_information":[{"code":"37294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Prq tcat plmt ntrac st 2+les","code_information":[{"code":"92930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Perc d-e cor stent ather s","code_information":[{"code":"C9602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Perc d-e cor revasc chro sin","code_information":[{"code":"C9607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revasc intra lithotrip-stent","code_information":[{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revasc intra lithotrip-ather","code_information":[{"code":"C9766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotrip-stent-ather","code_information":[{"code":"C9767","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotr-stent tib/per","code_information":[{"code":"C9773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotr-ather tib/per","code_information":[{"code":"C9774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lith-sten-ath tib/per","code_information":[{"code":"C9775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Vasc emb/occ w/prs cath","code_information":[{"code":"C9797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20443.49,"maximum":95624.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20443.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30665.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20852.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85128.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95624.42,"additional_payer_notes":"APC"}]}]},{"description":"Bundle of His recording","code_information":[{"code":"93600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8698.21,"maximum":40685.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13047.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36220.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40685.85,"additional_payer_notes":"APC"}]}]},{"description":"Intra-atrial recording","code_information":[{"code":"93602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8698.21,"maximum":40685.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13047.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36220.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40685.85,"additional_payer_notes":"APC"}]}]},{"description":"Intra-atrial pacing","code_information":[{"code":"93610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8698.21,"maximum":40685.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13047.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36220.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40685.85,"additional_payer_notes":"APC"}]}]},{"description":"Intraventricular pacing","code_information":[{"code":"93612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8698.21,"maximum":40685.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13047.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36220.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40685.85,"additional_payer_notes":"APC"}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8698.21,"maximum":40685.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13047.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36220.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40685.85,"additional_payer_notes":"APC"}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8698.21,"maximum":40685.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13047.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36220.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40685.85,"additional_payer_notes":"APC"}]}]},{"description":"Electrophysiologic study","code_information":[{"code":"93624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8698.21,"maximum":40685.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13047.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36220.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40685.85,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl cardiac modulj pls gen","code_information":[{"code":"0412T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl car modulj tranvns elt","code_information":[{"code":"0413T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl pg compnt wcs","code_information":[{"code":"0518T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal complete iims","code_information":[{"code":"0530T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal iims electrode only","code_information":[{"code":"0531T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal iims implt mntr only","code_information":[{"code":"0532T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal ss dfb electrode","code_information":[{"code":"0573T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Repos prev ss impl dfb eltrd","code_information":[{"code":"0574T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl ss impl dfb pg only","code_information":[{"code":"0580T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl pg wcs lv both compnt","code_information":[{"code":"0861T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl perm ccm-d sys pg only","code_information":[{"code":"0919T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl perm ccm-d sys 1 pac ld","code_information":[{"code":"0920T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl perm ccm-d sys 1 dfb ld","code_information":[{"code":"0921T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl perm ccm-d sys dual ld","code_information":[{"code":"0922T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4167.47,"maximum":19493.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4167.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6251.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17353.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19493.33,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplc car modulj atr elt","code_information":[{"code":"0410T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9228.74,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplc car modulj vnt elt","code_information":[{"code":"0411T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9228.74,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt iims eltrd only","code_information":[{"code":"0526T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9228.74,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt iims implt mntr","code_information":[{"code":"0527T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9228.74,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insertion ss dfb electrode","code_information":[{"code":"0572T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9228.74,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insj perm ccm-d sys 1 lead","code_information":[{"code":"0917T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9228.74,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insj perm ccm-d sys dual ld","code_information":[{"code":"0918T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9228.74,"maximum":43167.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9228.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13843.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38429.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43167.41,"additional_payer_notes":"APC"}]}]},{"description":"Insj wcs lv eltrd only","code_information":[{"code":"0516T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11656.09,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"Insj wcs lv pg compnt","code_information":[{"code":"0517T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11656.09,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl & rplcmt pg compnt wcs","code_information":[{"code":"0519T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11656.09,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rplcmt pg wcs new eltrd","code_information":[{"code":"0520T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11656.09,"maximum":54521.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11656.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17484.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11889.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48537.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54521.37,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt compl iims","code_information":[{"code":"0525T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21480.69,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 2chmbr ldls pm cmpl","code_information":[{"code":"0795T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21480.69,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 2chmbr ldls pm ra","code_information":[{"code":"0796T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21480.69,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 2chmbr ldls pm rv","code_information":[{"code":"0797T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21480.69,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl 2chmbr ldls pm","code_information":[{"code":"0801T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21480.69,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl2chmb ldls pm ra","code_information":[{"code":"0802T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21480.69,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl2chmb ldls pm rv","code_information":[{"code":"0803T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21480.69,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 1chmbr ldls pm ra","code_information":[{"code":"0823T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21480.69,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl1chmb ldls pm ra","code_information":[{"code":"0825T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21480.69,"maximum":100475.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21480.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32221.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21910.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":89447.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100475.92,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplc car modulj pls gn","code_information":[{"code":"0409T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24806.09,"maximum":116030.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24806.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37209.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25302.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103295.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116030.5,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl & rpl car modulj pls gn","code_information":[{"code":"0414T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24806.09,"maximum":116030.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24806.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37209.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25302.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103295.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116030.5,"additional_payer_notes":"APC"}]}]},{"description":"Insj wcs lv compl sys","code_information":[{"code":"0515T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24806.09,"maximum":116030.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24806.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37209.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25302.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103295.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116030.5,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rplcmt ss impl dfb pg","code_information":[{"code":"0614T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24806.09,"maximum":116030.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24806.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37209.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25302.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103295.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116030.5,"additional_payer_notes":"APC"}]}]},{"description":"Insj perm ccm-d sys pg only","code_information":[{"code":"0916T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24806.09,"maximum":116030.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24806.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37209.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25302.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103295.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116030.5,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rplcmt perm ccm-d pg","code_information":[{"code":"0923T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24806.09,"maximum":116030.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24806.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37209.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25302.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":103295.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116030.5,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplc cardiac modulj sys","code_information":[{"code":"0408T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35004.94,"maximum":163735.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52507.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35705.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145764.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163735.62,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt icds ss eltrd","code_information":[{"code":"0571T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35004.94,"maximum":163735.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52507.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35705.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145764.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163735.62,"additional_payer_notes":"APC"}]}]},{"description":"Insj perm ccm-d sys pg&eltrd","code_information":[{"code":"0915T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35004.94,"maximum":163735.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52507.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35705.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145764.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163735.62,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreserve stem cells","code_information":[{"code":"38207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Thaw preserved stem cells","code_information":[{"code":"38208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Wash harvest stem cells","code_information":[{"code":"38209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"T-cell depletion of harvest","code_information":[{"code":"38210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Tumor cell deplete of harvst","code_information":[{"code":"38211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Rbc depletion of harvest","code_information":[{"code":"38212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Platelet deplete of harvest","code_information":[{"code":"38213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Volume deplete of harvest","code_information":[{"code":"38214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Harvest stem cell concentrte","code_information":[{"code":"38215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Blood/lymph system procedure","code_information":[{"code":"38999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.00,"maximum":2301.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":492.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":738.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2048.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2301.32,"additional_payer_notes":"APC"}]}]},{"description":"Mag ctrld capsule endoscopy","code_information":[{"code":"0651T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Egd vol adjmt bariatric balo","code_information":[{"code":"0813T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Upr gi bld detcj snr capsule","code_information":[{"code":"0977T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus surgery procedure","code_information":[{"code":"43499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Stomach surgery procedure","code_information":[{"code":"43999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Intro gastrointestinal tube","code_information":[{"code":"44500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted px small intestine","code_information":[{"code":"44799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Bile tract surgery procedure","code_information":[{"code":"47999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Abdomen surgery procedure","code_information":[{"code":"49999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Perq elec nrv field stimj cn","code_information":[{"code":"64567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1011.47,"maximum":4731.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1011.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1517.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1031.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4211.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4731.16,"additional_payer_notes":"APC"}]}]},{"description":"Insj gtube perq mag gastrpxy","code_information":[{"code":"0647T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2139.97,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal dx br/wa","code_information":[{"code":"0652T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2139.97,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal bx 1/ml","code_information":[{"code":"0653T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2139.97,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy br/wa","code_information":[{"code":"44381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2139.97,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2139.97,"maximum":10009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3209.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8911.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10009.71,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal tube/cath","code_information":[{"code":"0654T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4299.63,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Esophag mucosal integ add-on","code_information":[{"code":"C9777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4299.63,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"ESD endoscopy or colonoscopy","code_information":[{"code":"C9779","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4299.63,"maximum":20111.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6449.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17904.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20111.53,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted procedure colon","code_information":[{"code":"45399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.09,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Rectum surgery procedure","code_information":[{"code":"45999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.09,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Anus surgery procedure","code_information":[{"code":"46999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.09,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Place endorectal app","code_information":[{"code":"C9725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.09,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"CA screen;flexi sigmoidscope","code_information":[{"code":"G0104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.09,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Fecal microbiota prep instil","code_information":[{"code":"G0455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.09,"maximum":4850.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1555.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1057.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4318.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.99,"additional_payer_notes":"APC"}]}]},{"description":"Anosc sbmcsl njx bulking agt","code_information":[{"code":"0963T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1334.50,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Tranal ins tmp clrc anst dev","code_information":[{"code":"0967T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1334.50,"maximum":6242.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1334.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2001.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5556.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6242.11,"additional_payer_notes":"APC"}]}]},{"description":"Rpr intst excl anrect fist","code_information":[{"code":"C9796","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3095.42,"maximum":14478.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3095.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4643.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3157.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12889.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14478.85,"additional_payer_notes":"APC"}]}]},{"description":"Exc rectal tumor endoscopic","code_information":[{"code":"0184T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6770.28,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Esphgsc flx 1st tndsc dilat","code_information":[{"code":"0884T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6770.28,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Colsc flx 1st tndsc dilat","code_information":[{"code":"0885T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6770.28,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Sgmdsc flx 1st tndsc dilat","code_information":[{"code":"0886T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6770.28,"maximum":31667.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28192.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31667.99,"additional_payer_notes":"APC"}]}]},{"description":"Inst pleu-perit shnt w pump","code_information":[{"code":"C8006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7219.62,"maximum":33769.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10829.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30063.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33769.78,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc spleen","code_information":[{"code":"38129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Explore deep node(s) neck","code_information":[{"code":"38542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc lymphatic","code_information":[{"code":"38589","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc esoph","code_information":[{"code":"43289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc stom","code_information":[{"code":"43659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc intestine","code_information":[{"code":"44238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc app","code_information":[{"code":"44979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc rectum","code_information":[{"code":"45499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope procedure liver","code_information":[{"code":"47379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc biliary","code_information":[{"code":"47579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc abdm/per/oment","code_information":[{"code":"49329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc hernia repair","code_information":[{"code":"49659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc renal","code_information":[{"code":"50549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc ureter","code_information":[{"code":"50949","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc bla","code_information":[{"code":"51999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc testis","code_information":[{"code":"54699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc spermatic cord","code_information":[{"code":"55559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc uterus","code_information":[{"code":"58578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc oviduct-ovary","code_information":[{"code":"58679","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc ob care/deliver","code_information":[{"code":"59898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc endocrine","code_information":[{"code":"60659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Endocrine surgery procedure","code_information":[{"code":"60699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6741.99,"maximum":31535.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10112.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28074.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31535.65,"additional_payer_notes":"APC"}]}]},{"description":"Ire abltj 1+tum organ perq","code_information":[{"code":"0600T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Ire abltj 1+tumors open","code_information":[{"code":"0601T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laps repos lead isdss 1st ld","code_information":[{"code":"0677T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Laps rmvl lead isdss","code_information":[{"code":"0679T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Lap revise/remv eltrd antrum","code_information":[{"code":"43648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Gstr rstcv px trnsorl esg","code_information":[{"code":"43889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Abltj ire liver 1+ tum perq","code_information":[{"code":"47384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Lap srg prst8ct lymph nod bx","code_information":[{"code":"55868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Lap srg prst8ct bi pl lmphad","code_information":[{"code":"55869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Abltj ire prst8 1+ tum perq","code_information":[{"code":"55877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Endo outlet restrict w/tube","code_information":[{"code":"C9785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Endo defect closure GI tract","code_information":[{"code":"C9901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11854.42,"maximum":55449.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17781.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":49362.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55449.04,"additional_payer_notes":"APC"}]}]},{"description":"Low ntsty eswt corpus cvrnsm","code_information":[{"code":"0864T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.63,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl balo cntnc dev adjmt","code_information":[{"code":"53454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.63,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Urology surgery procedure","code_information":[{"code":"53899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.63,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Dynamic cavernosometry","code_information":[{"code":"54231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.63,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Penile injection","code_information":[{"code":"54235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.63,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Penis study","code_information":[{"code":"54250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.63,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Genital surgery procedure","code_information":[{"code":"55899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":278.63,"maximum":1303.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":417.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1160.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1303.3,"additional_payer_notes":"APC"}]}]},{"description":"Temp fml iu vlv-pmp 1st insj","code_information":[{"code":"0596T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":777.63,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Temp fml iu valve-pmp rplcmt","code_information":[{"code":"0597T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":777.63,"maximum":3637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1166.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3238.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3637.35,"additional_payer_notes":"APC"}]}]},{"description":"Frenulotomy of penis","code_information":[{"code":"54164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2331.20,"maximum":10904.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2331.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3496.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2377.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9707.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10904.19,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl balo cntnc dev rmvl ea","code_information":[{"code":"53453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Remove muti-comp penis pros","code_information":[{"code":"54406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Remove self-contd penis pros","code_information":[{"code":"54415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Repair of penis","code_information":[{"code":"54440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Incision of sperm duct","code_information":[{"code":"55200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Repair of sperm duct","code_information":[{"code":"55400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 trct us guided","code_information":[{"code":"55707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 trct us w/mri fus 1","code_information":[{"code":"55708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 tprnl us guided","code_information":[{"code":"55709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 tprn us w/mri fus 1","code_information":[{"code":"55710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 trct mri-us 1st","code_information":[{"code":"55711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 tprnl mri-us 1st","code_information":[{"code":"55712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Sex transformation f to m","code_information":[{"code":"55980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3931.07,"maximum":18387.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3931.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5896.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16369.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18387.57,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl focal abltj mal prst8","code_information":[{"code":"0655T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5979.49,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl lsr ablt b9 prst8 hypr","code_information":[{"code":"0714T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5979.49,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Tpla b9 prst8 hyprplsa>=50ml","code_information":[{"code":"0867T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5979.49,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Repair multi-comp penis pros","code_information":[{"code":"54408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5979.49,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Revision of testis","code_information":[{"code":"54660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5979.49,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 in-bore ct/mri bx 1","code_information":[{"code":"55713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5979.49,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 in-bore ct/mri 1","code_information":[{"code":"55714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5979.49,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy prostatic imp 1-3","code_information":[{"code":"C9739","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5979.49,"maximum":27969.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8969.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":24899.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.06,"additional_payer_notes":"APC"}]}]},{"description":"Abltj b9 prst8 tissue hifu","code_information":[{"code":"0950T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10557.02,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Cysto lo-nrg lithtrp&mcrsphr","code_information":[{"code":"0991T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10557.02,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Cysto 1st trurl prst8 comis","code_information":[{"code":"52443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10557.02,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Trurl rbtc wtrjt rescj prst8","code_information":[{"code":"52597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10557.02,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl balo cntnc dev uni","code_information":[{"code":"53452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10557.02,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Cysto impl 4 or more","code_information":[{"code":"C9740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10557.02,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Cysto, litho, vacuum kidney","code_information":[{"code":"C9761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10557.02,"maximum":49380.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10557.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15835.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10768.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43960.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49380.47,"additional_payer_notes":"APC"}]}]},{"description":"Insert self-contd prosthesis","code_information":[{"code":"54401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23113.83,"maximum":108114.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23113.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34670.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23576.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96248.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108114.92,"additional_payer_notes":"APC"}]}]},{"description":"Insert multi-comp penis pros","code_information":[{"code":"54405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23113.83,"maximum":108114.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23113.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34670.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23576.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96248.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108114.92,"additional_payer_notes":"APC"}]}]},{"description":"Remove/replace penis prosth","code_information":[{"code":"54410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23113.83,"maximum":108114.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23113.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34670.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23576.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96248.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108114.92,"additional_payer_notes":"APC"}]}]},{"description":"Remov/replc penis pros comp","code_information":[{"code":"54411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23113.83,"maximum":108114.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23113.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34670.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23576.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96248.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108114.92,"additional_payer_notes":"APC"}]}]},{"description":"Remv/repl penis contain pros","code_information":[{"code":"54416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23113.83,"maximum":108114.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23113.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34670.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23576.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96248.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108114.92,"additional_payer_notes":"APC"}]}]},{"description":"Remv/replc penis pros compl","code_information":[{"code":"54417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23113.83,"maximum":108114.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23113.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34670.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23576.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":96248.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108114.92,"additional_payer_notes":"APC"}]}]},{"description":"Unsched dialysis ESRD pt hos","code_information":[{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":765.38,"maximum":3580.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1148.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":780.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3187.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3580.07,"additional_payer_notes":"APC"}]}]},{"description":"Artificial insemination","code_information":[{"code":"58322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.46,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Sperm washing","code_information":[{"code":"58323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.46,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscope procedure","code_information":[{"code":"58579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.46,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Genital surgery procedure","code_information":[{"code":"58999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.46,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Fetal invas px w/us","code_information":[{"code":"59897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.46,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Maternity care procedure","code_information":[{"code":"59899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.46,"maximum":1054.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":338.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":229.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":938.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1054.6,"additional_payer_notes":"APC"}]}]},{"description":"Artificial insemination","code_information":[{"code":"58321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.84,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of embryo","code_information":[{"code":"58976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.84,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Abortion (mpr)","code_information":[{"code":"59866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.84,"maximum":1589.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1415.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1589.58,"additional_payer_notes":"APC"}]}]},{"description":"Electroejaculation","code_information":[{"code":"55870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1027.16,"maximum":4804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1540.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4277.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4804.53,"additional_payer_notes":"APC"}]}]},{"description":"Retrieval of oocyte","code_information":[{"code":"58970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1027.16,"maximum":4804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1540.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4277.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4804.53,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of embryo","code_information":[{"code":"58974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1027.16,"maximum":4804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1540.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4277.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4804.53,"additional_payer_notes":"APC"}]}]},{"description":"Us leiomyomata ablate <200","code_information":[{"code":"0071T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3610.05,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Us leiomyomata ablate >200","code_information":[{"code":"0072T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3610.05,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Reopen fallopian tube","code_information":[{"code":"58345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3610.05,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Antepartum manipulation","code_information":[{"code":"59412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3610.05,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Vbac delivery only","code_information":[{"code":"59612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3610.05,"maximum":16886.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3610.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5415.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3682.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15032.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16886.01,"additional_payer_notes":"APC"}]}]},{"description":"Sex transformation m to f","code_information":[{"code":"55970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5578.74,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Reopen fallopian tube","code_information":[{"code":"58350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5578.74,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Colpopexy, min/inv, ex-perit","code_information":[{"code":"C9778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5578.74,"maximum":26094.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8368.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23230.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.58,"additional_payer_notes":"APC"}]}]},{"description":"Abltj perc uxtr/perph nrv","code_information":[{"code":"0440T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2177.68,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Abltj perc lxtr/perph nrv","code_information":[{"code":"0441T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2177.68,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Dcmprn median nrv carpl tunl","code_information":[{"code":"64728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2177.68,"maximum":10186.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2177.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3266.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9068.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.12,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl bat modulj sys tot sys","code_information":[{"code":"64657","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3809.70,"maximum":17819.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3809.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5714.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15863.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17819.86,"additional_payer_notes":"APC"}]}]},{"description":"Nervous system surgery","code_information":[{"code":"64999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.31,"maximum":1601.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":349.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1425.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1601.17,"additional_payer_notes":"APC"}]}]},{"description":"Inj for sacroiliac jt anesth","code_information":[{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":787.20,"maximum":3682.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1180.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":802.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3277.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3682.13,"additional_payer_notes":"APC"}]}]},{"description":"Njx paravert w/us cer/thor","code_information":[{"code":"0213T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":986.37,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Njx paravert w/us lumb/sac","code_information":[{"code":"0216T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":986.37,"maximum":4613.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":986.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1479.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4107.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4613.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision/removal isdns ptn","code_information":[{"code":"0588T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pulse gen only isdss","code_information":[{"code":"0681T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Removal pulse gen only isdss","code_information":[{"code":"0682T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea spi w/nstim","code_information":[{"code":"0785T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea sac w/nstim","code_information":[{"code":"0787T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subq","code_information":[{"code":"0818T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subf","code_information":[{"code":"0819T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl int nstim sys vagus nrv","code_information":[{"code":"0910T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subq&subf","code_information":[{"code":"0989T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Rev/rmv lw esoph sphnc npg/r","code_information":[{"code":"1015T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea pn w/int nstim","code_information":[{"code":"64598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rplcmt bat mod sys lead","code_information":[{"code":"64655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl bat modul sys lead only","code_information":[{"code":"64658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl bat modulj sys pg only","code_information":[{"code":"64659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3898.87,"maximum":18236.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3898.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5848.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3976.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16235.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18236.95,"additional_payer_notes":"APC"}]}]},{"description":"Perq impltj/rplcmt isdns ptn","code_information":[{"code":"0587T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7107.18,"maximum":33243.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10660.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29595.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33243.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt pg only isdss","code_information":[{"code":"0680T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21635.06,"maximum":101197.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21635.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32452.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22067.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90090.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101197.98,"additional_payer_notes":"APC"}]}]},{"description":"Opn insj/rplcmt ins ptn subq","code_information":[{"code":"0816T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21635.06,"maximum":101197.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21635.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32452.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22067.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90090.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101197.98,"additional_payer_notes":"APC"}]}]},{"description":"Opn insj/rplcmt ins ptn subf","code_information":[{"code":"0817T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21635.06,"maximum":101197.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21635.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32452.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22067.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90090.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101197.98,"additional_payer_notes":"APC"}]}]},{"description":"Lap srg imp/rpl eso nea&pg/r","code_information":[{"code":"1013T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21635.06,"maximum":101197.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21635.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32452.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22067.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90090.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101197.98,"additional_payer_notes":"APC"}]}]},{"description":"Laps insj nw/rpcmt prm isdss","code_information":[{"code":"0674T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34412.59,"maximum":160964.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34412.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51618.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143297.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160964.87,"additional_payer_notes":"APC"}]}]},{"description":"Opn imp int nstm sys vgs nrv","code_information":[{"code":"0908T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34412.59,"maximum":160964.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34412.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51618.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143297.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160964.87,"additional_payer_notes":"APC"}]}]},{"description":"Rplcmt int nstim sys vgs nrv","code_information":[{"code":"0909T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34412.59,"maximum":160964.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34412.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51618.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143297.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160964.87,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rplcmt bat mod sys pg","code_information":[{"code":"64656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34412.59,"maximum":160964.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34412.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51618.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35100.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143297.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160964.87,"additional_payer_notes":"APC"}]}]},{"description":"RSA lower extr exam","code_information":[{"code":"0350T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Tactile breast img uni/bi","code_information":[{"code":"0422T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct scan f/biomchn ct alys","code_information":[{"code":"0558T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Quan us tis charac w/o dx us","code_information":[{"code":"0689T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct hrt w/o dye w/ca test","code_information":[{"code":"75571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Mr spectroscopy","code_information":[{"code":"76390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Fluoroscopic procedure","code_information":[{"code":"76496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct procedure","code_information":[{"code":"76497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Mri procedure","code_information":[{"code":"76498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Radiographic procedure","code_information":[{"code":"76499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Echo examination procedure","code_information":[{"code":"76999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Fracture assessment via dxa","code_information":[{"code":"77086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral periapical first","code_information":[{"code":"D0220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral occlusal film","code_information":[{"code":"D0240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Extraoral 2d project image","code_information":[{"code":"D0250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Extraoral posterior image","code_information":[{"code":"D0251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Dental bitewing single image","code_information":[{"code":"D0270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Dental bitewings two images","code_information":[{"code":"D0272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Other tmj images by report","code_information":[{"code":"D0321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"2d cephalometric image","code_information":[{"code":"D0340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Oral/facial photo images","code_information":[{"code":"D0350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Sialoendoscopy capt & interp","code_information":[{"code":"D0371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Trtmnt simulation 3d image","code_information":[{"code":"D0393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Digital sub 2 or more images","code_information":[{"code":"D0394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Fusion 2 or more 3d images","code_information":[{"code":"D0395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=61.50","code_information":[{"code":"D0701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=52.50 and M <61.50","code_information":[{"code":"D0702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=41.50 and M <52.50","code_information":[{"code":"D0703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Extra oral post radio image","code_information":[{"code":"D0705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral occlus radio image","code_information":[{"code":"D0706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral periap radio image","code_information":[{"code":"D0707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral bite radio image","code_information":[{"code":"D0708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral cmplt radio images","code_information":[{"code":"D0709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"Software meas of cardiac vol","code_information":[{"code":"G0183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.05,"maximum":453.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":404.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.95,"additional_payer_notes":"APC"}]}]},{"description":"RSA spine exam","code_information":[{"code":"0348T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"RSA upper extr exam","code_information":[{"code":"0349T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d uni c-","code_information":[{"code":"0633T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Opto-acoustic img breast uni","code_information":[{"code":"0857T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Ortho impl mvmt alys pair ct","code_information":[{"code":"0946T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of penis","code_information":[{"code":"74445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Dxa bone density study","code_information":[{"code":"77085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Dental tomographic survey","code_information":[{"code":"D0322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt & interp","code_information":[{"code":"D0364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete man","code_information":[{"code":"D0365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete max","code_information":[{"code":"D0366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interp both jaw","code_information":[{"code":"D0367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete TMJ","code_information":[{"code":"D0368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Max MRI capture & interprete","code_information":[{"code":"D0369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Max ultrasound capt & interp","code_information":[{"code":"D0370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capture limited","code_information":[{"code":"D0380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt mandible","code_information":[{"code":"D0381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt maxilla","code_information":[{"code":"D0382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct both jaws","code_information":[{"code":"D0383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capture TMJ","code_information":[{"code":"D0384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Max MRI image capture","code_information":[{"code":"D0385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Max ultrasound image capture","code_information":[{"code":"D0386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"Single energy x-ray study","code_information":[{"code":"G0130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.59,"maximum":545.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":174.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.35,"additional_payer_notes":"APC"}]}]},{"description":"B1 str & fx rsk assessment","code_information":[{"code":"0556T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mrs disc pain acquisj data","code_information":[{"code":"0609T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mrs disc pain alg alys data","code_information":[{"code":"0611T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d bi c-","code_information":[{"code":"0636T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"B1 str & fx rsk vrt fx assmt","code_information":[{"code":"0743T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Quan mri alys brn w/o dx mri","code_information":[{"code":"0865T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Quan mri alys brn w/dx mri","code_information":[{"code":"0866T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"3d cntr simula trgt lvr les","code_information":[{"code":"0944T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt car rsk w/o ct","code_information":[{"code":"0992T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt car rsk w/ct","code_information":[{"code":"0993T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of tear duct","code_information":[{"code":"70170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Fmri brain by phys/psych","code_information":[{"code":"70555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray urethra/bladder","code_information":[{"code":"74450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of perineum","code_information":[{"code":"74775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"GI endoscopic ultrasound","code_information":[{"code":"76975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o cont, abd","code_information":[{"code":"C8901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/o cont, chest","code_information":[{"code":"C8910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o cont, lwr ext","code_information":[{"code":"C8913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/o cont, pelvis","code_information":[{"code":"C8919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o dye, spinal canal","code_information":[{"code":"C8932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o dye, upper extr","code_information":[{"code":"C8935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Intraor complete film series","code_information":[{"code":"D0210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Bitewings - three images","code_information":[{"code":"D0273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Bitewings four images","code_information":[{"code":"D0274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Vert bitewings 7 to 8 images","code_information":[{"code":"D0277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Dental saliography","code_information":[{"code":"D0310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Dental tmj arthrogram incl i","code_information":[{"code":"D0320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Panoramic image","code_information":[{"code":"D0330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.09,"maximum":1244.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":399.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1108.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1244.63,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain w/o dye","code_information":[{"code":"70557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.36,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of peritoneum","code_information":[{"code":"74190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.36,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of kidney lesion","code_information":[{"code":"74470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.36,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.36,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Echo Transesophageal Intraop","code_information":[{"code":"93318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.36,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac MRI seg dys strain","code_information":[{"code":"C9762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.36,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac MRI seg dys stress","code_information":[{"code":"C9763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.36,"maximum":2850.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":914.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2537.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d uni c+","code_information":[{"code":"0634T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d uni c-/c+","code_information":[{"code":"0635T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct cere prfu aly c+wo ct/cta","code_information":[{"code":"70473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain w/dye","code_information":[{"code":"70558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain w/o & w/dye","code_information":[{"code":"70559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/cont, breast,  uni","code_information":[{"code":"C8903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.61,"maximum":914.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":814.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.95,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d bi c+","code_information":[{"code":"0637T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d bi c-/c+","code_information":[{"code":"0638T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Cta h&n c+ w/noncontrast img","code_information":[{"code":"70471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/cont, abd","code_information":[{"code":"C8900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o fol w/cont, abd","code_information":[{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/o fol w/cont, brst, un","code_information":[{"code":"C8905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/cont, breast,  bi","code_information":[{"code":"C8906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/o fol w/cont, breast,","code_information":[{"code":"C8908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/cont, chest","code_information":[{"code":"C8909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/o fol w/cont, chest","code_information":[{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/cont, lwr ext","code_information":[{"code":"C8912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o fol w/cont, lwr ext","code_information":[{"code":"C8914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/cont, pelvis","code_information":[{"code":"C8918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o fol w/cont, pelvis","code_information":[{"code":"C8920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"2d tte w or w/o fol w/con,fu","code_information":[{"code":"C8924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/dye, spinal canal","code_information":[{"code":"C8931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o&w/dye, spinal canal","code_information":[{"code":"C8933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/dye, upper extremity","code_information":[{"code":"C8934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o&w/dye, upper extr","code_information":[{"code":"C8936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Non-ophthalmic FVA","code_information":[{"code":"C9733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.06,"maximum":1819.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":583.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1620.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1819.85,"additional_payer_notes":"APC"}]}]},{"description":"Tte w or w/o fol w/cont, com","code_information":[{"code":"C8921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.23,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Tte w or w/o fol w/cont, f/u","code_information":[{"code":"C8922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.23,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"2d tte w or w/o fol w/con,co","code_information":[{"code":"C8923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.23,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"2d tee w or w/o fol w/con,in","code_information":[{"code":"C8925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.23,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Tee w or w/o fol w/cont,cong","code_information":[{"code":"C8926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.23,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"TEE w or w/o fol w/cont, mon","code_information":[{"code":"C8927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.23,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Tte w or w/o fol w/con,stres","code_information":[{"code":"C8928","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.23,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"TTE w or wo fol wcon,Doppler","code_information":[{"code":"C8929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.23,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"TTE w or w/o contr, cont ECG","code_information":[{"code":"C8930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.23,"maximum":4089.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1311.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3640.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4089.21,"additional_payer_notes":"APC"}]}]},{"description":"Endocrine nuclear procedure","code_information":[{"code":"78099","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Blood/lymph nuclear exam","code_information":[{"code":"78199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"GI protein loss exam","code_information":[{"code":"78282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"GI nuclear procedure","code_information":[{"code":"78299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Musculoskeletal nuclear exam","code_information":[{"code":"78399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular nuclear exam","code_information":[{"code":"78499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory nuclear exam","code_information":[{"code":"78599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Nervous system nuclear exam","code_information":[{"code":"78699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Genitourinary nuclear exam","code_information":[{"code":"78799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear diagnostic exam","code_information":[{"code":"78999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"PET not otherwise specified","code_information":[{"code":"G0235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.83,"maximum":2085.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1856.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2085.35,"additional_payer_notes":"APC"}]}]},{"description":"Blood volume","code_information":[{"code":"78122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":605.52,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Non-imaging heart function","code_information":[{"code":"78414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":605.52,"maximum":2832.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2521.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2832.32,"additional_payer_notes":"APC"}]}]},{"description":"Heart symp image plnr","code_information":[{"code":"0331T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1443.80,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Heart symp image plnr spect","code_information":[{"code":"0332T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1443.80,"maximum":6753.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1443.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2165.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1472.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6012.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6753.35,"additional_payer_notes":"APC"}]}]},{"description":"Pet image full body","code_information":[{"code":"78813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1594.68,"maximum":7459.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2392.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6640.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7459.12,"additional_payer_notes":"APC"}]}]},{"description":"Alt elec fld dos&dlv sim mdl","code_information":[{"code":"1025T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.89,"maximum":701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.12,"additional_payer_notes":"APC"}]}]},{"description":"Radiation therapy planning","code_information":[{"code":"77299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.89,"maximum":701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.12,"additional_payer_notes":"APC"}]}]},{"description":"External radiation dosimetry","code_information":[{"code":"77399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.89,"maximum":701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":624.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701.12,"additional_payer_notes":"APC"}]}]},{"description":"Place device/marker, non pro","code_information":[{"code":"C9728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1543.59,"maximum":7220.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1543.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2315.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1574.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6427.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7220.12,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":430.13,"maximum":2011.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":430.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":645.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":438.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1791.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2011.93,"additional_payer_notes":"APC"}]}]},{"description":"Hdr rdncl skn surf brachytx","code_information":[{"code":"77767","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":430.13,"maximum":2011.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":430.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":645.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":438.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1791.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2011.93,"additional_payer_notes":"APC"}]}]},{"description":"Hdr rdncl skn surf brachytx","code_information":[{"code":"77768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":430.13,"maximum":2011.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":430.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":645.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":438.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1791.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2011.93,"additional_payer_notes":"APC"}]}]},{"description":"Neutron beam tx complex","code_information":[{"code":"77423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":616.20,"maximum":2882.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":924.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2565.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.26,"additional_payer_notes":"APC"}]}]},{"description":"Proton trmt simple w/o comp","code_information":[{"code":"77520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":616.20,"maximum":2882.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":924.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2565.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.26,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":616.20,"maximum":2882.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":924.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2565.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.26,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":616.20,"maximum":2882.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":616.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":924.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":628.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2565.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2882.26,"additional_payer_notes":"APC"}]}]},{"description":"Hdr elctr ntrst/ntrcv brchtx","code_information":[{"code":"0395T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":776.71,"maximum":3633.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1165.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3234.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3633.06,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":776.71,"maximum":3633.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1165.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3234.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3633.06,"additional_payer_notes":"APC"}]}]},{"description":"Hdr rdncl ntrstl/icav brchtx","code_information":[{"code":"77770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":776.71,"maximum":3633.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1165.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3234.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3633.06,"additional_payer_notes":"APC"}]}]},{"description":"Hdr rdncl ntrstl/icav brchtx","code_information":[{"code":"77771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":776.71,"maximum":3633.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1165.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3234.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3633.06,"additional_payer_notes":"APC"}]}]},{"description":"Hdr rdncl ntrstl/icav brchtx","code_information":[{"code":"77772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":776.71,"maximum":3633.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":776.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1165.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3234.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3633.06,"additional_payer_notes":"APC"}]}]},{"description":"Nuclr rx interstit colloid","code_information":[{"code":"79300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.22,"maximum":1217.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1083.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1217.16,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear rx intra-arterial","code_information":[{"code":"79445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.22,"maximum":1217.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1083.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1217.16,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear medicine therapy","code_information":[{"code":"79999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.22,"maximum":1217.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1083.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1217.16,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv authrj","code_information":[{"code":"86079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody screen","code_information":[{"code":"86850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath cell enhance tech","code_information":[{"code":"88112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Forensic cytopathology","code_information":[{"code":"88125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath smear other source","code_information":[{"code":"88162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath eval fna report","code_information":[{"code":"88173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Cell marker study","code_information":[{"code":"88182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Cytopathology procedure","code_information":[{"code":"88199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetic study","code_information":[{"code":"88299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Special stains group 1","code_information":[{"code":"88312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Microslide consultation","code_information":[{"code":"88323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Analysis nerve","code_information":[{"code":"88356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Surgical pathology procedure","code_information":[{"code":"88399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Collect sweat for test","code_information":[{"code":"89230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Pathology lab procedure","code_information":[{"code":"89240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Prepare embryo for transfer","code_information":[{"code":"89255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Sperm identification","code_information":[{"code":"89257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Sperm isolation simple","code_information":[{"code":"89260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Sperm isolation complex","code_information":[{"code":"89261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Identify sperm tissue","code_information":[{"code":"89264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreserve testicular tiss","code_information":[{"code":"89335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved sperm","code_information":[{"code":"89353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted reprod med lab proc","code_information":[{"code":"89398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.11,"maximum":271.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":242.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv reactj","code_information":[{"code":"86078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody elution","code_information":[{"code":"86860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test indirect qual","code_information":[{"code":"86885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test indirect titer","code_information":[{"code":"86886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Autologous blood process","code_information":[{"code":"86890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test spin","code_information":[{"code":"86920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test incubate","code_information":[{"code":"86921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test antiglob","code_information":[{"code":"86922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test electric","code_information":[{"code":"86923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Plasma fresh frozen","code_information":[{"code":"86927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood prep","code_information":[{"code":"86930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood thaw","code_information":[{"code":"86931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Leukacyte transfusion","code_information":[{"code":"86950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Vol reduction of blood/prod","code_information":[{"code":"86960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Pooling blood platelets","code_information":[{"code":"86965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/enzymes","code_information":[{"code":"86971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/density","code_information":[{"code":"86972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Rbc serum pretx incubj/inhib","code_information":[{"code":"86977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Split blood or products","code_information":[{"code":"86985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Cytp urne 3-5 probes ea spec","code_information":[{"code":"88120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Cytp urine 3-5 probes cmptr","code_information":[{"code":"88121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Cytp dx eval fna 1st ea site","code_information":[{"code":"88172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensive review of data","code_information":[{"code":"88325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Path consult intraop 1 bloc","code_information":[{"code":"88331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Immunohisto antb 1st stain","code_information":[{"code":"88342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Immunofluor antb 1st stain","code_information":[{"code":"88346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Analysis skeletal muscle","code_information":[{"code":"88355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Analysis tumor","code_information":[{"code":"88358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Tumor immunohistochem/manual","code_information":[{"code":"88360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization (fish)","code_information":[{"code":"88365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization (fish)","code_information":[{"code":"88366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"M/phmtrc alys ishquant/semiq","code_information":[{"code":"88374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"M/phmtrc alys ishquant/semiq","code_information":[{"code":"88377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Chct for mal hyperthermia","code_information":[{"code":"89049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Sputum specimen collection","code_information":[{"code":"89220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Cultr oocyte/embryo <4 days","code_information":[{"code":"89250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Cultr oocyte/embryo <4 days","code_information":[{"code":"89251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Embryo hatching","code_information":[{"code":"89253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Oocyte identification","code_information":[{"code":"89254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreservation sperm","code_information":[{"code":"89259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Insemination of oocytes","code_information":[{"code":"89268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Assist oocyte fertilization","code_information":[{"code":"89281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy oocyte polar body","code_information":[{"code":"89290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy oocyte polar body","code_information":[{"code":"89291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreservation oocyte(s)","code_information":[{"code":"89337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year embryo(s)","code_information":[{"code":"89342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year sperm/semen","code_information":[{"code":"89343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year reprod tissue","code_information":[{"code":"89344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year oocyte(s)","code_information":[{"code":"89346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved embryo","code_information":[{"code":"89352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Thaw cryoprsvrd reprod tiss","code_information":[{"code":"89354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved oocyte","code_information":[{"code":"89356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.00,"maximum":888.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":888.71,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody identification","code_information":[{"code":"86870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.74,"maximum":1869.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":599.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1664.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.78,"additional_payer_notes":"APC"}]}]},{"description":"Blood type antigen donor ea","code_information":[{"code":"86902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.74,"maximum":1869.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":599.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1664.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.78,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing rbc antigens","code_information":[{"code":"86905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.74,"maximum":1869.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":599.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1664.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.78,"additional_payer_notes":"APC"}]}]},{"description":"Flowcytometry/ tc 1 marker","code_information":[{"code":"88184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.74,"maximum":1869.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":599.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1664.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.78,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.74,"maximum":1869.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":599.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1664.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.78,"additional_payer_notes":"APC"}]}]},{"description":"Immunohisto antibody slide","code_information":[{"code":"88344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.74,"maximum":1869.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":599.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1664.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.78,"additional_payer_notes":"APC"}]}]},{"description":"Tumor immunohistochem/comput","code_information":[{"code":"88361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.74,"maximum":1869.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":599.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1664.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.78,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization auto","code_information":[{"code":"88367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.74,"maximum":1869.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":599.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1664.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.78,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization manual","code_information":[{"code":"88368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.74,"maximum":1869.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":599.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1664.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1869.78,"additional_payer_notes":"APC"}]}]},{"description":"Applicaton on-body injector","code_information":[{"code":"96377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.22,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Ther/prop/diag inj/inf proc","code_information":[{"code":"96379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.22,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy unspecified","code_information":[{"code":"96549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.22,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Admin influenza virus vac","code_information":[{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.22,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Admin pneumococcal vaccine","code_information":[{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.22,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Admin hepatitis b vaccine","code_information":[{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.22,"maximum":244.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":217.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244.26,"additional_payer_notes":"APC"}]}]},{"description":"Immune admin oral/nasal","code_information":[{"code":"90473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.30,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Injection of hiv prep drug","code_information":[{"code":"G0012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.30,"maximum":375.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":334.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":375.58,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj ia","code_information":[{"code":"96373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":237.21,"maximum":1109.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":355.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":987.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.54,"additional_payer_notes":"APC"}]}]},{"description":"Prolonged iv inf, req pump","code_information":[{"code":"C8957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":237.21,"maximum":1109.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":355.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":987.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1109.54,"additional_payer_notes":"APC"}]}]},{"description":"Thrombolytic therapy stroke","code_information":[{"code":"37195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":368.36,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemo extend iv infus w/pump","code_information":[{"code":"G0498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":368.36,"maximum":1722.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.99,"additional_payer_notes":"APC"}]}]},{"description":"Compre audiometry evaluation","code_information":[{"code":"0212T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Tempr","code_information":[{"code":"0278T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Visual ep test for glaucoma","code_information":[{"code":"0464T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Colonic lavage 35+l water","code_information":[{"code":"0736T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Smmg cncrnt appl imu snr","code_information":[{"code":"0778T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Tc auriculr neurostimulation","code_information":[{"code":"0783T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Rem mlt day uroflow dev sply","code_information":[{"code":"0812T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Gastroenterology procedure","code_information":[{"code":"91299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Auditory function 60 min","code_information":[{"code":"92620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Tinnitus assessment","code_information":[{"code":"92625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Eval aud rehab status","code_information":[{"code":"92626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Interrog crtd sins bat ip wo","code_information":[{"code":"93145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Interrog crtd sins bat ip w/","code_information":[{"code":"93146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Temperature gradient studies","code_information":[{"code":"93740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular procedure","code_information":[{"code":"93799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Ped home apnea rec hk-up","code_information":[{"code":"94775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Ped home apnea rec downld","code_information":[{"code":"94776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Pulmonary service/procedure","code_information":[{"code":"94799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Neurological procedure","code_information":[{"code":"95999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Devel tst phys/qhp 1st hr","code_information":[{"code":"96112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"3d anat seg imaging preop","code_information":[{"code":"C8001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"3d bn img algor drvd fr mri","code_information":[{"code":"G0566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.50,"maximum":671.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":597.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":671.2,"additional_payer_notes":"APC"}]}]},{"description":"Pattern erg w/i&r","code_information":[{"code":"0509T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Ncntc r-t fluor wnd img 1st","code_information":[{"code":"0598T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"N-nvs artl plaq alys quan","code_information":[{"code":"0712T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Tc mag stimj pn 1st tx 1nrv","code_information":[{"code":"0766T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Pulm tiss vntj alys prev ct","code_information":[{"code":"0807T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Pulm tiss vntj alys w/ct","code_information":[{"code":"0808T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Penis study","code_information":[{"code":"54240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcranial magn stim tx plan","code_information":[{"code":"90867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcranial magn stim tx deli","code_information":[{"code":"90868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcran magn stim redetemine","code_information":[{"code":"90869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Rct snsatn tone&cmplianc std","code_information":[{"code":"91124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Eeg cont rec w/vid eeg tech","code_information":[{"code":"95700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid 2-12 hr unmntr","code_information":[{"code":"95705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Eeg wo vid 2-12hr intmt mntr","code_information":[{"code":"95706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid 2-12hr cont mntr","code_information":[{"code":"95707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr unmonitored","code_information":[{"code":"95711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test one fiber","code_information":[{"code":"95872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Dynamic surface emg","code_information":[{"code":"96002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Neurobehavioral status exam","code_information":[{"code":"96116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS 10-15dos","code_information":[{"code":"G0303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 2 porta","code_information":[{"code":"G0398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 3 porta","code_information":[{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 4 porta","code_information":[{"code":"G0400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.80,"maximum":1126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1002.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1126.33,"additional_payer_notes":"APC"}]}]},{"description":"Myocardial imaging mcg","code_information":[{"code":"0541T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Gi myoelectrical actv study","code_information":[{"code":"0779T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Hi-res gastric ep mapping","code_information":[{"code":"0868T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Anrct mano rct snsatn&balo","code_information":[{"code":"91125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Breath recording infant","code_information":[{"code":"94772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Eeg wo vid ea 12-26hr unmntr","code_information":[{"code":"95708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid ea 12-26hr intmt","code_information":[{"code":"95709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid ea 12-26hr cont","code_information":[{"code":"95710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr intmt mntr","code_information":[{"code":"95712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr cont mntr","code_information":[{"code":"95713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26 hr unmntr","code_information":[{"code":"95714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26hr intmt mntr","code_information":[{"code":"95715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Eeg cerebral death only","code_information":[{"code":"95824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"EEG monitoring/giving drugs","code_information":[{"code":"95954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Motion analysis video/3d","code_information":[{"code":"96000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS complete","code_information":[{"code":"G0302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS 1-9 dos","code_information":[{"code":"G0304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Post op service LVRS min 6","code_information":[{"code":"G0305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"Blinded conv. Tx MDD clin tr","code_information":[{"code":"G2000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.15,"maximum":1946.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1946.52,"additional_payer_notes":"APC"}]}]},{"description":"N-invas augmnt arrhyt alys","code_information":[{"code":"0897T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"N-invas prst8 cancer est map","code_information":[{"code":"0898T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26hr cont mntr","code_information":[{"code":"95716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"EEG monitoring/function test","code_information":[{"code":"95958","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Meg spontaneous","code_information":[{"code":"95965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Meg evoked single","code_information":[{"code":"95966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Motion test w/ft press meas","code_information":[{"code":"96001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Pre-plan 3d model w/ccta","code_information":[{"code":"C9793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"Replacment pt electronic sys","code_information":[{"code":"G0555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":957.67,"maximum":4479.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1436.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3987.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4479.5,"additional_payer_notes":"APC"}]}]},{"description":"BIA whole body","code_information":[{"code":"0358T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Interrog dev eval wcs ip","code_information":[{"code":"0521T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"B1 str&fx rsk transmis data","code_information":[{"code":"0555T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Air displacmnt plethysmograp","code_information":[{"code":"1002T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv xmatch","code_information":[{"code":"86077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Skin test candida","code_information":[{"code":"86485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Skin test nos antigen","code_information":[{"code":"86486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"TB intradermal test","code_information":[{"code":"86580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Rbc serum pretx id dilution","code_information":[{"code":"86976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Transfusion procedure","code_information":[{"code":"86999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath fl nongyn filter","code_information":[{"code":"88106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath smear other source","code_information":[{"code":"88160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath smear other source","code_information":[{"code":"88161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Surgical path gross","code_information":[{"code":"88300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Xm archive tissue molec anal","code_information":[{"code":"88363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Eye service or procedure","code_information":[{"code":"92499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Ent procedure/service","code_information":[{"code":"92700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Noninvas vasc dx study proc","code_information":[{"code":"93998","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Allergy immunology services","code_information":[{"code":"95199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Acupunct w/o stimul 15 min","code_information":[{"code":"97810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Acupunct w/stimul 15 min","code_information":[{"code":"97813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Glaucoma scrn hgh risk direc","code_information":[{"code":"G0117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic procd strg endur","code_information":[{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Oth resp proc, indiv","code_information":[{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"EKG tracing for initial prev","code_information":[{"code":"G0404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"No pt prsnt train initial 30","code_information":[{"code":"G0541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Group train w/o patient","code_information":[{"code":"G0543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Alcohol/sub abuse assess","code_information":[{"code":"G2011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Obtaining screen pap smear","code_information":[{"code":"Q0091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.26,"maximum":150.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":134.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.88,"additional_payer_notes":"APC"}]}]},{"description":"Touch Quant Sensory Test","code_information":[{"code":"0106T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Vibrate Quant Sensory Test","code_information":[{"code":"0107T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Heat Quant Sensory Test","code_information":[{"code":"0109T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Audiometry air only","code_information":[{"code":"0208T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Audiometry air & bone","code_information":[{"code":"0209T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Speech audiometry threshold","code_information":[{"code":"0210T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Speech audiom thresh & recog","code_information":[{"code":"0211T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Tear film img uni/bi w/i&r","code_information":[{"code":"0330T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Vis field assmnt tech suppt","code_information":[{"code":"0379T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Oct mid ear i&r unilateral","code_information":[{"code":"0485T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Oct mid ear i&r bilateral","code_information":[{"code":"0486T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Ncntc nr ifr spctrsc wnd","code_information":[{"code":"0640T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Surf radj ther tx planning","code_information":[{"code":"77436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasmosis skin test","code_information":[{"code":"86510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing serologic rh(d)","code_information":[{"code":"86901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Bld typing serologic rh phnt","code_information":[{"code":"86906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood freeze/thaw","code_information":[{"code":"86932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Blood product/irradiation","code_information":[{"code":"86945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath fl nongyn smears","code_information":[{"code":"88104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath concentrate tech","code_information":[{"code":"88108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Microslide consultation","code_information":[{"code":"88321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Rx corneoscleral cntact lens","code_information":[{"code":"92317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Fit spectacles single system","code_information":[{"code":"92354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Fit spectacles compound lens","code_information":[{"code":"92355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Ear protector evaluation","code_information":[{"code":"92596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Car seat/bed test 60 min","code_information":[{"code":"94780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Appl modality 1+lllt po pain","code_information":[{"code":"97037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Glaucoma scrn hgh risk direc","code_information":[{"code":"G0118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Oth resp proc, group","code_information":[{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Non-cov surg proc,clin trial","code_information":[{"code":"G0293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Non-cov proc, clinical trial","code_information":[{"code":"G0294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Cardiokymography","code_information":[{"code":"Q0035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.65,"maximum":194.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.84,"additional_payer_notes":"APC"}]}]},{"description":"Cool Quant Sensory Test","code_information":[{"code":"0108T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Ins bone device for rsa","code_information":[{"code":"0347T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Mac pgmt opt dns meas hfp","code_information":[{"code":"0506T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Near ifr 2img mibmn glnd i&r","code_information":[{"code":"0507T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Evac meibomian glnd heat bi","code_information":[{"code":"0563T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Elec impd spectrsc 1+skn les","code_information":[{"code":"0658T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Car acous wavfrm rec cad rsk","code_information":[{"code":"0716T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Augmnt ai-based fcl phnt a/r","code_information":[{"code":"0731T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Rem auton alg nsln cal setup","code_information":[{"code":"0740T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Pt spec alg rx-onc tx option","code_information":[{"code":"0794T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Ecg alg 12 ld rdcd trcg only","code_information":[{"code":"0904T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Elec aly nstm sys vgs nrv wo","code_information":[{"code":"0911T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Elec aly npgs esoph sbsq w/o","code_information":[{"code":"1017T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Raman spectroscopy 1+skn les","code_information":[{"code":"1020T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test direct","code_information":[{"code":"86880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing patient serum","code_information":[{"code":"86904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/chemicl","code_information":[{"code":"86970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretreatment serum","code_information":[{"code":"86978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Path consult introp","code_information":[{"code":"88329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Img rta detc/mntr ds poc aly","code_information":[{"code":"92229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Replacement of contact lens","code_information":[{"code":"92326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Fit aphakia spectcl monofocl","code_information":[{"code":"92352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Fit aphakia spectcl multifoc","code_information":[{"code":"92353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Aphakia prosth service temp","code_information":[{"code":"92358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Repair & adjust spectacles","code_information":[{"code":"92371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Peripheral Vascular Rehab","code_information":[{"code":"93668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Slp stdy unatnd w/anal","code_information":[{"code":"95801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Actigraphy testing","code_information":[{"code":"95803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Trim nail(s)","code_information":[{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Pathogen test for platelets","code_information":[{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.79,"maximum":307.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307.72,"additional_payer_notes":"APC"}]}]},{"description":"Nos Quant Sensory Test","code_information":[{"code":"0110T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Ocular blood flow measure","code_information":[{"code":"0198T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Clear eyelid gland w/heat","code_information":[{"code":"0207T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Antmc mdl 3d print 1st cmpnt","code_information":[{"code":"0559T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Antmc guide 3d print 1st gd","code_information":[{"code":"0561T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Eye mvmt alys w/o calbrj i&r","code_information":[{"code":"0615T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg ecg rsk asmt cncrt","code_information":[{"code":"0764T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg ecg rsk asmt prev","code_information":[{"code":"0765T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Instlj fecal microbiota ssp","code_information":[{"code":"0780T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt bld oxygnation","code_information":[{"code":"0893T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Qtc ntrvl augmnt alg aly ecg","code_information":[{"code":"0902T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg alys acous&ecg rec","code_information":[{"code":"0962T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Elec alys s-scl eeg wo prgrm","code_information":[{"code":"1004T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Cptr oph alys monoc eye mvmt","code_information":[{"code":"1010T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Insert drug implant device","code_information":[{"code":"11981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing serologic abo","code_information":[{"code":"86900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Special stains group 2","code_information":[{"code":"88313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Contact lens fitting","code_information":[{"code":"92312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Contact lens fitting","code_information":[{"code":"92313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Rx cntact lens aphakia 1 eye","code_information":[{"code":"92315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Rx cntact lens aphakia 2 eye","code_information":[{"code":"92316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Modification of contact lens","code_information":[{"code":"92325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>48hr<7d scan a/r","code_information":[{"code":"93243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>7d<15d scan a/r","code_information":[{"code":"93247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Chest wall manipulation","code_information":[{"code":"94667","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Chest wall manipulation","code_information":[{"code":"94668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Extrnl counterpulse, per tx","code_information":[{"code":"G0166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.38,"maximum":694.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":617.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.03,"additional_payer_notes":"APC"}]}]},{"description":"Njx platelet plasma","code_information":[{"code":"0232T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Njx autol wbc concentrate","code_information":[{"code":"0481T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Cryotherapy oral cavity","code_information":[{"code":"0881T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Implant hormone pellet(s)","code_information":[{"code":"11980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Remove/insert drug implant","code_information":[{"code":"11983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Rbc serum pretx incubj drugs","code_information":[{"code":"86975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Contact lens fitting","code_information":[{"code":"92311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Psycl/nrpsyc tech 1st","code_information":[{"code":"96138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Insert drug del implant, >4","code_information":[{"code":"G0516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Remove drug implant","code_information":[{"code":"G0517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Remove w insert drug implant","code_information":[{"code":"G0518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.19,"maximum":2330.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":498.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":747.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2074.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2330.27,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg eval cardiac modulj","code_information":[{"code":"0417T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Interro eval cardiac modulj","code_information":[{"code":"0418T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg dev eval wcs ip","code_information":[{"code":"0522T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg dev eval iims ip","code_information":[{"code":"0528T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Interrog dev eval iims ip","code_information":[{"code":"0529T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg dev eval icds ss ip","code_information":[{"code":"0575T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Interrog dev eval icds ss ip","code_information":[{"code":"0576T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem interrog dev icds tech","code_information":[{"code":"0579T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg dev eval scrms remote","code_information":[{"code":"0650T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg dev eval isdss ip","code_information":[{"code":"0683T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Interrog dev eval isdss ip","code_information":[{"code":"0685T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Bdy surf mapg pm/cvdfb f/up","code_information":[{"code":"0696T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem auton alg nsln data coll","code_information":[{"code":"0741T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg evl ldls pm 2chmbr ip","code_information":[{"code":"0804T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg evl ldls pm 1chmbr ip","code_information":[{"code":"0826T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Prgrmg dev eval ccm-d ip","code_information":[{"code":"0926T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Interrog dev eval ccm-d ip","code_information":[{"code":"0927T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem interrog dev ccm-d tech","code_information":[{"code":"0929T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem interrog dev ccm tech","code_information":[{"code":"0949T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr impl ivc snr phys","code_information":[{"code":"0983T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Elec alys npgs esoph sbsq w/","code_information":[{"code":"1018T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem ther mntr dev sply cbt","code_information":[{"code":"98978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rtm dev sply resp sys 2-15 d","code_information":[{"code":"98984","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rtm dev sply mscsk sys 2-15d","code_information":[{"code":"98985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rtm dev sply cbt 2-15 d","code_information":[{"code":"98986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr physiol param 2-15","code_information":[{"code":"99445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr physiol param dev","code_information":[{"code":"99454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.62,"maximum":194.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":173.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194.68,"additional_payer_notes":"APC"}]}]},{"description":"Reprgrmg io rta eltrd ra","code_information":[{"code":"0473T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.02,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Elec alys smpl prgrmg iins","code_information":[{"code":"0589T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.02,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Elec alys cplx prgrmg iins","code_information":[{"code":"0590T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.02,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Elec aly smp iins sp/sac nrv","code_information":[{"code":"0788T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.02,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Elec aly cpx iins sp/sac nrv","code_information":[{"code":"0789T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.02,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Elec alys nstim sys vgs smpl","code_information":[{"code":"0912T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.02,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Elec alys s-scl eeg prgr 1st","code_information":[{"code":"1005T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.02,"maximum":495.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":441.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.92,"additional_payer_notes":"APC"}]}]},{"description":"Intens cardiac rehab w/exerc","code_information":[{"code":"G0422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.76,"maximum":672.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":598.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":672.43,"additional_payer_notes":"APC"}]}]},{"description":"Intens cardiac rehab no exer","code_information":[{"code":"G0423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.76,"maximum":672.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":598.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":672.43,"additional_payer_notes":"APC"}]}]},{"description":"Temporary external pacing","code_information":[{"code":"92953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.09,"maximum":3447.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1105.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":751.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3069.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3447.72,"additional_payer_notes":"APC"}]}]},{"description":"Cardioversion electric int","code_information":[{"code":"92961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.09,"maximum":3447.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1105.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":751.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3069.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3447.72,"additional_payer_notes":"APC"}]}]},{"description":"Aerosol inhalation treatment","code_information":[{"code":"94642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.20,"maximum":1142.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":366.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1016.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1142.26,"additional_payer_notes":"APC"}]}]},{"description":"Pos airway pressure cpap","code_information":[{"code":"94660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.20,"maximum":1142.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":366.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1016.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1142.26,"additional_payer_notes":"APC"}]}]},{"description":"Mechanical chest wall oscill","code_information":[{"code":"94669","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.20,"maximum":1142.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":366.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1016.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1142.26,"additional_payer_notes":"APC"}]}]},{"description":"Vent mgmt inpat init day","code_information":[{"code":"94002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":688.96,"maximum":3222.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":688.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1033.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":702.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2868.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"}]}]},{"description":"Vent mgmt inpat subq day","code_information":[{"code":"94003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":688.96,"maximum":3222.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":688.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1033.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":702.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2868.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon hydrochloride/1 mg","code_information":[{"code":"J1610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.45,"maximum":853.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":273.67,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":186.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":759.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":853.4,"additional_payer_notes":"APC"}]}]},{"description":"Gallium ga-68","code_information":[{"code":"A9587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.63,"maximum":232.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":206.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":232.14,"additional_payer_notes":"APC"}]}]},{"description":"Inj, clevidepine, 1 mg","code_information":[{"code":"J0759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.85,"maximum":13.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"}]}]},{"description":"Prothrombin complex kcentra","code_information":[{"code":"J7168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.14,"maximum":10.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"}]}]},{"description":"Injection, udenyca 0.5 mg","code_information":[{"code":"Q5111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.33,"maximum":497.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":442.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":497.38,"additional_payer_notes":"APC"}]}]},{"description":"Rabies ig ht&sol human im/sc","code_information":[{"code":"90377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.25,"maximum":1039.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":333.37,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":226.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":925.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1039.56,"additional_payer_notes":"APC"}]}]},{"description":"Leuprolide acetate suspnsion","code_information":[{"code":"J9217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.45,"maximum":825.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":264.67,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":734.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":825.33,"additional_payer_notes":"APC"}]}]},{"description":"Belatacept injection","code_information":[{"code":"J0485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.89,"maximum":18.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18.18,"additional_payer_notes":"APC"}]}]},{"description":"Injection, carfilzomib, 1 mg","code_information":[{"code":"J9047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.65,"maximum":260.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":231.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":260.29,"additional_payer_notes":"APC"}]}]},{"description":"Inj., kanjinti, 10 mg","code_information":[{"code":"Q5117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.55,"maximum":222.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":197.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":222.4,"additional_payer_notes":"APC"}]}]},{"description":"Daratumumab, hyaluronidase","code_information":[{"code":"J9144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.57,"maximum":259.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":231.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":259.91,"additional_payer_notes":"APC"}]}]},{"description":"Piflu f-18, dia 1 millicurie","code_information":[{"code":"A9595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.49,"maximum":1620.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":519.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1442.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1620.71,"additional_payer_notes":"APC"}]}]},{"description":"Inj pegfilgrast ex bio 0.5mg","code_information":[{"code":"J2506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":89.34,"maximum":417.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":134.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":372.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":417.91,"additional_payer_notes":"APC"}]}]},{"description":"Injection, mepolizumab, 1mg","code_information":[{"code":"J2182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.27,"maximum":146.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":130.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":146.27,"additional_payer_notes":"APC"}]}]},{"description":"Inj., durvalumab, 10 mg","code_information":[{"code":"J9173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.12,"maximum":398.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":354.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":398.15,"additional_payer_notes":"APC"}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.59,"maximum":2392.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":511.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":767.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":521.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2130.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2392.96,"additional_payer_notes":"APC"}]}]},{"description":"Plasma, frz between 8-24hour","code_information":[{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.77,"maximum":345.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.77,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":307.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":345.06,"additional_payer_notes":"APC"}]}]},{"description":"Platelets, pathogen reduced","code_information":[{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":607.43,"maximum":2841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":607.43,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":911.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":619.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2529.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2841.25,"additional_payer_notes":"APC"}]}]},{"description":"Cntct lens hydrophil photoch","code_information":[{"code":"V2524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":186.27,"maximum":871.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":186.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":279.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":775.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":871.28,"additional_payer_notes":"APC"}]}]},{"description":"Oral speech device eval","code_information":[{"code":"92597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.93,"maximum":331.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":106.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":295.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":331.78,"additional_payer_notes":"APC"}]}]},{"description":"Range of motion measurements","code_information":[{"code":"95851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.66,"maximum":31.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":27.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31.15,"additional_payer_notes":"APC"}]}]},{"description":"Assessment of aphasia","code_information":[{"code":"96105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.88,"maximum":453.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.88,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":403.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":453.16,"additional_payer_notes":"APC"}]}]},{"description":"Mlt fam grp bhv train 1st 60","code_information":[{"code":"96202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.37,"maximum":81.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":72.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81.25,"additional_payer_notes":"APC"}]}]},{"description":"Mlt fam grp bhv train ea add","code_information":[{"code":"96203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.99,"maximum":23.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.34,"additional_payer_notes":"APC"}]}]},{"description":"Medical nutrition indiv in","code_information":[{"code":"97802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.34,"maximum":123.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":109.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123.21,"additional_payer_notes":"APC"}]}]},{"description":"Med nutrition indiv subseq","code_information":[{"code":"97803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.01,"maximum":102.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102.95,"additional_payer_notes":"APC"}]}]},{"description":"Medical nutrition group","code_information":[{"code":"97804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.32,"maximum":57.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.63,"additional_payer_notes":"APC"}]}]},{"description":"Vr cbt therapy","code_information":[{"code":"E1905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.77,"maximum":3156.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":674.77,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1012.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":688.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2809.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3156.24,"additional_payer_notes":"APC"}]}]},{"description":"Diab manage trn  per indiv","code_information":[{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.5,"maximum":259.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":231.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":259.6,"additional_payer_notes":"APC"}]}]},{"description":"Diab manage trn ind/group","code_information":[{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.95,"maximum":74.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74.61,"additional_payer_notes":"APC"}]}]},{"description":"MNT subs tx for change dx","code_information":[{"code":"G0270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.01,"maximum":102.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":91.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102.95,"additional_payer_notes":"APC"}]}]},{"description":"Group MNT 2 or more 30 mins","code_information":[{"code":"G0271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.32,"maximum":57.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57.63,"additional_payer_notes":"APC"}]}]},{"description":"Elec stim unattend for press","code_information":[{"code":"G0281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.62,"maximum":54.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54.35,"additional_payer_notes":"APC"}]}]},{"description":"Elec stim other than wound","code_information":[{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.61,"maximum":58.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":52.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58.98,"additional_payer_notes":"APC"}]}]},{"description":"Electromagntic tx for ulcers","code_information":[{"code":"G0329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.56,"maximum":49.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.56,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.39,"additional_payer_notes":"APC"}]}]},{"description":"Neuromod sti sys adj rehab","code_information":[{"code":"A4593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.81,"maximum":247.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":219.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":247.02,"additional_payer_notes":"APC"}]}]},{"description":"G com garmnt glove nghttime","code_information":[{"code":"A6520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.45,"maximum":591.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":189.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":526.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":591.47,"additional_payer_notes":"APC"}]}]},{"description":"G com garmnt glove nght cust","code_information":[{"code":"A6521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":501.75,"maximum":2346.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":501.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":752.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":511.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2089.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2346.94,"additional_payer_notes":"APC"}]}]},{"description":"G com garment arm nighttime","code_information":[{"code":"A6522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":307.26,"maximum":1437.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":460.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":313.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1279.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1437.21,"additional_payer_notes":"APC"}]}]},{"description":"G com garment arm nght custm","code_information":[{"code":"A6523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":729.02,"maximum":3409.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":729.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1093.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":743.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3035.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3409.99,"additional_payer_notes":"APC"}]}]},{"description":"G com garmnt lwr leg/ft nght","code_information":[{"code":"A6524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":383.34,"maximum":1793.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":383.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":575.01,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1596.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1793.07,"additional_payer_notes":"APC"}]}]},{"description":"G com garm lwrleg/ft ngt cus","code_information":[{"code":"A6525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":773.9,"maximum":3619.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":773.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1160.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3222.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3619.92,"additional_payer_notes":"APC"}]}]},{"description":"G com garmt full leg/ft nght","code_information":[{"code":"A6526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.06,"maximum":3241.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":693.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1039.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":706.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2885.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3241.79,"additional_payer_notes":"APC"}]}]},{"description":"G garmt full leg/ft nght cus","code_information":[{"code":"A6527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1274.45,"maximum":5961.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1274.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1911.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1299.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5306.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5961.24,"additional_payer_notes":"APC"}]}]},{"description":"G com garment bra nighttime","code_information":[{"code":"A6528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":666.42,"maximum":3117.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":666.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":999.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":679.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2775.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3117.18,"additional_payer_notes":"APC"}]}]},{"description":"G com garmt bra night custm","code_information":[{"code":"A6529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1053.04,"maximum":4925.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1053.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1579.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1074.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4384.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4925.59,"additional_payer_notes":"APC"}]}]},{"description":"Compression stocking bk18-30","code_information":[{"code":"A6530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.07,"maximum":182.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":162.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":182.75,"additional_payer_notes":"APC"}]}]},{"description":"Compression stocking bk30-40","code_information":[{"code":"A6531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.66,"maximum":288.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":256.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":288.41,"additional_payer_notes":"APC"}]}]},{"description":"Compression stocking bk40-50","code_information":[{"code":"A6532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.88,"maximum":406.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.88,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":130.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":361.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"}]}]},{"description":"Gc stocking thighlngth 18-30","code_information":[{"code":"A6533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.86,"maximum":256.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":228.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":256.61,"additional_payer_notes":"APC"}]}]},{"description":"Gc stocking thighlngth 30-40","code_information":[{"code":"A6534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.65,"maximum":293.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":93.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":260.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":293.05,"additional_payer_notes":"APC"}]}]},{"description":"Gc stocking thighlngth 40-50","code_information":[{"code":"A6535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.13,"maximum":337.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":108.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":300.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":337.39,"additional_payer_notes":"APC"}]}]},{"description":"Gc stocking full lngth 18-30","code_information":[{"code":"A6536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.95,"maximum":345.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110.93,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":307.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":345.9,"additional_payer_notes":"APC"}]}]},{"description":"Gc stocking full lngth 30-40","code_information":[{"code":"A6537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.67,"maximum":410.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":365.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":410.08,"additional_payer_notes":"APC"}]}]},{"description":"Gc stocking full lngth 40-50","code_information":[{"code":"A6538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.65,"maximum":480.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":153.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":427.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":480.15,"additional_payer_notes":"APC"}]}]},{"description":"Gc stocking waistlngth 18-30","code_information":[{"code":"A6539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.86,"maximum":457.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":146.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":407.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":457.74,"additional_payer_notes":"APC"}]}]},{"description":"Gc stocking waistlngth 30-40","code_information":[{"code":"A6540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.68,"maximum":545.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":175.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":485.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":545.77,"additional_payer_notes":"APC"}]}]},{"description":"Gc stocking waistlngth 40-50","code_information":[{"code":"A6541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.21,"maximum":646.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":207.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":575.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":646.48,"additional_payer_notes":"APC"}]}]},{"description":"Grad comp non-elastic BK","code_information":[{"code":"A6545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.41,"maximum":567.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":182.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":123.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":505.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":567.9,"additional_payer_notes":"APC"}]}]},{"description":"Grad com stocking bk 30-40","code_information":[{"code":"A6552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.97,"maximum":271.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":241.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271.15,"additional_payer_notes":"APC"}]}]},{"description":"G com stcking bk 30-40 custm","code_information":[{"code":"A6553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.38,"maximum":1058.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":226.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":339.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":942.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1058.89,"additional_payer_notes":"APC"}]}]},{"description":"Grad com stocking bk 40+","code_information":[{"code":"A6554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.72,"maximum":372.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":119.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":331.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":372.89,"additional_payer_notes":"APC"}]}]},{"description":"G com stcking bk 40+ custm","code_information":[{"code":"A6555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.38,"maximum":1058.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":226.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":339.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":942.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1058.89,"additional_payer_notes":"APC"}]}]},{"description":"G com stcking thgh18-30 cust","code_information":[{"code":"A6556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.25,"maximum":1451.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":465.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":316.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1291.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1451.19,"additional_payer_notes":"APC"}]}]},{"description":"G com stcking thgh30-40 cust","code_information":[{"code":"A6557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.25,"maximum":1451.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":465.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":316.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1291.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1451.19,"additional_payer_notes":"APC"}]}]},{"description":"G com stcking thgh 40+ cust","code_information":[{"code":"A6558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.17,"maximum":1497.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":480.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1333.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1497.6,"additional_payer_notes":"APC"}]}]},{"description":"G com stckng waist18-30 cust","code_information":[{"code":"A6562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1015.37,"maximum":4749.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1015.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1523.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1035.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4228.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4749.39,"additional_payer_notes":"APC"}]}]},{"description":"G com stckng waist30-40 cust","code_information":[{"code":"A6563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1015.37,"maximum":4749.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1015.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1523.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1035.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4228.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4749.39,"additional_payer_notes":"APC"}]}]},{"description":"G com stckng waist 40+ cust","code_information":[{"code":"A6564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1093.78,"maximum":5116.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1093.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1640.67,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1115.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4554.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5116.16,"additional_payer_notes":"APC"}]}]},{"description":"Grad comp gauntlet custom","code_information":[{"code":"A6565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.45,"maximum":820.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":263.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":730.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":820.67,"additional_payer_notes":"APC"}]}]},{"description":"Grad com garment neck/head","code_information":[{"code":"A6566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.75,"maximum":1191.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":382.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":259.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1191.59,"additional_payer_notes":"APC"}]}]},{"description":"G com garment neck/head cust","code_information":[{"code":"A6567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":800.42,"maximum":3743.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":800.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1200.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":816.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3333.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3743.96,"additional_payer_notes":"APC"}]}]},{"description":"G com garment torso/shldr","code_information":[{"code":"A6568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.26,"maximum":777.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":249.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":692.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":777.68,"additional_payer_notes":"APC"}]}]},{"description":"G com garmnt torso/shdr cust","code_information":[{"code":"A6569","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":946.74,"maximum":4428.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":946.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1420.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":965.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3942.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4428.38,"additional_payer_notes":"APC"}]}]},{"description":"Grad com garment genital","code_information":[{"code":"A6570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.28,"maximum":529.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":169.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":471.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":529.87,"additional_payer_notes":"APC"}]}]},{"description":"G com garment genital custm","code_information":[{"code":"A6571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":680.84,"maximum":3184.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":680.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1021.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":694.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2835.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3184.63,"additional_payer_notes":"APC"}]}]},{"description":"Grad com garment toe caps","code_information":[{"code":"A6572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.11,"maximum":491.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":157.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":437.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":491.65,"additional_payer_notes":"APC"}]}]},{"description":"Grad com garmnt toe cap cust","code_information":[{"code":"A6573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.43,"maximum":1166.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.43,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":374.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1038.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1166.71,"additional_payer_notes":"APC"}]}]},{"description":"Custom gradient sleev/glov","code_information":[{"code":"A6574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":317.99,"maximum":1487.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":476.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":324.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1324.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1487.4,"additional_payer_notes":"APC"}]}]},{"description":"Gradient comp sleev/glov","code_information":[{"code":"A6575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.05,"maximum":482.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":154.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":429.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":482.02,"additional_payer_notes":"APC"}]}]},{"description":"Custom grad com sleeve med","code_information":[{"code":"A6576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.16,"maximum":912.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":292.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":812.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":912.86,"additional_payer_notes":"APC"}]}]},{"description":"Custom grad cm sleeve heavy","code_information":[{"code":"A6577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":161.53,"maximum":755.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":242.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":672.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":755.56,"additional_payer_notes":"APC"}]}]},{"description":"Gradient comp sleeve","code_information":[{"code":"A6578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.55,"maximum":372.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":119.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":331.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":372.1,"additional_payer_notes":"APC"}]}]},{"description":"Custom grad com glove med","code_information":[{"code":"A6579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":313.26,"maximum":1465.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":313.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":469.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":319.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1304.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1465.27,"additional_payer_notes":"APC"}]}]},{"description":"Custom grad com glove heavy","code_information":[{"code":"A6580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.96,"maximum":1454.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":466.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":317.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1294.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1454.52,"additional_payer_notes":"APC"}]}]},{"description":"Gradient comp glove","code_information":[{"code":"A6581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.99,"maximum":341.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":303.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":341.41,"additional_payer_notes":"APC"}]}]},{"description":"Gradient comp gauntlet","code_information":[{"code":"A6582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.68,"maximum":227.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":227.7,"additional_payer_notes":"APC"}]}]},{"description":"Grad com wrap w straps bk","code_information":[{"code":"A6583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.13,"maximum":749.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":240.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":666.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":749.01,"additional_payer_notes":"APC"}]}]},{"description":"Grad com wrap w straps ak","code_information":[{"code":"A6585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":189.6,"maximum":886.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":189.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":284.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":789.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":886.85,"additional_payer_notes":"APC"}]}]},{"description":"Grad com wrap w straps leg","code_information":[{"code":"A6586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":558.59,"maximum":2612.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":558.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":837.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":569.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2326.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2612.8,"additional_payer_notes":"APC"}]}]},{"description":"Grad com wrap w straps foot","code_information":[{"code":"A6587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.17,"maximum":342.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":304.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":342.25,"additional_payer_notes":"APC"}]}]},{"description":"Grad com wrap w straps arm","code_information":[{"code":"A6588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.87,"maximum":1140.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":365.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1015.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1140.7,"additional_payer_notes":"APC"}]}]},{"description":"Grad com wrap w straps bra","code_information":[{"code":"A6589","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.27,"maximum":450.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":144.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":400.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":450.3,"additional_payer_notes":"APC"}]}]},{"description":"G comp bandge liner lwr extr","code_information":[{"code":"A6594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.05,"maximum":163.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163.95,"additional_payer_notes":"APC"}]}]},{"description":"G comp bandge liner upr extr","code_information":[{"code":"A6595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.48,"maximum":161.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.48,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":143.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161.28,"additional_payer_notes":"APC"}]}]},{"description":"G comp bandge conform gauze","code_information":[{"code":"A6596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.18,"maximum":0.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":0.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":0.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":0.84,"additional_payer_notes":"APC"}]}]},{"description":"G comp bandage long stretch","code_information":[{"code":"A6597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1.55,"maximum":7.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7.25,"additional_payer_notes":"APC"}]}]},{"description":"G comp bandage med stretch","code_information":[{"code":"A6598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.75,"maximum":3.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3.51,"additional_payer_notes":"APC"}]}]},{"description":"G comp bandage short stretch","code_information":[{"code":"A6599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1.7,"maximum":7.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7.95,"additional_payer_notes":"APC"}]}]},{"description":"G com bandge hgh dn foam sht","code_information":[{"code":"A6600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.07,"maximum":14.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"}]}]},{"description":"G com bandge hgh dn foam pad","code_information":[{"code":"A6601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.45,"maximum":16.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16.14,"additional_payer_notes":"APC"}]}]},{"description":"G com bandge hgh dn foamroll","code_information":[{"code":"A6602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.03,"maximum":23.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.03,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23.53,"additional_payer_notes":"APC"}]}]},{"description":"G com bandge low dn foamchnl","code_information":[{"code":"A6603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.36,"maximum":11.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"}]}]},{"description":"G com bandge low dn foam flt","code_information":[{"code":"A6604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1.38,"maximum":6.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6.45,"additional_payer_notes":"APC"}]}]},{"description":"G com bandage padded foam","code_information":[{"code":"A6605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1.57,"maximum":7.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2.36,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"}]}]},{"description":"G com bandage padded textile","code_information":[{"code":"A6606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.67,"maximum":21.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21.84,"additional_payer_notes":"APC"}]}]},{"description":"G com bandage tub protct lyr","code_information":[{"code":"A6607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1.25,"maximum":5.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5.85,"additional_payer_notes":"APC"}]}]},{"description":"G com bandage tub protct pad","code_information":[{"code":"A6608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.21,"maximum":24.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.37,"additional_payer_notes":"APC"}]}]},{"description":"G com stcking bk 18-30 custm","code_information":[{"code":"A6610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.38,"maximum":1058.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":226.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":339.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":942.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1058.89,"additional_payer_notes":"APC"}]}]},{"description":"Penile contractur devic manu","code_information":[{"code":"E0201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.52,"maximum":685.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":219.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":610.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":685.35,"additional_payer_notes":"APC"}]}]},{"description":"Transcut tibial nerv stimula","code_information":[{"code":"E0736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.83,"maximum":219.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":195.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":219.05,"additional_payer_notes":"APC"}]}]},{"description":"Upper extremity rehab","code_information":[{"code":"E0738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.64,"maximum":9540.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.64,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3059.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2080.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8493.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9540.42,"additional_payer_notes":"APC"}]}]},{"description":"Rehab sys active assist rt","code_information":[{"code":"E0739","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1597.66,"maximum":7473.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1597.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2396.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1629.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6652.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7473.05,"additional_payer_notes":"APC"}]}]},{"description":"Glucose monitor w cartridge","code_information":[{"code":"E2104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.52,"maximum":255.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":227.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":255.02,"additional_payer_notes":"APC"}]}]},{"description":"Cranial cervical orthosis","code_information":[{"code":"L0112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1678.86,"maximum":7852.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1678.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2518.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1712.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6990.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7852.87,"additional_payer_notes":"APC"}]}]},{"description":"Cranial cervical torticollis","code_information":[{"code":"L0113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.07,"maximum":1600.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":342.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":513.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":348.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1424.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1600.03,"additional_payer_notes":"APC"}]}]},{"description":"Cerv flex n/adj foam pre ots","code_information":[{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.13,"maximum":150.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":133.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150.29,"additional_payer_notes":"APC"}]}]},{"description":"Flex thermoplastic collar mo","code_information":[{"code":"L0130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":227.12,"maximum":1062.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":340.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":945.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1062.35,"additional_payer_notes":"APC"}]}]},{"description":"Cervical semi-rigid adjustab","code_information":[{"code":"L0140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.11,"maximum":351.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":312.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":351.33,"additional_payer_notes":"APC"}]}]},{"description":"Cerv semi-rig adj molded chn","code_information":[{"code":"L0150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.78,"maximum":644.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":206.67,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":573.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":644.47,"additional_payer_notes":"APC"}]}]},{"description":"Cerv sr wire occ/man pre ots","code_information":[{"code":"L0160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.98,"maximum":841.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":269.97,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":749.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":841.86,"additional_payer_notes":"APC"}]}]},{"description":"Cervical collar molded to pt","code_information":[{"code":"L0170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":741.08,"maximum":3466.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":741.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1111.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":755.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3085.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3466.4,"additional_payer_notes":"APC"}]}]},{"description":"Cerv col sr foam 2pc pre ots","code_information":[{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.68,"maximum":751.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":241.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":669.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":751.58,"additional_payer_notes":"APC"}]}]},{"description":"Cerv sr 2pc thor ext pre ots","code_information":[{"code":"L0174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.67,"maximum":1476.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":315.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":473.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":321.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1314.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1476.55,"additional_payer_notes":"APC"}]}]},{"description":"Cer post col occ/man sup adj","code_information":[{"code":"L0180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":437.72,"maximum":2047.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":437.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":656.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":446.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1822.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2047.44,"additional_payer_notes":"APC"}]}]},{"description":"Cerv collar supp adj cerv ba","code_information":[{"code":"L0190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":569.23,"maximum":2662.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":569.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":853.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2370.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2662.57,"additional_payer_notes":"APC"}]}]},{"description":"Cerv col supp adj bar & thor","code_information":[{"code":"L0200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":593.42,"maximum":2775.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":593.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":890.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2471.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2775.72,"additional_payer_notes":"APC"}]}]},{"description":"Thor rib belt custom fabrica","code_information":[{"code":"L0220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.05,"maximum":757.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":243.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":674.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":757.99,"additional_payer_notes":"APC"}]}]},{"description":"Tlso flex trunk/thor pre ots","code_information":[{"code":"L0450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.31,"maximum":595.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":190.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":530.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":595.49,"additional_payer_notes":"APC"}]}]},{"description":"Tlso trnk sj-t9 pre cst","code_information":[{"code":"L0454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.01,"maximum":1945.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":624.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1732.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1945.89,"additional_payer_notes":"APC"}]}]},{"description":"Tlso flex trnk sj-t9 pre ots","code_information":[{"code":"L0455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.34,"maximum":1105.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":354.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":984.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1105.48,"additional_payer_notes":"APC"}]}]},{"description":"Tlso flex trnk sj-ss pre cst","code_information":[{"code":"L0456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1192.99,"maximum":5580.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1192.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1789.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1216.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4967.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5580.21,"additional_payer_notes":"APC"}]}]},{"description":"Tlso flex trnk sj-ss pre ots","code_information":[{"code":"L0457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":677.75,"maximum":3170.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":677.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1016.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":691.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2822.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3170.18,"additional_payer_notes":"APC"}]}]},{"description":"TLSO 2Mod symphis-xipho pre","code_information":[{"code":"L0458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1069.75,"maximum":5003.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1069.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1604.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1091.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4454.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5003.76,"additional_payer_notes":"APC"}]}]},{"description":"Tlso 2 shl symphys-stern cst","code_information":[{"code":"L0460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1204.08,"maximum":5632.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1204.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1806.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1228.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5013.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5632.08,"additional_payer_notes":"APC"}]}]},{"description":"TLSO 3Mod sacro-scap pre","code_information":[{"code":"L0462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1497.69,"maximum":7005.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1497.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2246.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1527.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6236.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7005.44,"additional_payer_notes":"APC"}]}]},{"description":"TLSO 4Mod sacro-scap pre","code_information":[{"code":"L0464","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1782.97,"maximum":8339.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1782.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2674.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1818.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7424.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8339.84,"additional_payer_notes":"APC"}]}]},{"description":"Tlso r fram soft ant pre cst","code_information":[{"code":"L0466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":433.36,"maximum":2027.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":433.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":650.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":442.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1804.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2027.04,"additional_payer_notes":"APC"}]}]},{"description":"Tlso r fram soft pre ots","code_information":[{"code":"L0467","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":265.06,"maximum":1239.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":397.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1103.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1239.82,"additional_payer_notes":"APC"}]}]},{"description":"Tlso rig fram pelvic pre cst","code_information":[{"code":"L0468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":574.13,"maximum":2685.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":574.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":861.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":585.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2390.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2685.49,"additional_payer_notes":"APC"}]}]},{"description":"Tlso rig fram pelvic pre ots","code_information":[{"code":"L0469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":337.73,"maximum":1579.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":337.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":506.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":344.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1406.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1579.73,"additional_payer_notes":"APC"}]}]},{"description":"TLSO rigid frame pre subclav","code_information":[{"code":"L0470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":732.62,"maximum":3426.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":732.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1098.93,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3050.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3426.83,"additional_payer_notes":"APC"}]}]},{"description":"TLSO rigid frame hyperex pre","code_information":[{"code":"L0472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":464.64,"maximum":2173.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":464.64,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":696.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":473.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1934.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2173.35,"additional_payer_notes":"APC"}]}]},{"description":"TLSO rigid plastic custom fa","code_information":[{"code":"L0480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1636.27,"maximum":7653.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1636.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2454.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1669.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6813.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7653.65,"additional_payer_notes":"APC"}]}]},{"description":"TLSO rigid lined custom fab","code_information":[{"code":"L0482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1900.6,"maximum":8890.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1900.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2850.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1938.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7914.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8890.06,"additional_payer_notes":"APC"}]}]},{"description":"TLSO rigid plastic cust fab","code_information":[{"code":"L0484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2042.14,"maximum":9552.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2042.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3063.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2082.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8503.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9552.11,"additional_payer_notes":"APC"}]}]},{"description":"TLSO rigidlined cust fab two","code_information":[{"code":"L0486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2166.6,"maximum":10134.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2166.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3249.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2209.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9021.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10134.27,"additional_payer_notes":"APC"}]}]},{"description":"TLSO rigid lined pre one pie","code_information":[{"code":"L0488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1204.08,"maximum":5632.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1204.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1806.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1228.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5013.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5632.08,"additional_payer_notes":"APC"}]}]},{"description":"TLSO rigid plastic pre one","code_information":[{"code":"L0490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.33,"maximum":1587.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1413.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1587.22,"additional_payer_notes":"APC"}]}]},{"description":"TLSO 2 piece rigid shell","code_information":[{"code":"L0491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":921.22,"maximum":4309.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":921.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1381.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":939.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3836.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4309.01,"additional_payer_notes":"APC"}]}]},{"description":"TLSO 3 piece rigid shell","code_information":[{"code":"L0492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":605.86,"maximum":2833.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":605.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":908.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2522.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2833.91,"additional_payer_notes":"APC"}]}]},{"description":"Sio flex pelvic/sacr pre ots","code_information":[{"code":"L0621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.12,"maximum":313.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":279.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":313.95,"additional_payer_notes":"APC"}]}]},{"description":"Sio flex pelvisacral custom","code_information":[{"code":"L0622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":347.06,"maximum":1623.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":347.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":520.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":354.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1445.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1623.37,"additional_payer_notes":"APC"}]}]},{"description":"Sio rig pnl pelv/sac pre ots","code_information":[{"code":"L0623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.32,"maximum":562.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":180.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":501.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":562.8,"additional_payer_notes":"APC"}]}]},{"description":"Lo flex l1-below l5 pre ots","code_information":[{"code":"L0625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.55,"maximum":175.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":156.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":175.64,"additional_payer_notes":"APC"}]}]},{"description":"Lo sag rig pnl stays pre cst","code_information":[{"code":"L0626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.48,"maximum":437.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.48,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":140.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":389.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"}]}]},{"description":"Lo sag ri an/pos pnl pre cst","code_information":[{"code":"L0627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":493.08,"maximum":2306.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":493.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":739.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":502.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2053.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2306.38,"additional_payer_notes":"APC"}]}]},{"description":"Lso flex no ri stays pre ots","code_information":[{"code":"L0628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.18,"maximum":267.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":238.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":267.46,"additional_payer_notes":"APC"}]}]},{"description":"Lso r post pnl sj-t9 pre cst","code_information":[{"code":"L0630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.26,"maximum":908.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":291.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":808.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":908.65,"additional_payer_notes":"APC"}]}]},{"description":"Lso sag r an/pos pnl pre cst","code_information":[{"code":"L0631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1231.38,"maximum":5759.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1231.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1847.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1256.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5127.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5759.78,"additional_payer_notes":"APC"}]}]},{"description":"Lso sc r pos/lat pnl pre cst","code_information":[{"code":"L0633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":343.97,"maximum":1608.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":515.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1432.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1608.92,"additional_payer_notes":"APC"}]}]},{"description":"Lso sagit rigid panel prefab","code_information":[{"code":"L0635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1099.93,"maximum":5144.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1099.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1649.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1121.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4580.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5144.92,"additional_payer_notes":"APC"}]}]},{"description":"Lso sagittal rigid panel cus","code_information":[{"code":"L0636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1628.31,"maximum":7616.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1628.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2442.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1660.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6780.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7616.42,"additional_payer_notes":"APC"}]}]},{"description":"Lso sc r ant/pos pnl pre cst","code_information":[{"code":"L0637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1288.6,"maximum":6027.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1932.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1314.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5365.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6027.43,"additional_payer_notes":"APC"}]}]},{"description":"Lso sag-coronal panel custom","code_information":[{"code":"L0638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1582.02,"maximum":7399.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1582.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2373.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1613.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6587.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7399.9,"additional_payer_notes":"APC"}]}]},{"description":"Lso s/c shell/panel prefab","code_information":[{"code":"L0639","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1288.6,"maximum":6027.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1932.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1314.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5365.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6027.43,"additional_payer_notes":"APC"}]}]},{"description":"Lso s/c shell/panel custom","code_information":[{"code":"L0640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1255.19,"maximum":5871.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1255.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1882.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1280.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5226.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5871.15,"additional_payer_notes":"APC"}]}]},{"description":"Lo rig pos pnl l1-l5 pre ots","code_information":[{"code":"L0641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.13,"maximum":248.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":221.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":248.52,"additional_payer_notes":"APC"}]}]},{"description":"Lo sag ri an/pos pnl pre ots","code_information":[{"code":"L0642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":280.18,"maximum":1310.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":420.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":285.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1166.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1310.54,"additional_payer_notes":"APC"}]}]},{"description":"Lso sag ctr rigi pos pre ots","code_information":[{"code":"L0643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.38,"maximum":516.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":165.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":459.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":516.3,"additional_payer_notes":"APC"}]}]},{"description":"Lso sag r an/pos pnl pre ots","code_information":[{"code":"L0648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":699.71,"maximum":3272.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1049.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":713.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2913.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3272.89,"additional_payer_notes":"APC"}]}]},{"description":"Lso sc r pos/lat pnl pre ots","code_information":[{"code":"L0649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.46,"maximum":914.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":293.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":813.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":914.26,"additional_payer_notes":"APC"}]}]},{"description":"Lso sc r ant/pos pnl pre ots","code_information":[{"code":"L0650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":809.61,"maximum":3786.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":809.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1214.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":825.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3371.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3786.95,"additional_payer_notes":"APC"}]}]},{"description":"LSO sag-co shell pnl pre ots","code_information":[{"code":"L0651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":809.61,"maximum":3786.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":809.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1214.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":825.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3371.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3786.95,"additional_payer_notes":"APC"}]}]},{"description":"Ctlso a-p-l control molded","code_information":[{"code":"L0700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2349.14,"maximum":10988.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2349.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3523.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2396.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9782.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10988.1,"additional_payer_notes":"APC"}]}]},{"description":"Ctlso a-p-l control w/ inter","code_information":[{"code":"L0710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2399.94,"maximum":11225.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2399.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3599.91,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2447.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9993.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11225.72,"additional_payer_notes":"APC"}]}]},{"description":"Ctlso a-p-l control custom","code_information":[{"code":"L0720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2220.69,"maximum":10387.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2220.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3331.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2265.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9247.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10387.28,"additional_payer_notes":"APC"}]}]},{"description":"Halo cervical into jckt vest","code_information":[{"code":"L0810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3001.43,"maximum":14039.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3001.43,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4502.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3061.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12498.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14039.19,"additional_payer_notes":"APC"}]}]},{"description":"Halo cervical into body jack","code_information":[{"code":"L0820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2693.97,"maximum":12601.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2693.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4040.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2747.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11217.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12601.04,"additional_payer_notes":"APC"}]}]},{"description":"Halo cerv into milwaukee typ","code_information":[{"code":"L0830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3796.61,"maximum":17758.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3796.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5694.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3872.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15809.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17758.64,"additional_payer_notes":"APC"}]}]},{"description":"MRI compatible system","code_information":[{"code":"L0859","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1582.21,"maximum":7400.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1582.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2373.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1613.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6588.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7400.79,"additional_payer_notes":"APC"}]}]},{"description":"Halo repl liner/interface","code_information":[{"code":"L0861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":258.53,"maximum":1209.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":387.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1076.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1209.27,"additional_payer_notes":"APC"}]}]},{"description":"Tlso corset front","code_information":[{"code":"L0970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":154.52,"maximum":722.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":154.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":231.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":643.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":722.77,"additional_payer_notes":"APC"}]}]},{"description":"Lso corset front","code_information":[{"code":"L0972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.79,"maximum":649.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":208.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":577.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":649.19,"additional_payer_notes":"APC"}]}]},{"description":"Tlso full corset","code_information":[{"code":"L0974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.1,"maximum":964.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":206.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":309.15,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":858.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":964.03,"additional_payer_notes":"APC"}]}]},{"description":"Lso full corset","code_information":[{"code":"L0976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.75,"maximum":859.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":187.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":765.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":859.49,"additional_payer_notes":"APC"}]}]},{"description":"Axillary crutch extension","code_information":[{"code":"L0978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":242.53,"maximum":1134.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":363.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1009.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1134.43,"additional_payer_notes":"APC"}]}]},{"description":"Peroneal straps pair pre ots","code_information":[{"code":"L0980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.47,"maximum":123.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":110.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123.81,"additional_payer_notes":"APC"}]}]},{"description":"Stocking sup grips 4 pre ots","code_information":[{"code":"L0982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.71,"maximum":87.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":77.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87.52,"additional_payer_notes":"APC"}]}]},{"description":"Protect body sock ea pre ots","code_information":[{"code":"L0984","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.67,"maximum":363.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":116.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":323.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":363.3,"additional_payer_notes":"APC"}]}]},{"description":"Ctlso milwauke initial model","code_information":[{"code":"L1000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2356.89,"maximum":11024.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2356.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3535.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2404.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9814.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11024.35,"additional_payer_notes":"APC"}]}]},{"description":"Tension based scoliosis orth","code_information":[{"code":"L1005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3839.2,"maximum":17957.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3839.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5758.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3915.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15986.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17957.86,"additional_payer_notes":"APC"}]}]},{"description":"Ctlso axilla sling","code_information":[{"code":"L1010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.12,"maximum":360.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":115.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":321.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":360.73,"additional_payer_notes":"APC"}]}]},{"description":"Kyphosis pad","code_information":[{"code":"L1020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.33,"maximum":464.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":149.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":413.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":464.62,"additional_payer_notes":"APC"}]}]},{"description":"Kyphosis pad floating","code_information":[{"code":"L1025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":189.6,"maximum":886.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":189.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":284.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":789.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":886.85,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar bolster pad","code_information":[{"code":"L1030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.1,"maximum":341.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109.65,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":304.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":341.93,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar or lumbar rib pad","code_information":[{"code":"L1040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.68,"maximum":447.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":143.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":398.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":447.54,"additional_payer_notes":"APC"}]}]},{"description":"Sternal pad","code_information":[{"code":"L1050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.32,"maximum":539.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":172.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":480.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":539.41,"additional_payer_notes":"APC"}]}]},{"description":"Thoracic pad","code_information":[{"code":"L1060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.32,"maximum":646.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":207.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":575.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":646.99,"additional_payer_notes":"APC"}]}]},{"description":"Trapezius sling","code_information":[{"code":"L1070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.06,"maximum":631.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":202.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":562.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":631.74,"additional_payer_notes":"APC"}]}]},{"description":"Outrigger","code_information":[{"code":"L1080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.96,"maximum":355.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":113.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":316.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":355.3,"additional_payer_notes":"APC"}]}]},{"description":"Outrigger bil w/ vert extens","code_information":[{"code":"L1085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":205.53,"maximum":961.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":308.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":855.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":961.37,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar sling","code_information":[{"code":"L1090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.96,"maximum":635.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":203.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":566.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":635.95,"additional_payer_notes":"APC"}]}]},{"description":"Ring flange plastic/leather","code_information":[{"code":"L1100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.13,"maximum":1015.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":325.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":221.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":904.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1015.63,"additional_payer_notes":"APC"}]}]},{"description":"Ring flange plas/leather mol","code_information":[{"code":"L1110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":293.49,"maximum":1372.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":293.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":440.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1222.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1372.8,"additional_payer_notes":"APC"}]}]},{"description":"Covers for upright each","code_information":[{"code":"L1120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.63,"maximum":232.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":206.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":232.14,"additional_payer_notes":"APC"}]}]},{"description":"Furnsh initial orthosis only","code_information":[{"code":"L1200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1800.47,"maximum":8421.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1800.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2700.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1836.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7497.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8421.7,"additional_payer_notes":"APC"}]}]},{"description":"Lateral thoracic extension","code_information":[{"code":"L1210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.68,"maximum":1406.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":451.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":306.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1252.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1406.43,"additional_payer_notes":"APC"}]}]},{"description":"Anterior thoracic extension","code_information":[{"code":"L1220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":287.24,"maximum":1343.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":287.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":430.86,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":292.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1196.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1343.57,"additional_payer_notes":"APC"}]}]},{"description":"Milwaukee type superstructur","code_information":[{"code":"L1230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":736.27,"maximum":3443.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":736.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1104.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":751.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3065.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3443.9,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar derotation pad","code_information":[{"code":"L1240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.53,"maximum":465.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":149.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":414.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":465.55,"additional_payer_notes":"APC"}]}]},{"description":"Anterior asis pad","code_information":[{"code":"L1250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.53,"maximum":465.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":149.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":414.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":465.55,"additional_payer_notes":"APC"}]}]},{"description":"Anterior thoracic derotation","code_information":[{"code":"L1260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.63,"maximum":475.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":152.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":423.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":475.37,"additional_payer_notes":"APC"}]}]},{"description":"Abdominal pad","code_information":[{"code":"L1270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.23,"maximum":482.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":154.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":429.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":482.86,"additional_payer_notes":"APC"}]}]},{"description":"Rib gusset (elastic) each","code_information":[{"code":"L1280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.75,"maximum":555.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":118.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":178.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":555.45,"additional_payer_notes":"APC"}]}]},{"description":"Lateral trochanteric pad","code_information":[{"code":"L1290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.0,"maximum":439.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":141.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":391.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":439.68,"additional_payer_notes":"APC"}]}]},{"description":"Body jacket mold to patient","code_information":[{"code":"L1300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2116.61,"maximum":9900.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2116.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3174.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2158.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8813.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9900.44,"additional_payer_notes":"APC"}]}]},{"description":"Post-operative body jacket","code_information":[{"code":"L1310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2174.83,"maximum":10172.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2174.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3262.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2218.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9056.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10172.77,"additional_payer_notes":"APC"}]}]},{"description":"Ho flex frejka w/cov pre cst","code_information":[{"code":"L1600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.08,"maximum":692.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":616.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":692.64,"additional_payer_notes":"APC"}]}]},{"description":"Ho frejka cov only pre cst","code_information":[{"code":"L1610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.35,"maximum":305.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":272.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":305.67,"additional_payer_notes":"APC"}]}]},{"description":"Ho flex pavlik harns pre cst","code_information":[{"code":"L1620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.07,"maximum":865.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":277.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":770.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":865.66,"additional_payer_notes":"APC"}]}]},{"description":"Abduct control hip semi-flex","code_information":[{"code":"L1630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.72,"maximum":910.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":292.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":810.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":910.8,"additional_payer_notes":"APC"}]}]},{"description":"Pelv band/spread bar thigh c","code_information":[{"code":"L1640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":592.73,"maximum":2772.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":592.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":889.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":604.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2468.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2772.49,"additional_payer_notes":"APC"}]}]},{"description":"HO abduction hip adjustable","code_information":[{"code":"L1650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.95,"maximum":1403.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":449.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1249.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1403.02,"additional_payer_notes":"APC"}]}]},{"description":"HO bi thighcuffs w sprdr bar","code_information":[{"code":"L1652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":427.56,"maximum":1999.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.56,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":641.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1780.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1999.91,"additional_payer_notes":"APC"}]}]},{"description":"HO abduction static plastic","code_information":[{"code":"L1660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.66,"maximum":919.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":294.99,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":818.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":919.88,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic & hip control thigh c","code_information":[{"code":"L1680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1400.11,"maximum":6549.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1400.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2100.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1428.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5830.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6549.01,"additional_payer_notes":"APC"}]}]},{"description":"Ho bilateral hip abduction","code_information":[{"code":"L1681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2638.78,"maximum":12342.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2638.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3958.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2691.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10988.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12342.89,"additional_payer_notes":"APC"}]}]},{"description":"Post-op hip abduct custom fa","code_information":[{"code":"L1685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1428.89,"maximum":6683.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1428.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2143.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1457.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5950.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6683.63,"additional_payer_notes":"APC"}]}]},{"description":"HO post-op hip abduction","code_information":[{"code":"L1686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1319.39,"maximum":6171.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1319.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1979.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1345.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5494.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6171.45,"additional_payer_notes":"APC"}]}]},{"description":"Combination bilateral HO","code_information":[{"code":"L1690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2319.54,"maximum":10849.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2319.54,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3479.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2365.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9658.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10849.65,"additional_payer_notes":"APC"}]}]},{"description":"Leg perthes orth toronto typ","code_information":[{"code":"L1700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1754.84,"maximum":8208.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1754.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2632.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1789.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7307.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8208.26,"additional_payer_notes":"APC"}]}]},{"description":"Legg perthes orth newington","code_information":[{"code":"L1710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2054.23,"maximum":9608.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2054.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3081.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2095.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8554.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9608.66,"additional_payer_notes":"APC"}]}]},{"description":"Legg perthes orthosis trilat","code_information":[{"code":"L1720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1514.21,"maximum":7082.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2271.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1544.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6305.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7082.72,"additional_payer_notes":"APC"}]}]},{"description":"Legg perthes orth scottish r","code_information":[{"code":"L1730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1300.56,"maximum":6083.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1300.56,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1950.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1326.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5415.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6083.37,"additional_payer_notes":"APC"}]}]},{"description":"Legg perthes patten bottom t","code_information":[{"code":"L1755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2063.91,"maximum":9653.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2063.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3095.86,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2105.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8594.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9653.94,"additional_payer_notes":"APC"}]}]},{"description":"Ko elastic with joints","code_information":[{"code":"L1810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.17,"maximum":529.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":169.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":471.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":529.35,"additional_payer_notes":"APC"}]}]},{"description":"Ko elastic w/joints pre ots","code_information":[{"code":"L1812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.63,"maximum":363.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":116.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":323.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":363.11,"additional_payer_notes":"APC"}]}]},{"description":"Ko elas w/ condyle pads & jo","code_information":[{"code":"L1820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.32,"maximum":820.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":262.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":730.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":820.06,"additional_payer_notes":"APC"}]}]},{"description":"Ko immob canvas long pre ots","code_information":[{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.94,"maximum":327.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":104.91,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":291.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":327.14,"additional_payer_notes":"APC"}]}]},{"description":"Knee orth pos locking joint","code_information":[{"code":"L1831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.04,"maximum":1651.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":529.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":360.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1470.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1651.34,"additional_payer_notes":"APC"}]}]},{"description":"Ko adj jnt pos r sup pre cst","code_information":[{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":812.69,"maximum":3801.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":812.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1219.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":828.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3384.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3801.36,"additional_payer_notes":"APC"}]}]},{"description":"Ko adj jnt pos r sup pre ots","code_information":[{"code":"L1833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.87,"maximum":2356.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":503.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":755.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":513.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2098.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2356.85,"additional_payer_notes":"APC"}]}]},{"description":"Ko w/0 joint rigid molded to","code_information":[{"code":"L1834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":892.02,"maximum":4172.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":892.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1338.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":909.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3714.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4172.42,"additional_payer_notes":"APC"}]}]},{"description":"Ko rigid w/o joints pre ots","code_information":[{"code":"L1836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.9,"maximum":462.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":148.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":411.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":462.6,"additional_payer_notes":"APC"}]}]},{"description":"Ko derot ant cruciate custom","code_information":[{"code":"L1840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1188.2,"maximum":5557.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1188.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1782.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1211.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4947.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5557.81,"additional_payer_notes":"APC"}]}]},{"description":"Ko single upright pre cst","code_information":[{"code":"L1843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1076.26,"maximum":5034.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1076.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1614.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1097.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4481.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5034.21,"additional_payer_notes":"APC"}]}]},{"description":"Ko w/adj jt rot cntrl molded","code_information":[{"code":"L1844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1865.51,"maximum":8725.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1865.51,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2798.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1902.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7768.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8725.92,"additional_payer_notes":"APC"}]}]},{"description":"Ko double upright pre cst","code_information":[{"code":"L1845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1116.88,"maximum":5224.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1116.88,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1675.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1139.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4650.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5224.21,"additional_payer_notes":"APC"}]}]},{"description":"Ko w adj flex/ext rotat mold","code_information":[{"code":"L1846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1369.37,"maximum":6405.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1369.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2054.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1396.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5702.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6405.23,"additional_payer_notes":"APC"}]}]},{"description":"Ko dbl upright w/air pre cst","code_information":[{"code":"L1847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":689.92,"maximum":3227.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":689.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1034.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":703.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2872.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3227.1,"additional_payer_notes":"APC"}]}]},{"description":"Ko dbl upright w/air pre ots","code_information":[{"code":"L1848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":689.92,"maximum":3227.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":689.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1034.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":703.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2872.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3227.1,"additional_payer_notes":"APC"}]}]},{"description":"Ko swedish type pre ots","code_information":[{"code":"L1850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":227.8,"maximum":1065.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":341.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":948.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1065.53,"additional_payer_notes":"APC"}]}]},{"description":"Ko single upright prefab ots","code_information":[{"code":"L1851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":665.06,"maximum":3110.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":665.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":997.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2769.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3110.82,"additional_payer_notes":"APC"}]}]},{"description":"Ko double upright prefab ots","code_information":[{"code":"L1852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.46,"maximum":2967.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":634.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":951.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":647.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2641.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2967.69,"additional_payer_notes":"APC"}]}]},{"description":"Ko supracondylar socket mold","code_information":[{"code":"L1860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1233.07,"maximum":5767.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1233.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1849.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1257.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5134.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5767.68,"additional_payer_notes":"APC"}]}]},{"description":"Afo sprng wir drsflx calf bd","code_information":[{"code":"L1900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":310.01,"maximum":1450.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":465.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":316.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1290.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1450.07,"additional_payer_notes":"APC"}]}]},{"description":"Afo ankle gauntlet pre ots","code_information":[{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.12,"maximum":501.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":160.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":446.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":501.05,"additional_payer_notes":"APC"}]}]},{"description":"Afo molded ankle gauntlet","code_information":[{"code":"L1904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":644.19,"maximum":3013.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":644.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":966.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":657.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2682.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3013.2,"additional_payer_notes":"APC"}]}]},{"description":"Afo multilig ank sup pre ots","code_information":[{"code":"L1906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.2,"maximum":646.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":207.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":575.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":646.43,"additional_payer_notes":"APC"}]}]},{"description":"AFO supramalleolar custom","code_information":[{"code":"L1907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.95,"maximum":3157.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":674.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1012.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":688.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2810.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3157.08,"additional_payer_notes":"APC"}]}]},{"description":"Afo sing bar clasp attach sh","code_information":[{"code":"L1910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":313.83,"maximum":1467.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":313.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":470.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1306.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1467.94,"additional_payer_notes":"APC"}]}]},{"description":"Afo sing upright w/ adjust s","code_information":[{"code":"L1920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":401.73,"maximum":1879.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":401.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":602.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":409.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1672.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1879.09,"additional_payer_notes":"APC"}]}]},{"description":"Afo plastic","code_information":[{"code":"L1930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":271.84,"maximum":1271.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":407.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1131.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1271.53,"additional_payer_notes":"APC"}]}]},{"description":"Afo rig ant tib prefab TCF/=","code_information":[{"code":"L1932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1070.39,"maximum":5006.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1070.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1605.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1091.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4457.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5006.75,"additional_payer_notes":"APC"}]}]},{"description":"Afo rig ant tib tcf/= ots","code_information":[{"code":"L1933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1070.39,"maximum":5006.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1070.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1605.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1091.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4457.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5006.75,"additional_payer_notes":"APC"}]}]},{"description":"Afo molded to patient plasti","code_information":[{"code":"L1940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":568.3,"maximum":2658.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":568.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":852.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":579.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2366.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2658.22,"additional_payer_notes":"APC"}]}]},{"description":"Afo molded plas rig ant tib","code_information":[{"code":"L1945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1358.69,"maximum":6355.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1358.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2038.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1385.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5657.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6355.27,"additional_payer_notes":"APC"}]}]},{"description":"Afo spiral molded to pt plas","code_information":[{"code":"L1950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":900.87,"maximum":4213.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":900.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1351.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":918.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3751.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4213.82,"additional_payer_notes":"APC"}]}]},{"description":"AFO spiral prefabricated","code_information":[{"code":"L1951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1007.37,"maximum":4711.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1007.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1511.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4194.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4711.97,"additional_payer_notes":"APC"}]}]},{"description":"Afo spiral prefab ots","code_information":[{"code":"L1952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1007.37,"maximum":4711.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1007.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1511.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1027.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4194.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4711.97,"additional_payer_notes":"APC"}]}]},{"description":"Afo pos solid ank plastic mo","code_information":[{"code":"L1960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.46,"maximum":3178.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":679.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1019.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":693.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2829.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3178.17,"additional_payer_notes":"APC"}]}]},{"description":"Afo plastic molded w/ankle j","code_information":[{"code":"L1970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":817.68,"maximum":3824.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":817.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1226.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":834.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3404.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3824.7,"additional_payer_notes":"APC"}]}]},{"description":"AFO w/ankle joint, prefab","code_information":[{"code":"L1971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":562.23,"maximum":2629.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":562.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":843.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":573.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2341.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2629.83,"additional_payer_notes":"APC"}]}]},{"description":"Afo sing solid stirrup calf","code_information":[{"code":"L1980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.73,"maximum":1972.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":632.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":430.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1756.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1972.64,"additional_payer_notes":"APC"}]}]},{"description":"Afo doub solid stirrup calf","code_information":[{"code":"L1990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":512.22,"maximum":2395.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":512.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":768.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":522.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2132.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2395.91,"additional_payer_notes":"APC"}]}]},{"description":"Kafo sing fre stirr thi/calf","code_information":[{"code":"L2000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1213.52,"maximum":5676.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1213.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1820.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1237.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5053.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5676.24,"additional_payer_notes":"APC"}]}]},{"description":"KAFO sng/dbl mechanical act","code_information":[{"code":"L2005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4915.21,"maximum":22990.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7372.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5013.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20467.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22990.89,"additional_payer_notes":"APC"}]}]},{"description":"Kafo sng solid stirrup w/o j","code_information":[{"code":"L2010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1132.06,"maximum":5295.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1132.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1698.09,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1154.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4714.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5295.21,"additional_payer_notes":"APC"}]}]},{"description":"Kafo dbl solid stirrup band/","code_information":[{"code":"L2020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1425.4,"maximum":6667.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1425.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2138.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1453.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5935.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6667.31,"additional_payer_notes":"APC"}]}]},{"description":"Kafo dbl solid stirrup w/o j","code_information":[{"code":"L2030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1293.94,"maximum":6052.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1293.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1940.91,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1319.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5388.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6052.4,"additional_payer_notes":"APC"}]}]},{"description":"Kafo pla sin up w/wo k/a cus","code_information":[{"code":"L2034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2443.99,"maximum":11431.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2443.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3665.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2492.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10177.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11431.76,"additional_payer_notes":"APC"}]}]},{"description":"KAFO plastic pediatric size","code_information":[{"code":"L2035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.89,"maximum":981.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":314.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":874.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":981.76,"additional_payer_notes":"APC"}]}]},{"description":"Kafo plas doub free knee mol","code_information":[{"code":"L2036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2209.36,"maximum":10334.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2209.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3314.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2253.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9200.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10334.28,"additional_payer_notes":"APC"}]}]},{"description":"Kafo plas sing free knee mol","code_information":[{"code":"L2037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2061.21,"maximum":9641.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2061.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3091.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2102.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8583.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9641.31,"additional_payer_notes":"APC"}]}]},{"description":"Kafo w/o joint multi-axis an","code_information":[{"code":"L2038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2093.86,"maximum":9794.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2093.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3140.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2135.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8719.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9794.03,"additional_payer_notes":"APC"}]}]},{"description":"Hkafo torsion bil rot straps","code_information":[{"code":"L2040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.95,"maximum":1187.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":380.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":259.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1057.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1187.85,"additional_payer_notes":"APC"}]}]},{"description":"Hkafo torsion cable hip pelv","code_information":[{"code":"L2050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":547.39,"maximum":2560.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":547.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":821.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":558.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2279.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2560.42,"additional_payer_notes":"APC"}]}]},{"description":"Hkafo torsion ball bearing j","code_information":[{"code":"L2060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":667.17,"maximum":3120.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":667.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1000.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":680.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2778.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3120.69,"additional_payer_notes":"APC"}]}]},{"description":"Hkafo torsion unilat rot str","code_information":[{"code":"L2070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":171.33,"maximum":801.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":257.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":713.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":801.4,"additional_payer_notes":"APC"}]}]},{"description":"Hkafo unilat torsion cable","code_information":[{"code":"L2080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":413.32,"maximum":1933.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":413.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":619.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":421.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1721.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1933.3,"additional_payer_notes":"APC"}]}]},{"description":"Hkafo unilat torsion ball br","code_information":[{"code":"L2090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.88,"maximum":2356.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":503.88,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":755.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":513.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2098.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2356.9,"additional_payer_notes":"APC"}]}]},{"description":"Afo tib fx cast plaster mold","code_information":[{"code":"L2106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":781.31,"maximum":3654.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":781.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1171.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":796.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3253.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3654.58,"additional_payer_notes":"APC"}]}]},{"description":"Afo tib fx cast molded to pt","code_information":[{"code":"L2108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1360.4,"maximum":6363.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1360.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2040.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1387.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5664.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6363.27,"additional_payer_notes":"APC"}]}]},{"description":"Afo tibial fracture soft","code_information":[{"code":"L2112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":625.72,"maximum":2926.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":625.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":938.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":638.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2605.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2926.81,"additional_payer_notes":"APC"}]}]},{"description":"Afo tib fx semi-rigid","code_information":[{"code":"L2114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":784.82,"maximum":3671.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":784.82,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1177.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":800.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3268.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3671.0,"additional_payer_notes":"APC"}]}]},{"description":"Afo tibial fracture rigid","code_information":[{"code":"L2116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":903.01,"maximum":4223.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":903.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1354.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":921.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3760.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4223.83,"additional_payer_notes":"APC"}]}]},{"description":"Kafo fem fx cast thermoplas","code_information":[{"code":"L2126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1510.57,"maximum":7065.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1510.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2265.86,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1540.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6290.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7065.69,"additional_payer_notes":"APC"}]}]},{"description":"Kafo fem fx cast molded to p","code_information":[{"code":"L2128","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2139.06,"maximum":10005.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2139.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3208.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2181.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8907.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10005.45,"additional_payer_notes":"APC"}]}]},{"description":"Kafo femoral fx cast soft","code_information":[{"code":"L2132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1159.73,"maximum":5424.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1159.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1739.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1182.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4829.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5424.64,"additional_payer_notes":"APC"}]}]},{"description":"Kafo fem fx cast semi-rigid","code_information":[{"code":"L2134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1237.52,"maximum":5788.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1237.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1856.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1262.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5153.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5788.5,"additional_payer_notes":"APC"}]}]},{"description":"Kafo femoral fx cast rigid","code_information":[{"code":"L2136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1477.06,"maximum":6908.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1477.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2215.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1506.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6150.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6908.95,"additional_payer_notes":"APC"}]}]},{"description":"Plas shoe insert w ank joint","code_information":[{"code":"L2180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.83,"maximum":644.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":206.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":573.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":644.7,"additional_payer_notes":"APC"}]}]},{"description":"Drop lock knee","code_information":[{"code":"L2182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.21,"maximum":534.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":171.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":475.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":534.22,"additional_payer_notes":"APC"}]}]},{"description":"Limited motion knee joint","code_information":[{"code":"L2184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.13,"maximum":730.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":234.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":650.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":730.3,"additional_payer_notes":"APC"}]}]},{"description":"Adj motion knee jnt lerman t","code_information":[{"code":"L2186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.56,"maximum":1012.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.56,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":324.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":901.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1012.96,"additional_payer_notes":"APC"}]}]},{"description":"Quadrilateral brim","code_information":[{"code":"L2188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":414.72,"maximum":1939.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":414.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":622.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1726.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1939.85,"additional_payer_notes":"APC"}]}]},{"description":"Waist belt","code_information":[{"code":"L2190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.15,"maximum":501.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":160.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":446.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":501.19,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic band & belt thigh fla","code_information":[{"code":"L2192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":470.55,"maximum":2201.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":470.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":705.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":479.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1959.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2201.0,"additional_payer_notes":"APC"}]}]},{"description":"Limited ankle motion ea jnt","code_information":[{"code":"L2200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.63,"maximum":255.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":227.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":255.53,"additional_payer_notes":"APC"}]}]},{"description":"Dorsiflexion assist each joi","code_information":[{"code":"L2210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.09,"maximum":369.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":329.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":369.94,"additional_payer_notes":"APC"}]}]},{"description":"Dorsi & plantar flex ass/res","code_information":[{"code":"L2220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.1,"maximum":440.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":141.15,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":391.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":440.15,"additional_payer_notes":"APC"}]}]},{"description":"Split flat caliper stirr & p","code_information":[{"code":"L2230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.17,"maximum":412.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":132.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":367.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":412.42,"additional_payer_notes":"APC"}]}]},{"description":"Rocker bottom, contact AFO","code_information":[{"code":"L2232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.38,"maximum":558.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":179.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":497.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":558.4,"additional_payer_notes":"APC"}]}]},{"description":"Round caliper and plate atta","code_information":[{"code":"L2240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.14,"maximum":510.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":163.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":454.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":510.5,"additional_payer_notes":"APC"}]}]},{"description":"Foot plate molded stirrup at","code_information":[{"code":"L2250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":442.46,"maximum":2069.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":442.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":663.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":451.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1842.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2069.61,"additional_payer_notes":"APC"}]}]},{"description":"Reinforced solid stirrup","code_information":[{"code":"L2260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":230.35,"maximum":1077.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":345.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":959.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1077.46,"additional_payer_notes":"APC"}]}]},{"description":"Long tongue stirrup","code_information":[{"code":"L2265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.33,"maximum":633.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":203.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":563.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":633.01,"additional_payer_notes":"APC"}]}]},{"description":"Varus/valgus strap padded/li","code_information":[{"code":"L2270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.44,"maximum":296.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.44,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":264.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":296.74,"additional_payer_notes":"APC"}]}]},{"description":"Plastic mod low ext pad/line","code_information":[{"code":"L2275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":149.59,"maximum":699.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":224.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":622.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":699.71,"additional_payer_notes":"APC"}]}]},{"description":"Molded inner boot","code_information":[{"code":"L2280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":523.1,"maximum":2446.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":523.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":784.65,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":533.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2178.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2446.8,"additional_payer_notes":"APC"}]}]},{"description":"Abduction bar jointed adjust","code_information":[{"code":"L2300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.01,"maximum":1534.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":492.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":334.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1365.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1534.27,"additional_payer_notes":"APC"}]}]},{"description":"Abduction bar-straight","code_information":[{"code":"L2310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.25,"maximum":768.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":246.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":683.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":768.28,"additional_payer_notes":"APC"}]}]},{"description":"Non-molded lacer","code_information":[{"code":"L2320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.44,"maximum":1105.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.44,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":354.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":984.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1105.95,"additional_payer_notes":"APC"}]}]},{"description":"Lacer molded to patient mode","code_information":[{"code":"L2330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":494.92,"maximum":2314.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":494.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":742.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":504.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2060.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2314.99,"additional_payer_notes":"APC"}]}]},{"description":"Anterior swing band","code_information":[{"code":"L2335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":305.56,"maximum":1429.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.56,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":458.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1272.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1429.26,"additional_payer_notes":"APC"}]}]},{"description":"Pre-tibial shell molded to p","code_information":[{"code":"L2340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":661.51,"maximum":3094.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":661.51,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":992.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":674.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2754.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3094.21,"additional_payer_notes":"APC"}]}]},{"description":"Prosthetic type socket molde","code_information":[{"code":"L2350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1142.48,"maximum":5343.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1142.48,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1713.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1165.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4757.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5343.95,"additional_payer_notes":"APC"}]}]},{"description":"Extended steel shank","code_information":[{"code":"L2360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.45,"maximum":278.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":247.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":278.08,"additional_payer_notes":"APC"}]}]},{"description":"Patten bottom","code_information":[{"code":"L2370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":385.26,"maximum":1802.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":385.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":577.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":392.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1604.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1802.05,"additional_payer_notes":"APC"}]}]},{"description":"Torsion ank & half solid sti","code_information":[{"code":"L2375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.73,"maximum":761.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":244.09,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":677.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":761.17,"additional_payer_notes":"APC"}]}]},{"description":"Torsion straight knee joint","code_information":[{"code":"L2380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":141.47,"maximum":661.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":141.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":212.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":589.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":661.73,"additional_payer_notes":"APC"}]}]},{"description":"Straight knee joint heavy du","code_information":[{"code":"L2385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.92,"maximum":719.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":230.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":640.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":719.96,"additional_payer_notes":"APC"}]}]},{"description":"Add le poly knee custom kafo","code_information":[{"code":"L2387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":221.76,"maximum":1037.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":221.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":332.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":226.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":923.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1037.28,"additional_payer_notes":"APC"}]}]},{"description":"Offset knee joint each","code_information":[{"code":"L2390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.89,"maximum":602.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":193.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":536.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":602.88,"additional_payer_notes":"APC"}]}]},{"description":"Offset knee joint heavy duty","code_information":[{"code":"L2395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.8,"maximum":841.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":269.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":748.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":841.01,"additional_payer_notes":"APC"}]}]},{"description":"Suspension sleeve lower ext","code_information":[{"code":"L2397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.07,"maximum":655.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":210.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":583.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":655.18,"additional_payer_notes":"APC"}]}]},{"description":"Knee joint drop lock ea jnt","code_information":[{"code":"L2405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":104.57,"maximum":489.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":156.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":435.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":489.13,"additional_payer_notes":"APC"}]}]},{"description":"Knee joint cam lock each joi","code_information":[{"code":"L2415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":145.69,"maximum":681.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":218.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":606.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":681.46,"additional_payer_notes":"APC"}]}]},{"description":"Knee disc/dial lock/adj flex","code_information":[{"code":"L2425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":171.93,"maximum":804.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":257.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":715.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":804.2,"additional_payer_notes":"APC"}]}]},{"description":"Knee jnt ratchet lock ea jnt","code_information":[{"code":"L2430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":171.93,"maximum":804.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":257.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":715.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":804.2,"additional_payer_notes":"APC"}]}]},{"description":"Knee lift loop drop lock rin","code_information":[{"code":"L2492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.11,"maximum":730.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":234.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":650.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":730.2,"additional_payer_notes":"APC"}]}]},{"description":"Thi/glut/ischia wgt bearing","code_information":[{"code":"L2500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":373.46,"maximum":1746.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":373.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":560.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":380.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1555.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1746.86,"additional_payer_notes":"APC"}]}]},{"description":"Th/wght bear quad-lat brim m","code_information":[{"code":"L2510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":837.92,"maximum":3919.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":837.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1256.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":854.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3489.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3919.37,"additional_payer_notes":"APC"}]}]},{"description":"Th/wght bear quad-lat brim c","code_information":[{"code":"L2520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":552.74,"maximum":2585.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":552.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":829.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":563.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2301.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2585.44,"additional_payer_notes":"APC"}]}]},{"description":"Th/wght bear nar m-l brim mo","code_information":[{"code":"L2525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1491.28,"maximum":6975.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1491.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2236.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1521.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6209.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6975.46,"additional_payer_notes":"APC"}]}]},{"description":"Th/wght bear nar m-l brim cu","code_information":[{"code":"L2526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.02,"maximum":3980.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":851.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1276.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":868.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3543.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3980.65,"additional_payer_notes":"APC"}]}]},{"description":"Thigh/wght bear lacer non-mo","code_information":[{"code":"L2530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":269.99,"maximum":1262.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":404.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1124.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1262.88,"additional_payer_notes":"APC"}]}]},{"description":"Thigh/wght bear lacer molded","code_information":[{"code":"L2540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":485.83,"maximum":2272.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":485.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":728.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":495.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2023.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2272.47,"additional_payer_notes":"APC"}]}]},{"description":"Thigh/wght bear high roll cu","code_information":[{"code":"L2550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":330.04,"maximum":1543.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":330.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":495.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1374.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1543.76,"additional_payer_notes":"APC"}]}]},{"description":"Hip clevis type 2 posit jnt","code_information":[{"code":"L2570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":547.34,"maximum":2560.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":547.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":821.01,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":558.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2560.18,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic control pelvic sling","code_information":[{"code":"L2580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":533.32,"maximum":2494.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":533.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":799.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":543.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2220.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2494.6,"additional_payer_notes":"APC"}]}]},{"description":"Hip clevis/thrust bearing fr","code_information":[{"code":"L2600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":292.05,"maximum":1366.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":292.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":438.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":297.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1216.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1366.06,"additional_payer_notes":"APC"}]}]},{"description":"Hip clevis/thrust bearing lo","code_information":[{"code":"L2610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.33,"maximum":1446.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":309.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":464.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":315.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1288.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1446.89,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic control hip heavy dut","code_information":[{"code":"L2620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":347.82,"maximum":1626.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":347.82,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":521.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":354.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1448.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1626.93,"additional_payer_notes":"APC"}]}]},{"description":"Hip joint adjustable flexion","code_information":[{"code":"L2622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.32,"maximum":1844.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":394.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":591.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":402.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1641.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1844.43,"additional_payer_notes":"APC"}]}]},{"description":"Hip adj flex ext abduct cont","code_information":[{"code":"L2624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.52,"maximum":1779.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":380.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":570.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":388.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1584.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1779.88,"additional_payer_notes":"APC"}]}]},{"description":"Plastic mold recipro hip & c","code_information":[{"code":"L2627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2076.41,"maximum":9712.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2076.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3114.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2117.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8646.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9712.41,"additional_payer_notes":"APC"}]}]},{"description":"Metal frame recipro hip & ca","code_information":[{"code":"L2628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2042.45,"maximum":9553.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2042.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3063.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2083.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8504.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9553.56,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic control band & belt u","code_information":[{"code":"L2630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":284.55,"maximum":1330.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":426.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":290.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1184.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1330.98,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic control band & belt b","code_information":[{"code":"L2640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":386.17,"maximum":1806.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":386.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":579.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":393.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1608.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1806.31,"additional_payer_notes":"APC"}]}]},{"description":"Pelv & thor control gluteal","code_information":[{"code":"L2650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.42,"maximum":769.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":246.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":684.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"}]}]},{"description":"Thoracic control thoracic ba","code_information":[{"code":"L2660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.17,"maximum":1001.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":321.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":891.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1001.78,"additional_payer_notes":"APC"}]}]},{"description":"Thorac cont paraspinal uprig","code_information":[{"code":"L2670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.69,"maximum":971.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":311.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":864.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":971.47,"additional_payer_notes":"APC"}]}]},{"description":"Thorac cont lat support upri","code_information":[{"code":"L2680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.38,"maximum":899.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":801.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":899.86,"additional_payer_notes":"APC"}]}]},{"description":"Plating chrome/nickel pr bar","code_information":[{"code":"L2750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.05,"maximum":449.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":144.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":399.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":449.27,"additional_payer_notes":"APC"}]}]},{"description":"Carbon graphite lamination","code_information":[{"code":"L2755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.7,"maximum":732.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":235.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":652.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":732.96,"additional_payer_notes":"APC"}]}]},{"description":"Extension per extension per","code_information":[{"code":"L2760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.82,"maximum":326.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.82,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":104.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":290.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":326.58,"additional_payer_notes":"APC"}]}]},{"description":"Ortho sidebar disconnect","code_information":[{"code":"L2768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.26,"maximum":730.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":234.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":650.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":730.91,"additional_payer_notes":"APC"}]}]},{"description":"Non-corrosive finish","code_information":[{"code":"L2780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.77,"maximum":363.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.77,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":116.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":323.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":363.77,"additional_payer_notes":"APC"}]}]},{"description":"Drop lock retainer each","code_information":[{"code":"L2785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.57,"maximum":171.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54.86,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":152.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171.06,"additional_payer_notes":"APC"}]}]},{"description":"Knee control full kneecap","code_information":[{"code":"L2795","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.18,"maximum":463.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":148.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":413.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":463.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee cap medial or lateral p","code_information":[{"code":"L2800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":152.45,"maximum":713.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":228.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":634.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":713.08,"additional_payer_notes":"APC"}]}]},{"description":"Knee control condylar pad","code_information":[{"code":"L2810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.67,"maximum":559.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":179.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":498.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":559.76,"additional_payer_notes":"APC"}]}]},{"description":"Soft interface below knee se","code_information":[{"code":"L2820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.79,"maximum":466.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":149.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":415.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":466.77,"additional_payer_notes":"APC"}]}]},{"description":"Soft interface above knee se","code_information":[{"code":"L2830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.96,"maximum":504.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":161.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":449.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":504.98,"additional_payer_notes":"APC"}]}]},{"description":"Tibial length sock fx or equ","code_information":[{"code":"L2840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.82,"maximum":298.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.82,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":265.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":298.52,"additional_payer_notes":"APC"}]}]},{"description":"Femoral lgth sock fx or equa","code_information":[{"code":"L2850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.15,"maximum":332.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":106.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":296.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":332.8,"additional_payer_notes":"APC"}]}]},{"description":"Ft insert ucb berkeley shell","code_information":[{"code":"L3000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":376.8,"maximum":1762.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":376.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":565.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":384.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1569.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1762.48,"additional_payer_notes":"APC"}]}]},{"description":"Foot insert remov molded spe","code_information":[{"code":"L3001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.66,"maximum":742.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":237.99,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":660.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":742.13,"additional_payer_notes":"APC"}]}]},{"description":"Foot insert plastazote or eq","code_information":[{"code":"L3002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.73,"maximum":906.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":290.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":806.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":906.17,"additional_payer_notes":"APC"}]}]},{"description":"Foot insert silicone gel eac","code_information":[{"code":"L3003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.04,"maximum":977.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":313.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":870.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":977.78,"additional_payer_notes":"APC"}]}]},{"description":"Foot longitudinal arch suppo","code_information":[{"code":"L3010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.04,"maximum":977.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":313.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":870.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":977.78,"additional_payer_notes":"APC"}]}]},{"description":"Foot longitud/metatarsal sup","code_information":[{"code":"L3020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":237.97,"maximum":1113.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":356.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":990.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1113.1,"additional_payer_notes":"APC"}]}]},{"description":"Foot arch support remov prem","code_information":[{"code":"L3030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.55,"maximum":428.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":381.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":428.23,"additional_payer_notes":"APC"}]}]},{"description":"Foot lamin/prepreg composite","code_information":[{"code":"L3031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.92,"maximum":687.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":146.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":220.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":611.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":687.22,"additional_payer_notes":"APC"}]}]},{"description":"Ft arch suprt premold longit","code_information":[{"code":"L3040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.45,"maximum":264.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":235.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":264.04,"additional_payer_notes":"APC"}]}]},{"description":"Foot arch supp premold metat","code_information":[{"code":"L3050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.45,"maximum":264.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":235.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":264.04,"additional_payer_notes":"APC"}]}]},{"description":"Foot arch supp longitud/meta","code_information":[{"code":"L3060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.45,"maximum":413.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":132.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":368.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":413.72,"additional_payer_notes":"APC"}]}]},{"description":"Arch suprt att to sho longit","code_information":[{"code":"L3070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.11,"maximum":178.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":158.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178.26,"additional_payer_notes":"APC"}]}]},{"description":"Arch supp att to shoe metata","code_information":[{"code":"L3080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.11,"maximum":178.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":158.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178.26,"additional_payer_notes":"APC"}]}]},{"description":"Arch supp att to shoe long/m","code_information":[{"code":"L3090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.83,"maximum":228.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":203.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":228.4,"additional_payer_notes":"APC"}]}]},{"description":"Hallus-valgus nt dyn pre ots","code_information":[{"code":"L3100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.86,"maximum":242.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":215.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":242.58,"additional_payer_notes":"APC"}]}]},{"description":"Abduction rotation bar shoe","code_information":[{"code":"L3140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.8,"maximum":499.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":160.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":444.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":499.56,"additional_payer_notes":"APC"}]}]},{"description":"Abduct rotation bar w/o shoe","code_information":[{"code":"L3150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.63,"maximum":456.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":146.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":406.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":456.66,"additional_payer_notes":"APC"}]}]},{"description":"Foot plas heel stabi pre ots","code_information":[{"code":"L3170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.04,"maximum":285.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":254.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":285.51,"additional_payer_notes":"APC"}]}]},{"description":"Woman's shoe oxford brace","code_information":[{"code":"L3224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.44,"maximum":357.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.44,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":114.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":318.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":357.55,"additional_payer_notes":"APC"}]}]},{"description":"Man's shoe oxford brace","code_information":[{"code":"L3225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.49,"maximum":367.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":117.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":326.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":367.14,"additional_payer_notes":"APC"}]}]},{"description":"Sho lift taper to metatarsal","code_information":[{"code":"L3300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.55,"maximum":292.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":93.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":260.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":292.58,"additional_payer_notes":"APC"}]}]},{"description":"Shoe lift elev heel/sole neo","code_information":[{"code":"L3310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.63,"maximum":456.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":146.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":406.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":456.66,"additional_payer_notes":"APC"}]}]},{"description":"Lifts elevation metal extens","code_information":[{"code":"L3330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":678.86,"maximum":3175.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1018.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":692.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2826.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3175.37,"additional_payer_notes":"APC"}]}]},{"description":"Shoe lifts tapered to one-ha","code_information":[{"code":"L3332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.45,"maximum":413.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":132.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":368.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":413.72,"additional_payer_notes":"APC"}]}]},{"description":"Shoe lifts elevation heel /i","code_information":[{"code":"L3334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.78,"maximum":214.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68.67,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":190.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214.14,"additional_payer_notes":"APC"}]}]},{"description":"Shoe wedge sach","code_information":[{"code":"L3340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.26,"maximum":478.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":153.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":478.32,"additional_payer_notes":"APC"}]}]},{"description":"Shoe heel wedge","code_information":[{"code":"L3350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.48,"maximum":128.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.48,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128.54,"additional_payer_notes":"APC"}]}]},{"description":"Shoe sole wedge outside sole","code_information":[{"code":"L3360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.72,"maximum":199.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":177.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":199.82,"additional_payer_notes":"APC"}]}]},{"description":"Shoe sole wedge between sole","code_information":[{"code":"L3370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.46,"maximum":278.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":247.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":278.12,"additional_payer_notes":"APC"}]}]},{"description":"Shoe clubfoot wedge","code_information":[{"code":"L3380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.46,"maximum":278.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":247.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":278.12,"additional_payer_notes":"APC"}]}]},{"description":"Shoe outflare wedge","code_information":[{"code":"L3390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.46,"maximum":278.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":247.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":278.12,"additional_payer_notes":"APC"}]}]},{"description":"Shoe metatarsal bar wedge ro","code_information":[{"code":"L3400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.83,"maximum":228.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":203.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":228.4,"additional_payer_notes":"APC"}]}]},{"description":"Shoe metatarsal bar between","code_information":[{"code":"L3410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":111.35,"maximum":520.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":111.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":167.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":463.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":520.84,"additional_payer_notes":"APC"}]}]},{"description":"Full sole/heel wedge btween","code_information":[{"code":"L3420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.62,"maximum":306.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":273.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":306.94,"additional_payer_notes":"APC"}]}]},{"description":"Sho heel count plast reinfor","code_information":[{"code":"L3430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.22,"maximum":899.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":288.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":196.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":800.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":899.11,"additional_payer_notes":"APC"}]}]},{"description":"Heel leather reinforced","code_information":[{"code":"L3440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.55,"maximum":428.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":381.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":428.23,"additional_payer_notes":"APC"}]}]},{"description":"Shoe heel sach cushion type","code_information":[{"code":"L3450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.64,"maximum":592.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.64,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":189.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":527.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":592.36,"additional_payer_notes":"APC"}]}]},{"description":"Shoe heel new leather standa","code_information":[{"code":"L3455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.83,"maximum":228.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":203.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":228.4,"additional_payer_notes":"APC"}]}]},{"description":"Shoe heel new rubber standar","code_information":[{"code":"L3460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.16,"maximum":192.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":171.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":192.53,"additional_payer_notes":"APC"}]}]},{"description":"Shoe heel thomas with wedge","code_information":[{"code":"L3465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.16,"maximum":328.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":292.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":328.17,"additional_payer_notes":"APC"}]}]},{"description":"Shoe heel thomas extend to b","code_information":[{"code":"L3470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.74,"maximum":349.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":311.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":349.6,"additional_payer_notes":"APC"}]}]},{"description":"Shoe heel pad & depress for","code_information":[{"code":"L3480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.74,"maximum":349.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":311.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":349.6,"additional_payer_notes":"APC"}]}]},{"description":"Ortho shoe add leather insol","code_information":[{"code":"L3500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"Orthopedic shoe add rub insl","code_information":[{"code":"L3510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":164.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":146.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164.13,"additional_payer_notes":"APC"}]}]},{"description":"O shoe add felt w leath insl","code_information":[{"code":"L3520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.11,"maximum":178.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":158.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178.26,"additional_payer_notes":"APC"}]}]},{"description":"Ortho shoe add half sole","code_information":[{"code":"L3530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.11,"maximum":178.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":158.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178.26,"additional_payer_notes":"APC"}]}]},{"description":"Ortho shoe add full sole","code_information":[{"code":"L3540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.04,"maximum":285.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":254.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":285.51,"additional_payer_notes":"APC"}]}]},{"description":"O shoe add standard toe tap","code_information":[{"code":"L3550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.65,"maximum":49.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.82,"additional_payer_notes":"APC"}]}]},{"description":"O shoe add horseshoe toe tap","code_information":[{"code":"L3560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.48,"maximum":128.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.48,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128.54,"additional_payer_notes":"APC"}]}]},{"description":"O shoe add instep extension","code_information":[{"code":"L3570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.26,"maximum":478.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":153.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":478.32,"additional_payer_notes":"APC"}]}]},{"description":"O shoe add instep velcro clo","code_information":[{"code":"L3580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.81,"maximum":363.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":324.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":363.96,"additional_payer_notes":"APC"}]}]},{"description":"O shoe convert to sof counte","code_information":[{"code":"L3590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.07,"maximum":299.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":266.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":299.69,"additional_payer_notes":"APC"}]}]},{"description":"Ortho shoe add march bar","code_information":[{"code":"L3595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.33,"maximum":235.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":209.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":235.42,"additional_payer_notes":"APC"}]}]},{"description":"Trans shoe calip plate exist","code_information":[{"code":"L3600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.55,"maximum":428.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":381.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":428.23,"additional_payer_notes":"APC"}]}]},{"description":"Trans shoe caliper plate new","code_information":[{"code":"L3610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.51,"maximum":563.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.51,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":180.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":501.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":563.69,"additional_payer_notes":"APC"}]}]},{"description":"Trans shoe solid stirrup exi","code_information":[{"code":"L3620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.55,"maximum":428.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":381.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":428.23,"additional_payer_notes":"APC"}]}]},{"description":"Trans shoe solid stirrup new","code_information":[{"code":"L3630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.51,"maximum":563.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.51,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":180.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":501.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":563.69,"additional_payer_notes":"APC"}]}]},{"description":"Shoe dennis browne splint bo","code_information":[{"code":"L3640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.86,"maximum":242.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":215.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":242.58,"additional_payer_notes":"APC"}]}]},{"description":"So 8 abd restraint pre ots","code_information":[{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.41,"maximum":357.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":114.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":318.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":357.41,"additional_payer_notes":"APC"}]}]},{"description":"So 8 ab rstr can/web pre ots","code_information":[{"code":"L3660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.57,"maximum":540.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.57,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":173.36,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":481.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":540.58,"additional_payer_notes":"APC"}]}]},{"description":"So acro/clav can web pre ots","code_information":[{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":152.73,"maximum":714.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":152.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":229.09,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":155.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":635.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":714.39,"additional_payer_notes":"APC"}]}]},{"description":"SO cap design w/o jnts CF","code_information":[{"code":"L3671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":983.68,"maximum":4601.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":983.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1475.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1003.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4096.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4601.16,"additional_payer_notes":"APC"}]}]},{"description":"SO airplane w/wo joint CF","code_information":[{"code":"L3674","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1290.37,"maximum":6035.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1290.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1935.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1316.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5373.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6035.71,"additional_payer_notes":"APC"}]}]},{"description":"So vest canvas/web pre ots","code_information":[{"code":"L3675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.58,"maximum":896.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":191.58,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":287.37,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":797.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":896.12,"additional_payer_notes":"APC"}]}]},{"description":"EO w/o joints CF","code_information":[{"code":"L3702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":315.21,"maximum":1474.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":315.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":472.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":321.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1312.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1474.39,"additional_payer_notes":"APC"}]}]},{"description":"Eo elas w/metal jnts pre ots","code_information":[{"code":"L3710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.72,"maximum":821.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":263.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":731.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":821.93,"additional_payer_notes":"APC"}]}]},{"description":"Forearm/arm cuffs free motio","code_information":[{"code":"L3720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":784.06,"maximum":3667.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":784.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1176.09,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3264.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3667.44,"additional_payer_notes":"APC"}]}]},{"description":"Forearm/arm cuffs ext/flex a","code_information":[{"code":"L3730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1013.66,"maximum":4741.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1013.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1520.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1033.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4220.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4741.39,"additional_payer_notes":"APC"}]}]},{"description":"Cuffs adj lock w/ active con","code_information":[{"code":"L3740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1201.78,"maximum":5621.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1201.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1802.67,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1225.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5004.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5621.33,"additional_payer_notes":"APC"}]}]},{"description":"EO withjoint, Prefabricated","code_information":[{"code":"L3760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":545.9,"maximum":2553.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":545.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":818.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":556.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2273.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2553.45,"additional_payer_notes":"APC"}]}]},{"description":"Eo, adj lock joint prefab ot","code_information":[{"code":"L3761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":545.9,"maximum":2553.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":545.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":818.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":556.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2273.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2553.45,"additional_payer_notes":"APC"}]}]},{"description":"Eo rigid w/o joints pre ots","code_information":[{"code":"L3762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.38,"maximum":549.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":176.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":488.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":549.04,"additional_payer_notes":"APC"}]}]},{"description":"EWHO rigid w/o jnts CF","code_information":[{"code":"L3763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":766.28,"maximum":3584.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1149.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":781.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3190.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3584.27,"additional_payer_notes":"APC"}]}]},{"description":"EWHO w/joint(s) CF","code_information":[{"code":"L3764","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1000.17,"maximum":4678.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1000.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1500.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1020.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4164.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4678.3,"additional_payer_notes":"APC"}]}]},{"description":"EWHFO rigid w/o jnts CF","code_information":[{"code":"L3765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1399.76,"maximum":6547.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1399.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2099.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1427.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5828.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6547.38,"additional_payer_notes":"APC"}]}]},{"description":"EWHFO w/joint(s) CF","code_information":[{"code":"L3766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1482.24,"maximum":6933.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1482.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2223.36,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1511.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6172.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6933.18,"additional_payer_notes":"APC"}]}]},{"description":"WHFO w/joint(s) custom fab","code_information":[{"code":"L3806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":495.89,"maximum":2319.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":495.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":743.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":505.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2064.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2319.53,"additional_payer_notes":"APC"}]}]},{"description":"Whfo w/o joints pre cst","code_information":[{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":272.97,"maximum":1276.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":272.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":409.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1136.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1276.82,"additional_payer_notes":"APC"}]}]},{"description":"WHFO, rigid w/o joints","code_information":[{"code":"L3808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":408.22,"maximum":1909.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":408.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":612.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1699.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1909.45,"additional_payer_notes":"APC"}]}]},{"description":"Whfo w/o joints pre ots","code_information":[{"code":"L3809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":272.97,"maximum":1276.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":272.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":409.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":278.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1136.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1276.82,"additional_payer_notes":"APC"}]}]},{"description":"Hinge extension/flex wrist/f","code_information":[{"code":"L3900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1591.75,"maximum":7445.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1591.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2387.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1623.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6628.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7445.41,"additional_payer_notes":"APC"}]}]},{"description":"Hinge ext/flex wrist finger","code_information":[{"code":"L3901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1807.62,"maximum":8455.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1807.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2711.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1843.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7527.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8455.14,"additional_payer_notes":"APC"}]}]},{"description":"Whfo electric custom fitted","code_information":[{"code":"L3904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3292.96,"maximum":15402.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3292.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4939.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3358.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13712.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15402.82,"additional_payer_notes":"APC"}]}]},{"description":"Who w/nontorsion jnt(s) cf","code_information":[{"code":"L3905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1082.62,"maximum":5063.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1082.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1623.93,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1104.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4508.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5063.96,"additional_payer_notes":"APC"}]}]},{"description":"Who w/o joints cf","code_information":[{"code":"L3906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":480.66,"maximum":2248.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":480.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":720.99,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":490.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2001.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2248.29,"additional_payer_notes":"APC"}]}]},{"description":"Who cock-up nonmolde pre ots","code_information":[{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.64,"maximum":353.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.64,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":113.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":314.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":353.81,"additional_payer_notes":"APC"}]}]},{"description":"Hfo flexion glove pre ots","code_information":[{"code":"L3912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.04,"maximum":612.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":196.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":545.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":612.94,"additional_payer_notes":"APC"}]}]},{"description":"HFO w/o joints CF","code_information":[{"code":"L3913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.66,"maximum":1382.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":295.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":443.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1231.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1382.95,"additional_payer_notes":"APC"}]}]},{"description":"Who nontorsion jnts pre cst","code_information":[{"code":"L3915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.28,"maximum":2714.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":870.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":591.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2416.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2714.26,"additional_payer_notes":"APC"}]}]},{"description":"Who nontorsion jnts pre ots","code_information":[{"code":"L3916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.28,"maximum":2714.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":870.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":591.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2416.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2714.26,"additional_payer_notes":"APC"}]}]},{"description":"Metacarp fx orthosis pre cst","code_information":[{"code":"L3917","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.37,"maximum":539.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":173.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":480.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":539.64,"additional_payer_notes":"APC"}]}]},{"description":"Metacarp fx orthosis pre ots","code_information":[{"code":"L3918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.37,"maximum":539.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":173.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":480.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":539.64,"additional_payer_notes":"APC"}]}]},{"description":"HO w/o joints CF","code_information":[{"code":"L3919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.66,"maximum":1382.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":295.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":443.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1231.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1382.95,"additional_payer_notes":"APC"}]}]},{"description":"HFO w/joint(s) CF","code_information":[{"code":"L3921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":350.66,"maximum":1640.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":525.99,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":357.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1460.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1640.21,"additional_payer_notes":"APC"}]}]},{"description":"Hfo without joints pre cst","code_information":[{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.37,"maximum":492.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":158.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":438.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":492.87,"additional_payer_notes":"APC"}]}]},{"description":"Hfo without joints pre ots","code_information":[{"code":"L3924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.37,"maximum":492.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":158.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":438.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":492.87,"additional_payer_notes":"APC"}]}]},{"description":"Fo pip dip jnt/sprng pre ots","code_information":[{"code":"L3925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.51,"maximum":264.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.51,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":235.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"}]}]},{"description":"Fo pip dip no jt spr pre ots","code_information":[{"code":"L3927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.17,"maximum":178.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":158.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178.54,"additional_payer_notes":"APC"}]}]},{"description":"Hfo nontorsion jnts pre cst","code_information":[{"code":"L3929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.12,"maximum":468.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":150.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":416.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":468.31,"additional_payer_notes":"APC"}]}]},{"description":"Hfo nontorsion jnts pre ots","code_information":[{"code":"L3930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.12,"maximum":468.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":150.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":416.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":468.31,"additional_payer_notes":"APC"}]}]},{"description":"WHFO nontorsion joint prefab","code_information":[{"code":"L3931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":205.04,"maximum":959.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":307.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":853.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":959.07,"additional_payer_notes":"APC"}]}]},{"description":"FO w/o joints CF","code_information":[{"code":"L3933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.89,"maximum":1089.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":349.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":969.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1089.34,"additional_payer_notes":"APC"}]}]},{"description":"FO nontorsion joint CF","code_information":[{"code":"L3935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.15,"maximum":1127.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":361.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1004.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1127.98,"additional_payer_notes":"APC"}]}]},{"description":"Sewho airplan desig abdu pos","code_information":[{"code":"L3960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":827.16,"maximum":3869.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":827.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1240.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":843.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3444.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3869.04,"additional_payer_notes":"APC"}]}]},{"description":"Sewho cap design w/o jnts cf","code_information":[{"code":"L3961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.09,"maximum":8578.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1834.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2751.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1870.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7637.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8578.96,"additional_payer_notes":"APC"}]}]},{"description":"Sewho erbs palsey design abd","code_information":[{"code":"L3962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":806.8,"maximum":3773.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":806.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1210.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":822.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3359.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3773.81,"additional_payer_notes":"APC"}]}]},{"description":"Sewho airplane w/o jnts cf","code_information":[{"code":"L3967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2165.46,"maximum":10128.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2165.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3248.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2208.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9017.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10128.94,"additional_payer_notes":"APC"}]}]},{"description":"Sewho cap design w/jnt(s) cf","code_information":[{"code":"L3971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2055.53,"maximum":9614.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3083.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2096.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8559.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9614.74,"additional_payer_notes":"APC"}]}]},{"description":"Sewho airplane w/jnt(s) cf","code_information":[{"code":"L3973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2165.46,"maximum":10128.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2165.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3248.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2208.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9017.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10128.94,"additional_payer_notes":"APC"}]}]},{"description":"Sewhfo cap design w/o jnt cf","code_information":[{"code":"L3975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.09,"maximum":8578.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1834.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2751.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1870.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7637.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8578.96,"additional_payer_notes":"APC"}]}]},{"description":"Sewhfo airplane w/o jnts cf","code_information":[{"code":"L3976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1834.09,"maximum":8578.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1834.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2751.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1870.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7637.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8578.96,"additional_payer_notes":"APC"}]}]},{"description":"Sewhfo cap desgn w/jnt(s) cf","code_information":[{"code":"L3977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2055.53,"maximum":9614.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2055.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3083.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2096.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8559.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9614.74,"additional_payer_notes":"APC"}]}]},{"description":"Sewhfo airplane w/jnt(s) cf","code_information":[{"code":"L3978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2165.46,"maximum":10128.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2165.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3248.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2208.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9017.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10128.94,"additional_payer_notes":"APC"}]}]},{"description":"Up ext fx orthos humeral nos","code_information":[{"code":"L3980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":360.07,"maximum":1684.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":360.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":540.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":367.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1499.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1684.23,"additional_payer_notes":"APC"}]}]},{"description":"Ue fx orth shoul cap forearm","code_information":[{"code":"L3981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1098.83,"maximum":5139.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1098.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1648.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1120.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4575.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5139.78,"additional_payer_notes":"APC"}]}]},{"description":"Upper ext fx orthosis rad/ul","code_information":[{"code":"L3982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.78,"maximum":1963.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":629.67,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":428.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1748.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.52,"additional_payer_notes":"APC"}]}]},{"description":"Upper ext fx orthosis wrist","code_information":[{"code":"L3984","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":387.03,"maximum":1810.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":387.03,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":580.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":394.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1611.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1810.33,"additional_payer_notes":"APC"}]}]},{"description":"Sock fracture or equal each","code_information":[{"code":"L3995","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.11,"maximum":187.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":167.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":187.61,"additional_payer_notes":"APC"}]}]},{"description":"Repl girdle milwaukee orth","code_information":[{"code":"L4000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1581.89,"maximum":7399.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1581.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2372.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1613.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6587.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7399.29,"additional_payer_notes":"APC"}]}]},{"description":"Replace trilateral socket br","code_information":[{"code":"L4010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.19,"maximum":3607.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1156.79,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":786.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3211.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3607.24,"additional_payer_notes":"APC"}]}]},{"description":"Replace quadlat socket brim","code_information":[{"code":"L4020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1078.54,"maximum":5044.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.54,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1617.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1100.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4491.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5044.87,"additional_payer_notes":"APC"}]}]},{"description":"Replace socket brim cust fit","code_information":[{"code":"L4030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.17,"maximum":2713.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":870.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":591.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2415.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2713.75,"additional_payer_notes":"APC"}]}]},{"description":"Replace molded thigh lacer","code_information":[{"code":"L4040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":473.43,"maximum":2214.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":473.43,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":710.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1971.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2214.47,"additional_payer_notes":"APC"}]}]},{"description":"Replace non-molded thigh lac","code_information":[{"code":"L4045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":376.94,"maximum":1763.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":376.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":565.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":384.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1569.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1763.14,"additional_payer_notes":"APC"}]}]},{"description":"Replace molded calf lacer","code_information":[{"code":"L4050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":474.4,"maximum":2219.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":474.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":711.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1975.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2219.01,"additional_payer_notes":"APC"}]}]},{"description":"Replace non-molded calf lace","code_information":[{"code":"L4055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":307.2,"maximum":1436.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":460.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":313.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1279.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1436.93,"additional_payer_notes":"APC"}]}]},{"description":"Replace high roll cuff","code_information":[{"code":"L4060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":365.19,"maximum":1708.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":365.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":547.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":372.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1520.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1708.18,"additional_payer_notes":"APC"}]}]},{"description":"Replace prox & dist upright","code_information":[{"code":"L4070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":323.39,"maximum":1512.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":323.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":485.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1346.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1512.66,"additional_payer_notes":"APC"}]}]},{"description":"Repl met band kafo-afo prox","code_information":[{"code":"L4080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.66,"maximum":620.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":198.99,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":552.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":620.52,"additional_payer_notes":"APC"}]}]},{"description":"Repl met band kafo-afo calf/","code_information":[{"code":"L4090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":104.67,"maximum":489.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":157.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":435.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":489.59,"additional_payer_notes":"APC"}]}]},{"description":"Repl leath cuff kafo prox th","code_information":[{"code":"L4100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.45,"maximum":642.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":206.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":572.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":642.92,"additional_payer_notes":"APC"}]}]},{"description":"Repl leath cuff kafo-afo cal","code_information":[{"code":"L4110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.53,"maximum":484.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":155.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":431.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":484.26,"additional_payer_notes":"APC"}]}]},{"description":"Replace pretibial shell","code_information":[{"code":"L4130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":580.6,"maximum":2715.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":580.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":870.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":592.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2417.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2715.76,"additional_payer_notes":"APC"}]}]},{"description":"Ortho dvc repair per 15 min","code_information":[{"code":"L4205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.92,"maximum":139.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":124.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139.95,"additional_payer_notes":"APC"}]}]},{"description":"Ankle control ortho pre ots","code_information":[{"code":"L4350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.02,"maximum":538.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":172.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":117.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":478.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":538.01,"additional_payer_notes":"APC"}]}]},{"description":"Pneumat walking boot pre cst","code_information":[{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.59,"maximum":1653.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":360.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1472.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1653.92,"additional_payer_notes":"APC"}]}]},{"description":"Pneuma/vac walk boot pre ots","code_information":[{"code":"L4361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.59,"maximum":1653.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":530.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":360.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1472.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1653.92,"additional_payer_notes":"APC"}]}]},{"description":"Pneum full leg splnt pre ots","code_information":[{"code":"L4370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":233.82,"maximum":1093.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.82,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":350.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":973.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1093.69,"additional_payer_notes":"APC"}]}]},{"description":"Non-pneum walk boot pre cst","code_information":[{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.16,"maximum":889.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":889.47,"additional_payer_notes":"APC"}]}]},{"description":"Non-pneum walk boot pre ots","code_information":[{"code":"L4387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.16,"maximum":889.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":285.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":791.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":889.47,"additional_payer_notes":"APC"}]}]},{"description":"Replace AFO soft interface","code_information":[{"code":"L4392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.22,"maximum":132.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":117.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132.0,"additional_payer_notes":"APC"}]}]},{"description":"Replace foot drop spint","code_information":[{"code":"L4394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.58,"maximum":96.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.58,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":85.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96.26,"additional_payer_notes":"APC"}]}]},{"description":"Static or dynami afo pre cst","code_information":[{"code":"L4396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.26,"maximum":941.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":301.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":838.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":941.39,"additional_payer_notes":"APC"}]}]},{"description":"Static or dynami afo pre ots","code_information":[{"code":"L4397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.26,"maximum":941.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":301.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":205.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":838.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":941.39,"additional_payer_notes":"APC"}]}]},{"description":"Foot drop splint pre ots","code_information":[{"code":"L4398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.67,"maximum":433.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":139.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":385.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":433.46,"additional_payer_notes":"APC"}]}]},{"description":"Afo, walk boot type, cus fab","code_information":[{"code":"L4631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1912.64,"maximum":8946.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1912.64,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2868.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1950.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7964.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8946.37,"additional_payer_notes":"APC"}]}]},{"description":"Sho insert w arch toe filler","code_information":[{"code":"L5000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":682.33,"maximum":3191.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":682.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1023.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":695.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2841.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3191.6,"additional_payer_notes":"APC"}]}]},{"description":"Mold socket ank hgt w/ toe f","code_information":[{"code":"L5010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1490.45,"maximum":6971.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1490.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2235.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1520.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6206.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6971.58,"additional_payer_notes":"APC"}]}]},{"description":"Tibial tubercle hgt w/ toe f","code_information":[{"code":"L5020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2426.15,"maximum":11348.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2426.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3639.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2474.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10102.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11348.32,"additional_payer_notes":"APC"}]}]},{"description":"Ank symes mold sckt sach ft","code_information":[{"code":"L5050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2809.59,"maximum":13141.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2809.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4214.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2865.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11699.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13141.86,"additional_payer_notes":"APC"}]}]},{"description":"Symes met fr leath socket ar","code_information":[{"code":"L5060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3381.38,"maximum":15816.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3381.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5072.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3449.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14080.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15816.4,"additional_payer_notes":"APC"}]}]},{"description":"Molded socket shin sach foot","code_information":[{"code":"L5100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2926.84,"maximum":13690.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2926.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4390.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2985.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12187.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13690.29,"additional_payer_notes":"APC"}]}]},{"description":"Plast socket jts/thgh lacer","code_information":[{"code":"L5105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4645.53,"maximum":21729.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4645.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6968.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4738.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19344.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21729.47,"additional_payer_notes":"APC"}]}]},{"description":"Mold sckt ext knee shin sach","code_information":[{"code":"L5150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4299.18,"maximum":20109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6448.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17902.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20109.41,"additional_payer_notes":"APC"}]}]},{"description":"Mold socket bent knee shin s","code_information":[{"code":"L5160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4676.12,"maximum":21872.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4676.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7014.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4769.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19471.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21872.55,"additional_payer_notes":"APC"}]}]},{"description":"Kne sing axis fric shin sach","code_information":[{"code":"L5200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4073.31,"maximum":19052.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4073.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6109.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4154.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16961.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19052.91,"additional_payer_notes":"APC"}]}]},{"description":"No knee/ankle joints w/ ft b","code_information":[{"code":"L5210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2970.73,"maximum":13895.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2970.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4456.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3030.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12370.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13895.59,"additional_payer_notes":"APC"}]}]},{"description":"No knee joint with artic ali","code_information":[{"code":"L5220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3376.78,"maximum":15794.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3376.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5065.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3444.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14061.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15794.89,"additional_payer_notes":"APC"}]}]},{"description":"Fem focal defic constant fri","code_information":[{"code":"L5230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4657.24,"maximum":21784.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4657.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6985.86,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4750.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19393.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21784.24,"additional_payer_notes":"APC"}]}]},{"description":"Hip canad sing axi cons fric","code_information":[{"code":"L5250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6352.07,"maximum":29711.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9528.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6479.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26450.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29711.81,"additional_payer_notes":"APC"}]}]},{"description":"Tilt table locking hip sing","code_information":[{"code":"L5270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6296.42,"maximum":29451.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9444.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6422.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26218.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29451.5,"additional_payer_notes":"APC"}]}]},{"description":"Hemipelvect canad sing axis","code_information":[{"code":"L5280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6233.46,"maximum":29157.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6233.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9350.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6358.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25956.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29157.01,"additional_payer_notes":"APC"}]}]},{"description":"Bk mold socket sach ft endo","code_information":[{"code":"L5301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2810.9,"maximum":13147.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2810.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4216.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2867.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11704.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13147.98,"additional_payer_notes":"APC"}]}]},{"description":"Knee disart, SACH ft, endo","code_information":[{"code":"L5312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4038.17,"maximum":18888.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4038.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6057.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4118.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16815.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18888.54,"additional_payer_notes":"APC"}]}]},{"description":"Ak open end sach","code_information":[{"code":"L5321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4023.73,"maximum":18821.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4023.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6035.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4104.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16755.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18821.0,"additional_payer_notes":"APC"}]}]},{"description":"Hip disart canadian sach ft","code_information":[{"code":"L5331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5693.73,"maximum":26632.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8540.59,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5807.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23709.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26632.42,"additional_payer_notes":"APC"}]}]},{"description":"Hemipelvectomy canadian sach","code_information":[{"code":"L5341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6187.3,"maximum":28941.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6187.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9280.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6311.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25764.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28941.1,"additional_payer_notes":"APC"}]}]},{"description":"Postop dress & 1 cast chg bk","code_information":[{"code":"L5400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1473.43,"maximum":6891.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1473.43,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2210.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1502.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6135.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6891.97,"additional_payer_notes":"APC"}]}]},{"description":"Postop dsg bk ea add cast ch","code_information":[{"code":"L5410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":645.54,"maximum":3019.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":645.54,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":968.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":658.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2688.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3019.51,"additional_payer_notes":"APC"}]}]},{"description":"Postop dsg & 1 cast chg ak/d","code_information":[{"code":"L5420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1860.88,"maximum":8704.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1860.88,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2791.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1898.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7748.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8704.27,"additional_payer_notes":"APC"}]}]},{"description":"Postop dsg ak ea add cast ch","code_information":[{"code":"L5430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":821.42,"maximum":3842.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":821.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1232.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":837.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3420.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3842.19,"additional_payer_notes":"APC"}]}]},{"description":"Postop app non-wgt bear dsg","code_information":[{"code":"L5450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":525.47,"maximum":2457.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":525.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":788.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":535.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2188.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2457.89,"additional_payer_notes":"APC"}]}]},{"description":"Postop app non-wgt bear dsg","code_information":[{"code":"L5460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":774.5,"maximum":3622.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1161.75,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":789.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3225.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3622.72,"additional_payer_notes":"APC"}]}]},{"description":"Init bk ptb plaster direct","code_information":[{"code":"L5500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1572.33,"maximum":7354.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1572.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2358.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1603.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6547.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7354.57,"additional_payer_notes":"APC"}]}]},{"description":"Init ak ischal plstr direct","code_information":[{"code":"L5505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2129.35,"maximum":9960.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2129.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3194.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2171.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8866.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9960.03,"additional_payer_notes":"APC"}]}]},{"description":"Prep BK ptb plaster molded","code_information":[{"code":"L5510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1782.34,"maximum":8336.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1782.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2673.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1817.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7421.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8336.9,"additional_payer_notes":"APC"}]}]},{"description":"Perp BK ptb thermopls direct","code_information":[{"code":"L5520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1760.53,"maximum":8234.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1760.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2640.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1795.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7331.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8234.88,"additional_payer_notes":"APC"}]}]},{"description":"Prep BK ptb thermopls molded","code_information":[{"code":"L5530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2228.48,"maximum":10423.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2228.48,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3342.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2273.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9279.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10423.72,"additional_payer_notes":"APC"}]}]},{"description":"Prep BK ptb open end socket","code_information":[{"code":"L5535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2196.14,"maximum":10272.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2196.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3294.21,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9144.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10272.44,"additional_payer_notes":"APC"}]}]},{"description":"Prep BK ptb laminated socket","code_information":[{"code":"L5540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2319.02,"maximum":10847.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2319.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3478.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2365.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9656.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10847.22,"additional_payer_notes":"APC"}]}]},{"description":"Prep AK ischial plast molded","code_information":[{"code":"L5560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2379.43,"maximum":11129.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2379.43,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3569.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2427.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9908.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11129.78,"additional_payer_notes":"APC"}]}]},{"description":"Prep AK ischial direct form","code_information":[{"code":"L5570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.76,"maximum":11571.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3710.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2523.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10300.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11571.01,"additional_payer_notes":"APC"}]}]},{"description":"Prep AK ischial thermo mold","code_information":[{"code":"L5580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2887.94,"maximum":13508.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2887.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4331.91,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2945.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12025.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13508.34,"additional_payer_notes":"APC"}]}]},{"description":"Prep AK ischial open end","code_information":[{"code":"L5585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.31,"maximum":14651.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3132.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4698.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3194.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13043.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14651.38,"additional_payer_notes":"APC"}]}]},{"description":"Prep AK ischial laminated","code_information":[{"code":"L5590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2943.01,"maximum":13765.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2943.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4414.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3001.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12254.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13765.93,"additional_payer_notes":"APC"}]}]},{"description":"Hip disartic sach thermopls","code_information":[{"code":"L5595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5173.01,"maximum":24196.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5173.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7759.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5276.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21540.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24196.75,"additional_payer_notes":"APC"}]}]},{"description":"Hip disart sach laminat mold","code_information":[{"code":"L5600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5642.33,"maximum":26392.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5642.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8463.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5755.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23495.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26392.0,"additional_payer_notes":"APC"}]}]},{"description":"Above knee hydracadence","code_information":[{"code":"L5610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2534.66,"maximum":11855.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2534.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3801.99,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2585.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10554.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11855.87,"additional_payer_notes":"APC"}]}]},{"description":"Ak 4 bar link w/fric swing","code_information":[{"code":"L5611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.47,"maximum":9226.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1972.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2958.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2011.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8213.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9226.23,"additional_payer_notes":"APC"}]}]},{"description":"Ak 4 bar ling w/hydraul swig","code_information":[{"code":"L5613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3000.26,"maximum":14033.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3000.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4500.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3060.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12493.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14033.72,"additional_payer_notes":"APC"}]}]},{"description":"4-bar link above knee w/swng","code_information":[{"code":"L5614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2028.06,"maximum":9486.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2028.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3042.09,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2068.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8445.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9486.25,"additional_payer_notes":"APC"}]}]},{"description":"Ak 4 bar link hydl swg/stanc","code_information":[{"code":"L5615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6833.63,"maximum":31964.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6833.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10250.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":28455.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31964.3,"additional_payer_notes":"APC"}]}]},{"description":"Ak univ multiplex sys frict","code_information":[{"code":"L5616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.72,"maximum":7777.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2494.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1695.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6923.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7777.37,"additional_payer_notes":"APC"}]}]},{"description":"AK/BK self-aligning unit ea","code_information":[{"code":"L5617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.42,"maximum":3145.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1008.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2800.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3145.24,"additional_payer_notes":"APC"}]}]},{"description":"Test socket symes","code_information":[{"code":"L5618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":387.38,"maximum":1811.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":387.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":395.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1613.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1811.97,"additional_payer_notes":"APC"}]}]},{"description":"Test socket below knee","code_information":[{"code":"L5620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.36,"maximum":1592.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":510.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":347.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1417.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1592.03,"additional_payer_notes":"APC"}]}]},{"description":"Test socket knee disarticula","code_information":[{"code":"L5622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.79,"maximum":2431.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":519.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":779.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":530.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2164.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2431.32,"additional_payer_notes":"APC"}]}]},{"description":"Test socket above knee","code_information":[{"code":"L5624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":495.94,"maximum":2319.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":495.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":743.91,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":505.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2065.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2319.76,"additional_payer_notes":"APC"}]}]},{"description":"Test socket hip disarticulat","code_information":[{"code":"L5626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":697.12,"maximum":3260.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":697.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1045.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":711.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2902.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3260.78,"additional_payer_notes":"APC"}]}]},{"description":"Test socket hemipelvectomy","code_information":[{"code":"L5628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":660.26,"maximum":3088.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":660.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":990.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":673.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2749.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3088.37,"additional_payer_notes":"APC"}]}]},{"description":"Below knee acrylic socket","code_information":[{"code":"L5629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":504.21,"maximum":2358.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":504.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":756.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":514.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2099.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2358.44,"additional_payer_notes":"APC"}]}]},{"description":"Syme typ expandabl wall sckt","code_information":[{"code":"L5630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":549.44,"maximum":2570.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":549.44,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":824.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":560.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2287.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2570.01,"additional_payer_notes":"APC"}]}]},{"description":"Ak/knee disartic acrylic soc","code_information":[{"code":"L5631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":657.03,"maximum":3073.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":657.03,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":985.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":670.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2735.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3073.26,"additional_payer_notes":"APC"}]}]},{"description":"Symes type ptb brim design s","code_information":[{"code":"L5632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":271.83,"maximum":1271.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":271.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":407.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1131.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1271.48,"additional_payer_notes":"APC"}]}]},{"description":"Symes type poster opening so","code_information":[{"code":"L5634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":372.4,"maximum":1741.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":372.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":558.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":379.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1550.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1741.9,"additional_payer_notes":"APC"}]}]},{"description":"Symes type medial opening so","code_information":[{"code":"L5636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":311.94,"maximum":1459.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":311.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":467.91,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1298.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1459.1,"additional_payer_notes":"APC"}]}]},{"description":"Below knee total contact","code_information":[{"code":"L5637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.68,"maximum":1949.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":625.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":425.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1735.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1949.02,"additional_payer_notes":"APC"}]}]},{"description":"Below knee leather socket","code_information":[{"code":"L5638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":595.79,"maximum":2786.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":893.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":607.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2480.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2786.81,"additional_payer_notes":"APC"}]}]},{"description":"Below knee wood socket","code_information":[{"code":"L5639","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1397.7,"maximum":6537.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1397.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2096.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1425.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5820.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6537.74,"additional_payer_notes":"APC"}]}]},{"description":"Knee disarticulat leather so","code_information":[{"code":"L5640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":850.98,"maximum":3980.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":850.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1276.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":868.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3543.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3980.46,"additional_payer_notes":"APC"}]}]},{"description":"Above knee leather socket","code_information":[{"code":"L5642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":761.85,"maximum":3563.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":761.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1142.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":777.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3172.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3563.55,"additional_payer_notes":"APC"}]}]},{"description":"Hip flex inner socket ext fr","code_information":[{"code":"L5643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1905.46,"maximum":8912.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1905.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2858.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1943.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7934.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8912.79,"additional_payer_notes":"APC"}]}]},{"description":"Above knee wood socket","code_information":[{"code":"L5644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":723.09,"maximum":3382.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":723.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1084.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3011.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3382.25,"additional_payer_notes":"APC"}]}]},{"description":"Bk flex inner socket ext fra","code_information":[{"code":"L5645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":976.81,"maximum":4569.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":976.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1465.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4067.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4569.03,"additional_payer_notes":"APC"}]}]},{"description":"Below knee cushion socket","code_information":[{"code":"L5646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.77,"maximum":3137.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":670.77,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1006.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2793.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3137.53,"additional_payer_notes":"APC"}]}]},{"description":"Below knee suction socket","code_information":[{"code":"L5647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":973.84,"maximum":4555.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":973.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1460.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":993.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4055.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4555.14,"additional_payer_notes":"APC"}]}]},{"description":"Above knee cushion socket","code_information":[{"code":"L5648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":806.01,"maximum":3770.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":806.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1209.01,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":822.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3356.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3770.11,"additional_payer_notes":"APC"}]}]},{"description":"Isch containmt/narrow m-l so","code_information":[{"code":"L5649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2446.95,"maximum":11445.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2446.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3670.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2495.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10189.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11445.61,"additional_payer_notes":"APC"}]}]},{"description":"Tot contact ak/knee disart s","code_information":[{"code":"L5650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.66,"maximum":2795.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":896.49,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2488.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2795.55,"additional_payer_notes":"APC"}]}]},{"description":"Ak flex inner socket ext fra","code_information":[{"code":"L5651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1470.22,"maximum":6876.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1470.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2205.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1499.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6122.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6876.95,"additional_payer_notes":"APC"}]}]},{"description":"Suction susp ak/knee disart","code_information":[{"code":"L5652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":533.75,"maximum":2496.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":533.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":800.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":544.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2222.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2496.62,"additional_payer_notes":"APC"}]}]},{"description":"Knee disart expand wall sock","code_information":[{"code":"L5653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.51,"maximum":3332.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":712.51,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1068.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":726.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2966.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3332.77,"additional_payer_notes":"APC"}]}]},{"description":"Socket insert symes","code_information":[{"code":"L5654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":406.02,"maximum":1899.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":406.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":609.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":414.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1690.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1899.16,"additional_payer_notes":"APC"}]}]},{"description":"Socket insert below knee","code_information":[{"code":"L5655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":343.76,"maximum":1607.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":515.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1431.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1607.94,"additional_payer_notes":"APC"}]}]},{"description":"Socket insert knee articulat","code_information":[{"code":"L5656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":484.26,"maximum":2265.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":484.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":726.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":493.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2016.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2265.13,"additional_payer_notes":"APC"}]}]},{"description":"Socket insert above knee","code_information":[{"code":"L5658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":471.6,"maximum":2205.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":471.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":707.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":481.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1963.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2205.91,"additional_payer_notes":"APC"}]}]},{"description":"Multi-durometer symes","code_information":[{"code":"L5661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":819.53,"maximum":3833.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":819.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1229.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":835.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3412.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3833.35,"additional_payer_notes":"APC"}]}]},{"description":"Multi-durometer below knee","code_information":[{"code":"L5665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":626.84,"maximum":2932.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":626.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":940.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":639.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2610.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2932.04,"additional_payer_notes":"APC"}]}]},{"description":"Below knee cuff suspension","code_information":[{"code":"L5666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.15,"maximum":435.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":139.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":387.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":435.71,"additional_payer_notes":"APC"}]}]},{"description":"Bk molded distal cushion","code_information":[{"code":"L5668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.37,"maximum":581.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":186.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":517.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":581.74,"additional_payer_notes":"APC"}]}]},{"description":"Bk molded supracondylar susp","code_information":[{"code":"L5670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.61,"maximum":1770.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":567.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1576.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1770.95,"additional_payer_notes":"APC"}]}]},{"description":"Bk/ak locking mechanism","code_information":[{"code":"L5671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.96,"maximum":2848.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":913.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2535.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2848.41,"additional_payer_notes":"APC"}]}]},{"description":"Bk removable medial brim sus","code_information":[{"code":"L5672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":462.6,"maximum":2163.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":462.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":693.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":471.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1926.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2163.81,"additional_payer_notes":"APC"}]}]},{"description":"Socket insert w lock mech","code_information":[{"code":"L5673","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":860.1,"maximum":4023.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":860.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1290.15,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":877.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3581.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4023.12,"additional_payer_notes":"APC"}]}]},{"description":"Bk knee joints single axis p","code_information":[{"code":"L5676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.63,"maximum":2075.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":443.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":665.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":452.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1847.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2075.08,"additional_payer_notes":"APC"}]}]},{"description":"Bk knee joints polycentric p","code_information":[{"code":"L5677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":603.62,"maximum":2823.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":603.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":905.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":615.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2513.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2823.43,"additional_payer_notes":"APC"}]}]},{"description":"Bk joint covers pair","code_information":[{"code":"L5678","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.61,"maximum":227.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72.91,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":202.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":227.37,"additional_payer_notes":"APC"}]}]},{"description":"Socket insert w/o lock mech","code_information":[{"code":"L5679","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":716.74,"maximum":3352.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":716.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1075.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":731.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2984.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3352.55,"additional_payer_notes":"APC"}]}]},{"description":"Bk thigh lacer non-molded","code_information":[{"code":"L5680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.0,"maximum":1983.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":432.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1765.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1983.26,"additional_payer_notes":"APC"}]}]},{"description":"Intl custm cong/latyp insert","code_information":[{"code":"L5681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1580.9,"maximum":7394.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1580.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2371.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1612.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6583.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7394.66,"additional_payer_notes":"APC"}]}]},{"description":"Bk thigh lacer glut/ischia m","code_information":[{"code":"L5682","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":765.63,"maximum":3581.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":765.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1148.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":780.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3188.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3581.23,"additional_payer_notes":"APC"}]}]},{"description":"Initial custom socket insert","code_information":[{"code":"L5683","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1580.9,"maximum":7394.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1580.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2371.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1612.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6583.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7394.66,"additional_payer_notes":"APC"}]}]},{"description":"Bk fork strap","code_information":[{"code":"L5684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.93,"maximum":275.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":245.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":275.65,"additional_payer_notes":"APC"}]}]},{"description":"Below knee sus/seal sleeve","code_information":[{"code":"L5685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.94,"maximum":720.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":230.91,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":641.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":720.05,"additional_payer_notes":"APC"}]}]},{"description":"Bk back check","code_information":[{"code":"L5686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.48,"maximum":371.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.48,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":119.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":330.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":371.77,"additional_payer_notes":"APC"}]}]},{"description":"Bk waist belt webbing","code_information":[{"code":"L5688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.78,"maximum":349.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112.17,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":311.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":349.78,"additional_payer_notes":"APC"}]}]},{"description":"Bk waist belt padded and lin","code_information":[{"code":"L5690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.8,"maximum":677.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.8,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":217.2,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":602.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":677.3,"additional_payer_notes":"APC"}]}]},{"description":"Ak pelvic control belt light","code_information":[{"code":"L5692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.07,"maximum":786.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":168.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":252.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":699.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":786.15,"additional_payer_notes":"APC"}]}]},{"description":"Ak pelvic control belt pad/l","code_information":[{"code":"L5694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.1,"maximum":1038.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":333.15,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":226.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":924.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1038.87,"additional_payer_notes":"APC"}]}]},{"description":"Ak sleeve susp neoprene/equa","code_information":[{"code":"L5695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":232.98,"maximum":1089.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":349.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":970.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1089.76,"additional_payer_notes":"APC"}]}]},{"description":"Ak/knee disartic pelvic join","code_information":[{"code":"L5696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":254.62,"maximum":1190.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":254.62,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":381.93,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":259.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1060.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1190.99,"additional_payer_notes":"APC"}]}]},{"description":"Ak/knee disartic pelvic band","code_information":[{"code":"L5697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.43,"maximum":483.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.43,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":155.15,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":430.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":483.79,"additional_payer_notes":"APC"}]}]},{"description":"Ak/knee disartic silesian ba","code_information":[{"code":"L5698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.64,"maximum":601.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.64,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":192.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":535.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":601.71,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder harness","code_information":[{"code":"L5699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.26,"maximum":1067.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":342.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":950.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1067.69,"additional_payer_notes":"APC"}]}]},{"description":"Replace socket below knee","code_information":[{"code":"L5700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3526.96,"maximum":16497.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3526.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5290.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3597.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14686.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16497.36,"additional_payer_notes":"APC"}]}]},{"description":"Replace socket above knee","code_information":[{"code":"L5701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4375.51,"maximum":20466.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4375.51,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6563.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4463.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18220.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20466.45,"additional_payer_notes":"APC"}]}]},{"description":"Replace socket hip","code_information":[{"code":"L5702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5514.69,"maximum":25794.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8272.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5624.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22963.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25794.96,"additional_payer_notes":"APC"}]}]},{"description":"Symes ankle w/o (sach) foot","code_information":[{"code":"L5703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2560.96,"maximum":11978.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2560.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3841.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2612.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10664.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11978.89,"additional_payer_notes":"APC"}]}]},{"description":"Custom shape cover bk","code_information":[{"code":"L5704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":719.13,"maximum":3363.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":719.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1078.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":733.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2994.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3363.73,"additional_payer_notes":"APC"}]}]},{"description":"Custom shape cover ak","code_information":[{"code":"L5705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1318.46,"maximum":6167.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1318.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1977.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1344.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5490.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6167.1,"additional_payer_notes":"APC"}]}]},{"description":"Custom shape cvr knee disart","code_information":[{"code":"L5706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1285.99,"maximum":6015.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1285.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1928.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1311.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5354.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6015.22,"additional_payer_notes":"APC"}]}]},{"description":"Custom shape cvr hip disart","code_information":[{"code":"L5707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1727.71,"maximum":8081.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1727.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2591.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1762.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7194.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8081.36,"additional_payer_notes":"APC"}]}]},{"description":"Kne-shin exo sng axi mnl loc","code_information":[{"code":"L5710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":440.31,"maximum":2059.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":440.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":660.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":449.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1833.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2059.55,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin exo mnl lock ultra","code_information":[{"code":"L5711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":667.95,"maximum":3124.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":667.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1001.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":681.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2781.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3124.34,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin exo frict swg & st","code_information":[{"code":"L5712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":527.52,"maximum":2467.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":527.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":791.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":538.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2196.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2467.47,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin exo variable frict","code_information":[{"code":"L5714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":544.01,"maximum":2544.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":544.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":816.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":554.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2265.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2544.61,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin exo mech stance ph","code_information":[{"code":"L5716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":892.28,"maximum":4173.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":892.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1338.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":910.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3715.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4173.64,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin exo frct swg & sta","code_information":[{"code":"L5718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1115.26,"maximum":5216.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1115.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1672.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1137.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4644.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5216.63,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin pneum swg frct exo","code_information":[{"code":"L5722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1163.81,"maximum":5443.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1163.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1745.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1187.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4846.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5443.72,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin exo fluid swing ph","code_information":[{"code":"L5724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1847.9,"maximum":8643.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1847.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2771.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1884.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7694.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8643.55,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin ext jnts fld swg e","code_information":[{"code":"L5726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2426.49,"maximum":11349.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2426.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3639.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2475.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10104.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11349.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin fluid swg & stance","code_information":[{"code":"L5728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3023.08,"maximum":14140.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3023.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4534.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3083.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12588.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14140.46,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin pneum/hydra pneum","code_information":[{"code":"L5780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1457.58,"maximum":6817.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1457.58,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2186.37,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1486.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6069.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6817.83,"additional_payer_notes":"APC"}]}]},{"description":"Lower limb pros vacuum pump","code_information":[{"code":"L5781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4808.77,"maximum":22493.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4808.77,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7213.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20024.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22493.02,"additional_payer_notes":"APC"}]}]},{"description":"HD low limb pros vacuum pump","code_information":[{"code":"L5782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5069.52,"maximum":23712.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5069.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7604.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5170.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21109.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23712.68,"additional_payer_notes":"APC"}]}]},{"description":"Add low ext mec limb vol sys","code_information":[{"code":"L5783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3150.07,"maximum":14734.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3150.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4725.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3213.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13117.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14734.45,"additional_payer_notes":"APC"}]}]},{"description":"Exoskeletal bk ultralt mater","code_information":[{"code":"L5785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":636.06,"maximum":2975.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":636.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":954.09,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":648.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2648.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2975.17,"additional_payer_notes":"APC"}]}]},{"description":"Exoskeletal ak ultra-light m","code_information":[{"code":"L5790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":880.26,"maximum":4117.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":880.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1320.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":897.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3665.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4117.42,"additional_payer_notes":"APC"}]}]},{"description":"Exoskel hip ultra-light mate","code_information":[{"code":"L5795","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1314.46,"maximum":6148.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1314.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1971.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1340.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5473.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6148.39,"additional_payer_notes":"APC"}]}]},{"description":"Endoskel knee-shin mnl lock","code_information":[{"code":"L5810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":611.5,"maximum":2860.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":611.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":917.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":623.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2546.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2860.29,"additional_payer_notes":"APC"}]}]},{"description":"Endo knee-shin mnl lck ultra","code_information":[{"code":"L5811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":892.86,"maximum":4176.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":892.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1339.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":910.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3717.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4176.35,"additional_payer_notes":"APC"}]}]},{"description":"Endo knee-shin frct swg & st","code_information":[{"code":"L5812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":692.06,"maximum":3237.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":692.06,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1038.09,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":705.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2881.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3237.11,"additional_payer_notes":"APC"}]}]},{"description":"Endo knee-shin hydral swg ph","code_information":[{"code":"L5814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4463.44,"maximum":20877.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4463.44,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6695.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4552.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18586.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20877.74,"additional_payer_notes":"APC"}]}]},{"description":"Endo knee-shin polyc mch sta","code_information":[{"code":"L5816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1041.16,"maximum":4870.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1041.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1561.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1061.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4335.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4870.03,"additional_payer_notes":"APC"}]}]},{"description":"Endo knee-shin frct swg & st","code_information":[{"code":"L5818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1175.67,"maximum":5499.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1175.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1763.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1199.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4895.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5499.2,"additional_payer_notes":"APC"}]}]},{"description":"Endo knee-shin pneum swg frc","code_information":[{"code":"L5822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2280.9,"maximum":10668.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2280.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3421.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2326.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9497.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10668.91,"additional_payer_notes":"APC"}]}]},{"description":"Endo knee-shin fluid swing p","code_information":[{"code":"L5824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1877.46,"maximum":8781.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1877.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2816.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1915.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7817.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8781.82,"additional_payer_notes":"APC"}]}]},{"description":"Miniature knee joint","code_information":[{"code":"L5826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3790.76,"maximum":17731.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3790.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5686.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3866.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15785.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17731.28,"additional_payer_notes":"APC"}]}]},{"description":"Endo knee shin single axis","code_information":[{"code":"L5827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7025.35,"maximum":32861.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7025.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10538.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29254.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32861.07,"additional_payer_notes":"APC"}]}]},{"description":"Endo knee-shin fluid swg/sta","code_information":[{"code":"L5828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3578.82,"maximum":16739.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3578.82,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5368.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14902.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16739.93,"additional_payer_notes":"APC"}]}]},{"description":"Endo knee-shin pneum/swg pha","code_information":[{"code":"L5830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2542.92,"maximum":11894.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2542.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3814.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2593.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10588.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11894.51,"additional_payer_notes":"APC"}]}]},{"description":"Multi-axial knee/shin system","code_information":[{"code":"L5840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4484.12,"maximum":20974.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4484.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6726.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4573.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18672.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20974.47,"additional_payer_notes":"APC"}]}]},{"description":"Addition endoskletl knee-shi","code_information":[{"code":"L5841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3053.14,"maximum":14281.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3053.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4579.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3114.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12713.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14281.06,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin sys stance flexion","code_information":[{"code":"L5845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.15,"maximum":10076.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3231.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2197.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8970.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10076.04,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin sys hydraul stance","code_information":[{"code":"L5848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1292.38,"maximum":6045.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1292.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1938.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1318.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5381.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6045.11,"additional_payer_notes":"APC"}]}]},{"description":"Endo ak/hip knee extens assi","code_information":[{"code":"L5850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":162.6,"maximum":760.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":243.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":677.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":760.56,"additional_payer_notes":"APC"}]}]},{"description":"Mech hip extension assist","code_information":[{"code":"L5855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":378.09,"maximum":1768.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":378.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":567.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":385.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1574.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1768.52,"additional_payer_notes":"APC"}]}]},{"description":"Elec knee-shin swing/stance","code_information":[{"code":"L5856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28851.23,"maximum":134951.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28851.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43276.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29428.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":120139.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134951.63,"additional_payer_notes":"APC"}]}]},{"description":"Elec knee-shin swing only","code_information":[{"code":"L5857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10237.55,"maximum":47886.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10237.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15356.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10442.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42630.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47886.14,"additional_payer_notes":"APC"}]}]},{"description":"Stance phase only","code_information":[{"code":"L5858","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22336.47,"maximum":104478.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22336.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33504.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22783.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":93011.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104478.84,"additional_payer_notes":"APC"}]}]},{"description":"Knee-shin pro flex/ext cont","code_information":[{"code":"L5859","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17437.9,"maximum":81565.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17437.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26156.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17786.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":72613.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81565.78,"additional_payer_notes":"APC"}]}]},{"description":"Endo below knee alignable sy","code_information":[{"code":"L5910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":446.54,"maximum":2088.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":446.54,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":669.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":455.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1859.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2088.69,"additional_payer_notes":"APC"}]}]},{"description":"Endo ak/hip alignable system","code_information":[{"code":"L5920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":649.58,"maximum":3038.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":649.58,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":974.37,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":662.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2704.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3038.41,"additional_payer_notes":"APC"}]}]},{"description":"Above knee manual lock","code_information":[{"code":"L5925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":411.36,"maximum":1924.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":411.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":617.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1712.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1924.14,"additional_payer_notes":"APC"}]}]},{"description":"Endoskel posit rotat unit","code_information":[{"code":"L5926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":701.46,"maximum":3281.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":701.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1052.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":715.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2920.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3281.08,"additional_payer_notes":"APC"}]}]},{"description":"High activity knee frame","code_information":[{"code":"L5930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4045.31,"maximum":18921.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4045.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6067.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4126.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16845.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18921.94,"additional_payer_notes":"APC"}]}]},{"description":"Endo bk ultra-light material","code_information":[{"code":"L5940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":614.1,"maximum":2872.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":614.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":921.15,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":626.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2557.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2872.45,"additional_payer_notes":"APC"}]}]},{"description":"Endo ak ultra-light material","code_information":[{"code":"L5950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1037.42,"maximum":4852.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1037.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1556.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1058.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4319.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4852.53,"additional_payer_notes":"APC"}]}]},{"description":"Endo hip ultra-light materia","code_information":[{"code":"L5960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1242.67,"maximum":5812.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1242.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1864.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1267.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5174.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5812.59,"additional_payer_notes":"APC"}]}]},{"description":"Endo poly hip, pneu/hyd/rot","code_information":[{"code":"L5961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5569.67,"maximum":26052.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5569.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8354.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23192.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26052.13,"additional_payer_notes":"APC"}]}]},{"description":"Below knee flex cover system","code_information":[{"code":"L5962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":719.6,"maximum":3365.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":719.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1079.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":733.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2996.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3365.93,"additional_payer_notes":"APC"}]}]},{"description":"Above knee flex cover system","code_information":[{"code":"L5964","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1288.96,"maximum":6029.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1288.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1933.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1314.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5367.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6029.11,"additional_payer_notes":"APC"}]}]},{"description":"Hip flexible cover system","code_information":[{"code":"L5966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1660.39,"maximum":7766.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1660.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2490.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1693.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6914.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7766.47,"additional_payer_notes":"APC"}]}]},{"description":"Multiaxial ankle w dorsiflex","code_information":[{"code":"L5968","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4367.4,"maximum":20428.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4367.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6551.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4454.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18186.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20428.51,"additional_payer_notes":"APC"}]}]},{"description":"Foot external keel sach foot","code_information":[{"code":"L5970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.76,"maximum":1257.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":403.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1119.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1257.12,"additional_payer_notes":"APC"}]}]},{"description":"SACH foot, replacement","code_information":[{"code":"L5971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.76,"maximum":1257.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":403.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1119.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1257.12,"additional_payer_notes":"APC"}]}]},{"description":"Flexible keel foot","code_information":[{"code":"L5972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":431.46,"maximum":2018.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":431.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":647.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":440.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1796.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2018.15,"additional_payer_notes":"APC"}]}]},{"description":"Ank-foot sys dors-plant flex","code_information":[{"code":"L5973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21041.0,"maximum":98419.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21041.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31561.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21461.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":87616.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98419.28,"additional_payer_notes":"APC"}]}]},{"description":"Foot single axis ankle/foot","code_information":[{"code":"L5974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.02,"maximum":1702.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":546.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":371.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1515.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1702.7,"additional_payer_notes":"APC"}]}]},{"description":"Combo ankle/foot prosthesis","code_information":[{"code":"L5975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":557.15,"maximum":2606.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":557.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":835.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":568.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2320.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2606.07,"additional_payer_notes":"APC"}]}]},{"description":"Energy storing foot","code_information":[{"code":"L5976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":685.61,"maximum":3206.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1028.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":699.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2854.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3206.94,"additional_payer_notes":"APC"}]}]},{"description":"Ft prosth multiaxial ankl/ft","code_information":[{"code":"L5978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":357.27,"maximum":1671.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":357.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":535.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1487.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1671.13,"additional_payer_notes":"APC"}]}]},{"description":"Multi-axial ankle/ft prosth","code_information":[{"code":"L5979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2866.86,"maximum":13409.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2866.86,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4300.29,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2924.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11937.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13409.74,"additional_payer_notes":"APC"}]}]},{"description":"Flex foot system","code_information":[{"code":"L5980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4539.15,"maximum":21231.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4539.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6808.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4629.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18901.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21231.87,"additional_payer_notes":"APC"}]}]},{"description":"Flex-walk sys low ext prosth","code_information":[{"code":"L5981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3923.49,"maximum":18352.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3923.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5885.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4001.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16337.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18352.12,"additional_payer_notes":"APC"}]}]},{"description":"Exoskeletal axial rotation u","code_information":[{"code":"L5982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":707.75,"maximum":3310.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":707.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1061.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":721.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2947.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3310.5,"additional_payer_notes":"APC"}]}]},{"description":"Endoskeletal axial rotation","code_information":[{"code":"L5984","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":701.46,"maximum":3281.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":701.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1052.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":715.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2920.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3281.08,"additional_payer_notes":"APC"}]}]},{"description":"Lwr ext dynamic prosth pylon","code_information":[{"code":"L5985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.39,"maximum":1587.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":339.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":509.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1413.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1587.5,"additional_payer_notes":"APC"}]}]},{"description":"Multi-axial rotation unit","code_information":[{"code":"L5986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":779.9,"maximum":3647.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":779.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1169.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":795.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3247.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3647.98,"additional_payer_notes":"APC"}]}]},{"description":"Shank ft w vert load pylon","code_information":[{"code":"L5987","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8645.71,"maximum":40440.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8645.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12968.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8818.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36001.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40440.31,"additional_payer_notes":"APC"}]}]},{"description":"Vertical shock reducing pylo","code_information":[{"code":"L5988","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2400.94,"maximum":11230.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2400.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3601.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2448.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9997.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11230.4,"additional_payer_notes":"APC"}]}]},{"description":"User adjustable heel height","code_information":[{"code":"L5990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2180.41,"maximum":10198.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2180.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3270.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2224.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9079.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10198.87,"additional_payer_notes":"APC"}]}]},{"description":"Low pros ext osseo connector","code_information":[{"code":"L5991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11755.04,"maximum":54984.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11755.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17632.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11990.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48949.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54984.2,"additional_payer_notes":"APC"}]}]},{"description":"Part hand thumb rem","code_information":[{"code":"L6000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1626.65,"maximum":7608.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1626.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2439.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1659.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6773.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7608.66,"additional_payer_notes":"APC"}]}]},{"description":"Part hand little/ring","code_information":[{"code":"L6010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1810.19,"maximum":8467.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1810.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2715.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1846.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7537.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8467.16,"additional_payer_notes":"APC"}]}]},{"description":"Part hand no fingers","code_information":[{"code":"L6020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1687.71,"maximum":7894.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1687.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2531.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1721.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7027.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7894.26,"additional_payer_notes":"APC"}]}]},{"description":"Part hand myo exclu term dev","code_information":[{"code":"L6026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5177.21,"maximum":24216.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5177.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7765.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5280.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21558.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24216.4,"additional_payer_notes":"APC"}]}]},{"description":"Wrst MLd sck flx hng tri pad","code_information":[{"code":"L6050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2325.6,"maximum":10877.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2325.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3488.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2372.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9684.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10877.99,"additional_payer_notes":"APC"}]}]},{"description":"Wrst mold sock w/exp interfa","code_information":[{"code":"L6055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3696.64,"maximum":17291.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3696.64,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5544.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3770.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15393.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17291.03,"additional_payer_notes":"APC"}]}]},{"description":"Elb mold sock flex hinge pad","code_information":[{"code":"L6100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2356.19,"maximum":11021.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2356.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3534.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2403.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9811.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11021.08,"additional_payer_notes":"APC"}]}]},{"description":"Elbow mold sock suspension t","code_information":[{"code":"L6110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2499.14,"maximum":11689.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2499.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3748.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2549.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10406.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11689.73,"additional_payer_notes":"APC"}]}]},{"description":"Elbow mold doub splt soc ste","code_information":[{"code":"L6120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2912.39,"maximum":13622.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2912.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4368.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2970.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12127.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13622.7,"additional_payer_notes":"APC"}]}]},{"description":"Elbow stump activated lock h","code_information":[{"code":"L6130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3169.22,"maximum":14824.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3169.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4753.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3232.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13196.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14824.03,"additional_payer_notes":"APC"}]}]},{"description":"Elbow mold outsid lock hinge","code_information":[{"code":"L6200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3339.85,"maximum":15622.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3339.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5009.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3406.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13907.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15622.15,"additional_payer_notes":"APC"}]}]},{"description":"Elbow molded w/ expand inter","code_information":[{"code":"L6205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5565.49,"maximum":26032.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5565.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8348.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5676.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23175.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26032.58,"additional_payer_notes":"APC"}]}]},{"description":"Elbow inter loc elbow forarm","code_information":[{"code":"L6250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3287.52,"maximum":15377.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3287.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4931.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3353.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13689.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15377.37,"additional_payer_notes":"APC"}]}]},{"description":"Shlder disart int lock elbow","code_information":[{"code":"L6300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4561.09,"maximum":21334.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4561.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6841.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4652.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18992.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21334.5,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder passive restor comp","code_information":[{"code":"L6310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3750.9,"maximum":17544.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3750.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5626.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3825.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15619.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17544.83,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder passive restor cap","code_information":[{"code":"L6320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.15,"maximum":9786.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3138.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2133.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8711.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9786.03,"additional_payer_notes":"APC"}]}]},{"description":"Thoracic intern lock elbow","code_information":[{"code":"L6350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4795.29,"maximum":22429.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4795.29,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7192.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4891.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19968.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22429.97,"additional_payer_notes":"APC"}]}]},{"description":"Thoracic passive restor comp","code_information":[{"code":"L6360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3936.67,"maximum":18413.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3936.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5905.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4015.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16392.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18413.77,"additional_payer_notes":"APC"}]}]},{"description":"Thoracic passive restor cap","code_information":[{"code":"L6370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2963.68,"maximum":13862.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2963.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4445.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3022.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12341.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13862.61,"additional_payer_notes":"APC"}]}]},{"description":"Postop dsg cast chg wrst/elb","code_information":[{"code":"L6380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1600.65,"maximum":7487.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1600.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2400.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1632.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6665.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7487.04,"additional_payer_notes":"APC"}]}]},{"description":"Postop dsg cast chg elb dis/","code_information":[{"code":"L6382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1915.4,"maximum":8959.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1915.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2873.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1953.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7975.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8959.28,"additional_payer_notes":"APC"}]}]},{"description":"Postop dsg cast chg shlder/t","code_information":[{"code":"L6384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2337.34,"maximum":10932.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2337.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3506.01,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2384.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9732.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10932.91,"additional_payer_notes":"APC"}]}]},{"description":"Postop ea cast chg & realign","code_information":[{"code":"L6386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":560.51,"maximum":2621.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":560.51,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":840.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":571.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2334.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2621.79,"additional_payer_notes":"APC"}]}]},{"description":"Postop applicat rigid dsg on","code_information":[{"code":"L6388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.21,"maximum":2517.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":538.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":807.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":548.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2241.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2517.48,"additional_payer_notes":"APC"}]}]},{"description":"Below elbow prosth tiss shap","code_information":[{"code":"L6400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2846.73,"maximum":13315.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2846.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4270.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2903.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11854.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13315.58,"additional_payer_notes":"APC"}]}]},{"description":"Elb disart prosth tiss shap","code_information":[{"code":"L6450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3774.46,"maximum":17655.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3774.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5661.69,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3849.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15717.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17655.04,"additional_payer_notes":"APC"}]}]},{"description":"Above elbow prosth tiss shap","code_information":[{"code":"L6500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3777.54,"maximum":17669.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.54,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5666.31,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3853.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15730.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17669.44,"additional_payer_notes":"APC"}]}]},{"description":"Shldr disar prosth tiss shap","code_information":[{"code":"L6550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4668.36,"maximum":21836.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4668.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7002.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4761.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19439.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21836.25,"additional_payer_notes":"APC"}]}]},{"description":"Scap thorac prosth tiss shap","code_information":[{"code":"L6570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5664.32,"maximum":26494.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5664.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8496.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5777.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":23586.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26494.86,"additional_payer_notes":"APC"}]}]},{"description":"Wrist/elbow bowden cable mol","code_information":[{"code":"L6580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1977.21,"maximum":9248.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1977.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2965.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2016.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8233.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9248.4,"additional_payer_notes":"APC"}]}]},{"description":"Wrist/elbow bowden cbl dir f","code_information":[{"code":"L6582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1684.94,"maximum":7881.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1684.94,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2527.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1718.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7016.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7881.31,"additional_payer_notes":"APC"}]}]},{"description":"Elbow fair lead cable molded","code_information":[{"code":"L6584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2729.32,"maximum":12766.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2729.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4093.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2783.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11365.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12766.39,"additional_payer_notes":"APC"}]}]},{"description":"Elbow fair lead cable dir fo","code_information":[{"code":"L6586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2387.58,"maximum":11167.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2387.58,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3581.37,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2435.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":9942.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11167.91,"additional_payer_notes":"APC"}]}]},{"description":"Shdr fair lead cable molded","code_information":[{"code":"L6588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3941.34,"maximum":18435.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3941.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5912.01,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4020.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16412.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18435.62,"additional_payer_notes":"APC"}]}]},{"description":"Shdr fair lead cable direct","code_information":[{"code":"L6590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3605.22,"maximum":16863.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3605.22,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5407.83,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3677.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15012.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16863.42,"additional_payer_notes":"APC"}]}]},{"description":"Polycentric hinge pair","code_information":[{"code":"L6600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.26,"maximum":1137.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":364.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1012.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1137.85,"additional_payer_notes":"APC"}]}]},{"description":"Single pivot hinge pair","code_information":[{"code":"L6605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":227.07,"maximum":1062.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":340.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":945.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1062.12,"additional_payer_notes":"APC"}]}]},{"description":"Flexible metal hinge pair","code_information":[{"code":"L6610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.83,"maximum":953.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":203.83,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":305.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":848.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":953.41,"additional_payer_notes":"APC"}]}]},{"description":"Additional switch, ext power","code_information":[{"code":"L6611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":494.85,"maximum":2314.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":494.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":742.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":504.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2060.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2314.66,"additional_payer_notes":"APC"}]}]},{"description":"Disconnect locking wrist uni","code_information":[{"code":"L6615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.34,"maximum":1175.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":377.01,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1046.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1175.64,"additional_payer_notes":"APC"}]}]},{"description":"Disconnect insert locking wr","code_information":[{"code":"L6616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.88,"maximum":495.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.88,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":158.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":440.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":495.25,"additional_payer_notes":"APC"}]}]},{"description":"Flexion/extension wrist unit","code_information":[{"code":"L6620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.44,"maximum":1844.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":394.44,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":591.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":402.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1642.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1844.99,"additional_payer_notes":"APC"}]}]},{"description":"Flex/ext wrist w/wo friction","code_information":[{"code":"L6621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2748.98,"maximum":12858.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2748.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4123.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2803.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11447.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12858.35,"additional_payer_notes":"APC"}]}]},{"description":"Spring-ass rot wrst w/ latch","code_information":[{"code":"L6623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":902.89,"maximum":4223.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":902.89,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1354.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":920.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3759.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4223.27,"additional_payer_notes":"APC"}]}]},{"description":"Flex/ext/rotation wrist unit","code_information":[{"code":"L6624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4526.27,"maximum":21171.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4526.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6789.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4616.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18847.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21171.63,"additional_payer_notes":"APC"}]}]},{"description":"Rotation wrst w/ cable lock","code_information":[{"code":"L6625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":657.01,"maximum":3073.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":657.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":985.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":670.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2735.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3073.16,"additional_payer_notes":"APC"}]}]},{"description":"Quick disconn hook adapter o","code_information":[{"code":"L6628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":671.42,"maximum":3140.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":671.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1007.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2795.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3140.57,"additional_payer_notes":"APC"}]}]},{"description":"Lamination collar w/ couplin","code_information":[{"code":"L6629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.11,"maximum":837.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":268.67,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":182.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":745.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":837.79,"additional_payer_notes":"APC"}]}]},{"description":"Stainless steel any wrist","code_information":[{"code":"L6630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":263.85,"maximum":1234.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":395.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1098.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1234.16,"additional_payer_notes":"APC"}]}]},{"description":"Latex suspension sleeve each","code_information":[{"code":"L6632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.01,"maximum":411.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":132.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":366.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":411.67,"additional_payer_notes":"APC"}]}]},{"description":"Lift assist for elbow","code_information":[{"code":"L6635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.39,"maximum":1143.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":244.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":366.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1017.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1143.13,"additional_payer_notes":"APC"}]}]},{"description":"Nudge control elbow lock","code_information":[{"code":"L6637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":507.3,"maximum":2372.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":507.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":760.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":517.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2112.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2372.9,"additional_payer_notes":"APC"}]}]},{"description":"Elec lock on manual pw elbow","code_information":[{"code":"L6638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3005.49,"maximum":14058.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3005.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4508.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3065.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12515.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14058.18,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder abduction joint pai","code_information":[{"code":"L6640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.19,"maximum":1619.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":519.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1441.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1619.3,"additional_payer_notes":"APC"}]}]},{"description":"Excursion amplifier pulley t","code_information":[{"code":"L6641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":230.08,"maximum":1076.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":345.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":958.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1076.2,"additional_payer_notes":"APC"}]}]},{"description":"Excursion amplifier lever ty","code_information":[{"code":"L6642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.59,"maximum":1532.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":327.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":491.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":334.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1364.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1532.3,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder flexion-abduction j","code_information":[{"code":"L6645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":397.82,"maximum":1860.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":397.82,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":596.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":405.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1656.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1860.8,"additional_payer_notes":"APC"}]}]},{"description":"Multipo locking shoulder jnt","code_information":[{"code":"L6646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3790.61,"maximum":17730.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3790.61,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5685.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3866.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15784.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17730.58,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder lock actuator","code_information":[{"code":"L6647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":624.04,"maximum":2918.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":624.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":936.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":636.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2598.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2918.95,"additional_payer_notes":"APC"}]}]},{"description":"Ext pwrd shlder lock/unlock","code_information":[{"code":"L6648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3909.46,"maximum":18286.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3909.46,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5864.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3987.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16279.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18286.5,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder universal joint","code_information":[{"code":"L6650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":414.39,"maximum":1938.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":414.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":621.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":422.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1725.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1938.31,"additional_payer_notes":"APC"}]}]},{"description":"Standard control cable extra","code_information":[{"code":"L6655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.97,"maximum":430.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137.95,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":382.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":430.19,"additional_payer_notes":"APC"}]}]},{"description":"Heavy duty control cable","code_information":[{"code":"L6660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.37,"maximum":525.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":168.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":467.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":525.61,"additional_payer_notes":"APC"}]}]},{"description":"Teflon or equal cable lining","code_information":[{"code":"L6665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.25,"maximum":300.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":267.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":300.53,"additional_payer_notes":"APC"}]}]},{"description":"Hook to hand cable adapter","code_information":[{"code":"L6670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.91,"maximum":284.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.91,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91.36,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":253.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":284.91,"additional_payer_notes":"APC"}]}]},{"description":"Harness chest/shlder saddle","code_information":[{"code":"L6672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":206.43,"maximum":965.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":206.43,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":309.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":859.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":965.58,"additional_payer_notes":"APC"}]}]},{"description":"Harness figure of 8 sing con","code_information":[{"code":"L6675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":147.02,"maximum":687.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":220.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":612.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":687.69,"additional_payer_notes":"APC"}]}]},{"description":"Harness figure of 8 dual con","code_information":[{"code":"L6676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.47,"maximum":694.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":222.7,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":618.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":694.47,"additional_payer_notes":"APC"}]}]},{"description":"UE triple control harness","code_information":[{"code":"L6677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.52,"maximum":1667.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":356.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":534.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":363.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1484.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1667.62,"additional_payer_notes":"APC"}]}]},{"description":"Test sock wrist disart/bel e","code_information":[{"code":"L6680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":284.03,"maximum":1328.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":284.03,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":426.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":289.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1182.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1328.55,"additional_payer_notes":"APC"}]}]},{"description":"Test sock elbw disart/above","code_information":[{"code":"L6682","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.33,"maximum":1488.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":324.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1325.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1488.99,"additional_payer_notes":"APC"}]}]},{"description":"Test socket shldr disart/tho","code_information":[{"code":"L6684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":426.74,"maximum":1996.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":426.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":640.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1776.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1996.08,"additional_payer_notes":"APC"}]}]},{"description":"Suction socket","code_information":[{"code":"L6686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":793.56,"maximum":3711.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":793.56,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1190.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":809.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3304.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3711.88,"additional_payer_notes":"APC"}]}]},{"description":"Frame typ socket bel elbow/w","code_information":[{"code":"L6687","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.16,"maximum":3303.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":706.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1059.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2940.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3303.06,"additional_payer_notes":"APC"}]}]},{"description":"Frame typ sock above elb/dis","code_information":[{"code":"L6688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":683.09,"maximum":3195.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":683.09,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1024.64,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":696.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2844.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3195.15,"additional_payer_notes":"APC"}]}]},{"description":"Frame typ socket shoulder di","code_information":[{"code":"L6689","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":824.9,"maximum":3858.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1237.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3434.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3858.47,"additional_payer_notes":"APC"}]}]},{"description":"Frame typ sock interscap-tho","code_information":[{"code":"L6690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":893.33,"maximum":4178.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":893.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1340.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":911.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3719.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4178.55,"additional_payer_notes":"APC"}]}]},{"description":"Removable insert each","code_information":[{"code":"L6691","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":534.24,"maximum":2498.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":534.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":801.36,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":544.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2224.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2498.91,"additional_payer_notes":"APC"}]}]},{"description":"Silicone gel insert or equal","code_information":[{"code":"L6692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.63,"maximum":3202.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":684.63,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1026.94,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":698.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2850.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3202.36,"additional_payer_notes":"APC"}]}]},{"description":"Lockingelbow forearm cntrbal","code_information":[{"code":"L6693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3412.03,"maximum":15959.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3412.03,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5118.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3480.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14208.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15959.77,"additional_payer_notes":"APC"}]}]},{"description":"Elbow socket ins use w/lock","code_information":[{"code":"L6694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":860.1,"maximum":4023.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":860.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1290.15,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":877.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3581.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4023.12,"additional_payer_notes":"APC"}]}]},{"description":"Elbow socket ins use w/o lck","code_information":[{"code":"L6695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":716.74,"maximum":3352.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":716.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1075.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":731.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2984.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3352.55,"additional_payer_notes":"APC"}]}]},{"description":"Cus elbo skt in for con/atyp","code_information":[{"code":"L6696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1580.9,"maximum":7394.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1580.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2371.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1612.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6583.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7394.66,"additional_payer_notes":"APC"}]}]},{"description":"Cus elbo skt in not con/atyp","code_information":[{"code":"L6697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1580.9,"maximum":7394.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1580.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2371.35,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1612.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6583.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7394.66,"additional_payer_notes":"APC"}]}]},{"description":"Below/above elbow lock mech","code_information":[{"code":"L6698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.96,"maximum":2848.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":913.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2535.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2848.41,"additional_payer_notes":"APC"}]}]},{"description":"Ue add ext power myoel","code_information":[{"code":"L6700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29510.19,"maximum":138033.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29510.19,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44265.28,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30100.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":122883.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138033.91,"additional_payer_notes":"APC"}]}]},{"description":"Term dev, passive hand mitt","code_information":[{"code":"L6703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":432.97,"maximum":2025.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":432.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":649.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":441.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1802.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2025.22,"additional_payer_notes":"APC"}]}]},{"description":"Term dev, sport/rec/work att","code_information":[{"code":"L6704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":716.96,"maximum":3353.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":716.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1075.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":731.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2985.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3353.58,"additional_payer_notes":"APC"}]}]},{"description":"Term dev mech hook vol open","code_information":[{"code":"L6706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":427.16,"maximum":1998.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":640.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1778.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1998.04,"additional_payer_notes":"APC"}]}]},{"description":"Term dev mech hook vol close","code_information":[{"code":"L6707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1800.33,"maximum":8421.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1800.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2700.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1836.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7496.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8421.04,"additional_payer_notes":"APC"}]}]},{"description":"Term dev mech hand vol open","code_information":[{"code":"L6708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1024.05,"maximum":4789.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1024.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1536.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1044.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4264.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4789.99,"additional_payer_notes":"APC"}]}]},{"description":"Term dev mech hand vol close","code_information":[{"code":"L6709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1657.35,"maximum":7752.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1657.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2486.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1690.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6901.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7752.25,"additional_payer_notes":"APC"}]}]},{"description":"Ped term dev, hook, vol open","code_information":[{"code":"L6711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":808.0,"maximum":3779.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":808.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1212.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3364.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3779.42,"additional_payer_notes":"APC"}]}]},{"description":"Ped term dev, hook, vol clos","code_information":[{"code":"L6712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1487.69,"maximum":6958.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1487.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2231.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1517.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6194.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6958.67,"additional_payer_notes":"APC"}]}]},{"description":"Ped term dev, hand, vol open","code_information":[{"code":"L6713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1877.68,"maximum":8782.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1877.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2816.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1915.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7818.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8782.85,"additional_payer_notes":"APC"}]}]},{"description":"Ped term dev, hand, vol clos","code_information":[{"code":"L6714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1590.35,"maximum":7438.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1590.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2385.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1622.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6622.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7438.86,"additional_payer_notes":"APC"}]}]},{"description":"Term device, multi art digit","code_information":[{"code":"L6715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3794.37,"maximum":17748.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3794.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5691.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3870.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15800.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17748.17,"additional_payer_notes":"APC"}]}]},{"description":"Hook/hand, hvy dty, vol open","code_information":[{"code":"L6721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2826.66,"maximum":13221.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2826.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4239.99,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2883.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11770.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13221.7,"additional_payer_notes":"APC"}]}]},{"description":"Hook/hand, hvy dty, vol clos","code_information":[{"code":"L6722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2436.81,"maximum":11398.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2436.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3655.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2485.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10147.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11398.18,"additional_payer_notes":"APC"}]}]},{"description":"Term dev modifier wrist unit","code_information":[{"code":"L6805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":440.68,"maximum":2061.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":440.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":661.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":449.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1835.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2061.28,"additional_payer_notes":"APC"}]}]},{"description":"Term dev precision pinch dev","code_information":[{"code":"L6810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":240.21,"maximum":1123.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":240.21,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":360.32,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":245.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1000.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1123.58,"additional_payer_notes":"APC"}]}]},{"description":"Elec hand ind art digits","code_information":[{"code":"L6880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28715.0,"maximum":134314.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28715.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43072.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29289.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":119572.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134314.41,"additional_payer_notes":"APC"}]}]},{"description":"Term dev auto grasp feature","code_information":[{"code":"L6881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4913.43,"maximum":22982.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4913.43,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7370.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20460.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22982.57,"additional_payer_notes":"APC"}]}]},{"description":"Microprocessor control uplmb","code_information":[{"code":"L6882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3727.07,"maximum":17433.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3727.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5590.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3801.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15519.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17433.37,"additional_payer_notes":"APC"}]}]},{"description":"Replc sockt below e/w disa","code_information":[{"code":"L6883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1942.73,"maximum":9087.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1942.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2914.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1981.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8089.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9087.12,"additional_payer_notes":"APC"}]}]},{"description":"Replc sockt above elbow disa","code_information":[{"code":"L6884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2733.15,"maximum":12784.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2733.15,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4099.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2787.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":11381.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12784.31,"additional_payer_notes":"APC"}]}]},{"description":"Replc sockt shldr dis/interc","code_information":[{"code":"L6885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3936.67,"maximum":18413.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3936.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5905.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4015.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":16392.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18413.77,"additional_payer_notes":"APC"}]}]},{"description":"Prefab glove for term device","code_information":[{"code":"L6890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":208.23,"maximum":974.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":208.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":312.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":212.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":867.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":974.0,"additional_payer_notes":"APC"}]}]},{"description":"Custom glove for term device","code_information":[{"code":"L6895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":757.88,"maximum":3544.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":757.88,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1136.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":773.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3155.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3544.98,"additional_payer_notes":"APC"}]}]},{"description":"Hand restorat thumb/1 finger","code_information":[{"code":"L6900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1966.93,"maximum":9200.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1966.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2950.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2006.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8190.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9200.32,"additional_payer_notes":"APC"}]}]},{"description":"Hand restoration multiple fi","code_information":[{"code":"L6905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1930.97,"maximum":9032.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1930.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2896.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1969.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8040.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9032.11,"additional_payer_notes":"APC"}]}]},{"description":"Hand restoration no fingers","code_information":[{"code":"L6910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1982.27,"maximum":9272.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1982.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2973.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2021.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8254.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9272.07,"additional_payer_notes":"APC"}]}]},{"description":"Hand restoration replacmnt g","code_information":[{"code":"L6915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":766.41,"maximum":3584.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1149.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":781.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3191.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3584.88,"additional_payer_notes":"APC"}]}]},{"description":"Wrist disarticul switch ctrl","code_information":[{"code":"L6920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9436.79,"maximum":44140.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14155.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9625.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39295.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44140.59,"additional_payer_notes":"APC"}]}]},{"description":"Wrist disart myoelectronic c","code_information":[{"code":"L6925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10345.45,"maximum":48390.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15518.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10552.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43079.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48390.84,"additional_payer_notes":"APC"}]}]},{"description":"Below elbow switch control","code_information":[{"code":"L6930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8927.42,"maximum":41758.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8927.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13391.13,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9105.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":37174.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41758.01,"additional_payer_notes":"APC"}]}]},{"description":"Below elbow myoelectronic ct","code_information":[{"code":"L6935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10564.05,"maximum":49413.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10564.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15846.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43989.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49413.34,"additional_payer_notes":"APC"}]}]},{"description":"Elbow disarticulation switch","code_information":[{"code":"L6940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11638.52,"maximum":54439.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11638.52,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17457.78,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11871.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":48463.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54439.18,"additional_payer_notes":"APC"}]}]},{"description":"Elbow disart myoelectronic c","code_information":[{"code":"L6945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13017.45,"maximum":60889.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13017.45,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19526.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13277.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":54205.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60889.12,"additional_payer_notes":"APC"}]}]},{"description":"Above elbow switch control","code_information":[{"code":"L6950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12334.35,"maximum":57693.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12334.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18501.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12581.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":51361.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57693.92,"additional_payer_notes":"APC"}]}]},{"description":"Above elbow myoelectronic ct","code_information":[{"code":"L6955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15000.96,"maximum":70166.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15000.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22501.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15300.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":62465.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70166.99,"additional_payer_notes":"APC"}]}]},{"description":"Shldr disartic switch contro","code_information":[{"code":"L6960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15925.79,"maximum":74492.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15925.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23888.68,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16244.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":66316.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74492.88,"additional_payer_notes":"APC"}]}]},{"description":"Shldr disartic myoelectronic","code_information":[{"code":"L6965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18242.96,"maximum":85331.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18242.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27364.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18607.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":75965.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85331.45,"additional_payer_notes":"APC"}]}]},{"description":"Interscapular-thor switch ct","code_information":[{"code":"L6970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19607.53,"maximum":91714.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19607.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29411.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19999.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81647.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91714.22,"additional_payer_notes":"APC"}]}]},{"description":"Interscap-thor myoelectronic","code_information":[{"code":"L6975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21646.96,"maximum":101253.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21646.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32470.44,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22079.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":90140.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101253.66,"additional_payer_notes":"APC"}]}]},{"description":"Adult electric hand","code_information":[{"code":"L7007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4440.38,"maximum":20769.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4440.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6660.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4529.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18490.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20769.88,"additional_payer_notes":"APC"}]}]},{"description":"Pediatric electric hand","code_information":[{"code":"L7008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7501.44,"maximum":35087.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7501.44,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11252.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":31236.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35087.99,"additional_payer_notes":"APC"}]}]},{"description":"Adult electric hook","code_information":[{"code":"L7009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4540.82,"maximum":21239.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4540.82,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6811.23,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4631.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18908.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21239.69,"additional_payer_notes":"APC"}]}]},{"description":"Prehensile actuator","code_information":[{"code":"L7040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3561.4,"maximum":16658.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3561.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5342.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3632.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14830.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16658.45,"additional_payer_notes":"APC"}]}]},{"description":"Pediatric electric hook","code_information":[{"code":"L7045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1978.79,"maximum":9255.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1978.79,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2968.18,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2018.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8239.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9255.79,"additional_payer_notes":"APC"}]}]},{"description":"Electronic elbow hosmer swit","code_information":[{"code":"L7170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7178.38,"maximum":33576.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7178.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10767.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7321.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":29891.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33576.87,"additional_payer_notes":"APC"}]}]},{"description":"Electronic elbow sequential","code_information":[{"code":"L7180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42745.35,"maximum":199941.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42745.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64118.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43600.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":177995.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":199941.37,"additional_payer_notes":"APC"}]}]},{"description":"Electronic elbo simultaneous","code_information":[{"code":"L7181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48155.5,"maximum":225247.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48155.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72233.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49118.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":200524.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":225247.35,"additional_payer_notes":"APC"}]}]},{"description":"Electron elbow adolescent sw","code_information":[{"code":"L7185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7349.48,"maximum":34377.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.48,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11024.22,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7496.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":30603.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34377.19,"additional_payer_notes":"APC"}]}]},{"description":"Electron elbow child switch","code_information":[{"code":"L7186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11223.26,"maximum":52496.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11223.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16834.89,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11447.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46734.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52496.8,"additional_payer_notes":"APC"}]}]},{"description":"Elbow adolescent myoelectron","code_information":[{"code":"L7190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9568.74,"maximum":44757.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9568.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14353.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9760.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":39845.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44757.78,"additional_payer_notes":"APC"}]}]},{"description":"Elbow child myoelectronic ct","code_information":[{"code":"L7191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12088.38,"maximum":56543.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12088.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18132.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":50337.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56543.4,"additional_payer_notes":"APC"}]}]},{"description":"Electronic wrist rotator any","code_information":[{"code":"L7259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5104.76,"maximum":23877.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.76,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7657.14,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5206.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21256.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23877.51,"additional_payer_notes":"APC"}]}]},{"description":"Six volt bat otto bock/eq ea","code_information":[{"code":"L7360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":365.81,"maximum":1711.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":365.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":548.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":373.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1523.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1711.08,"additional_payer_notes":"APC"}]}]},{"description":"Battery chrgr six volt otto","code_information":[{"code":"L7362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.55,"maximum":1541.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.55,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":494.33,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":336.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1372.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1541.47,"additional_payer_notes":"APC"}]}]},{"description":"Twelve volt battery utah/equ","code_information":[{"code":"L7364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.14,"maximum":2849.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":609.14,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":913.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2536.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2849.25,"additional_payer_notes":"APC"}]}]},{"description":"Battery chrgr 12 volt utah/e","code_information":[{"code":"L7366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.67,"maximum":3838.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":820.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1231.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":837.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3417.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3838.68,"additional_payer_notes":"APC"}]}]},{"description":"Replacemnt lithium ionbatter","code_information":[{"code":"L7367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":467.9,"maximum":2188.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":467.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":701.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1948.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2188.6,"additional_payer_notes":"APC"}]}]},{"description":"Lithium ion battery charger","code_information":[{"code":"L7368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":606.56,"maximum":2837.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":606.56,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":909.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":618.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2525.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2837.18,"additional_payer_notes":"APC"}]}]},{"description":"Add ue prost be/wd, ultlite","code_information":[{"code":"L7400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":368.35,"maximum":1722.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":368.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1533.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1722.96,"additional_payer_notes":"APC"}]}]},{"description":"Add ue prost a/e ultlite mat","code_information":[{"code":"L7401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":412.39,"maximum":1928.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":412.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":618.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":420.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1717.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1928.95,"additional_payer_notes":"APC"}]}]},{"description":"Add ue prost s/d ultlite mat","code_information":[{"code":"L7402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":445.33,"maximum":2083.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":445.33,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":668.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":454.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1854.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2083.03,"additional_payer_notes":"APC"}]}]},{"description":"Add UE prost b/e acrylic","code_information":[{"code":"L7403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":442.58,"maximum":2070.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":442.58,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":663.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":451.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1842.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2070.17,"additional_payer_notes":"APC"}]}]},{"description":"Add UE prost a/e acrylic","code_information":[{"code":"L7404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":668.02,"maximum":3124.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":668.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1002.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":681.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2781.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3124.66,"additional_payer_notes":"APC"}]}]},{"description":"Add UE prost s/d acrylic","code_information":[{"code":"L7405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":873.65,"maximum":4086.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":873.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1310.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":891.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3637.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4086.5,"additional_payer_notes":"APC"}]}]},{"description":"Add to upp extr user adj mec","code_information":[{"code":"L7406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3150.07,"maximum":14734.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3150.07,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4725.11,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3213.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13117.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14734.45,"additional_payer_notes":"APC"}]}]},{"description":"Repair prosthesis per 15 min","code_information":[{"code":"L7520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.67,"maximum":190.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":169.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":190.23,"additional_payer_notes":"APC"}]}]},{"description":"Pros soc insert gasket/seal","code_information":[{"code":"L7700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.42,"maximum":825.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":264.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":734.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":825.2,"additional_payer_notes":"APC"}]}]},{"description":"Mastectomy bra","code_information":[{"code":"L8000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.7,"maximum":209.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67.05,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":186.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":209.08,"additional_payer_notes":"APC"}]}]},{"description":"Breast prosthesis bra & form","code_information":[{"code":"L8001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.77,"maximum":705.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.77,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":226.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":627.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":705.23,"additional_payer_notes":"APC"}]}]},{"description":"Brst prsth bra & bilat form","code_information":[{"code":"L8002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.27,"maximum":927.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":297.41,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":825.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":927.41,"additional_payer_notes":"APC"}]}]},{"description":"Ext breastprosthesis garment","code_information":[{"code":"L8015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.05,"maximum":337.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":108.07,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":300.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":337.01,"additional_payer_notes":"APC"}]}]},{"description":"Mastectomy form","code_information":[{"code":"L8020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":306.3,"maximum":1432.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":306.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":459.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":312.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1275.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1432.72,"additional_payer_notes":"APC"}]}]},{"description":"Breast prosthes w/o adhesive","code_information":[{"code":"L8030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.42,"maximum":1854.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":594.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1650.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1854.25,"additional_payer_notes":"APC"}]}]},{"description":"Breast prosthesis w adhesive","code_information":[{"code":"L8031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.42,"maximum":1854.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":396.42,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":594.63,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1650.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1854.25,"additional_payer_notes":"APC"}]}]},{"description":"Reusable nipple prosthesis","code_information":[{"code":"L8032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.08,"maximum":220.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":196.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":220.22,"additional_payer_notes":"APC"}]}]},{"description":"Custom breast prosthesis","code_information":[{"code":"L8035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4403.11,"maximum":20595.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4403.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6604.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4491.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18334.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20595.55,"additional_payer_notes":"APC"}]}]},{"description":"Nasal prosthesis","code_information":[{"code":"L8040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3063.25,"maximum":14328.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3063.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4594.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3124.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":12755.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14328.35,"additional_payer_notes":"APC"}]}]},{"description":"Midfacial prosthesis","code_information":[{"code":"L8041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3692.26,"maximum":17270.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3692.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5538.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3766.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":15374.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17270.55,"additional_payer_notes":"APC"}]}]},{"description":"Orbital prosthesis","code_information":[{"code":"L8042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4148.6,"maximum":19405.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4148.6,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6222.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":17275.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19405.08,"additional_payer_notes":"APC"}]}]},{"description":"Upper facial prosthesis","code_information":[{"code":"L8043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4646.49,"maximum":21733.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6969.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4739.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":19348.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21733.96,"additional_payer_notes":"APC"}]}]},{"description":"Hemi-facial prosthesis","code_information":[{"code":"L8044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5144.24,"maximum":24062.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5144.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7716.36,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5247.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":21421.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24062.18,"additional_payer_notes":"APC"}]}]},{"description":"Auricular prosthesis","code_information":[{"code":"L8045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3591.11,"maximum":16797.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5386.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3662.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":14953.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16797.42,"additional_payer_notes":"APC"}]}]},{"description":"Partial facial prosthesis","code_information":[{"code":"L8046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3318.85,"maximum":15523.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3318.85,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4978.27,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":13820.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15523.92,"additional_payer_notes":"APC"}]}]},{"description":"Nasal septal prosthesis","code_information":[{"code":"L8047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1700.95,"maximum":7956.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1700.95,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2551.43,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1734.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7082.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7956.19,"additional_payer_notes":"APC"}]}]},{"description":"Truss single w/ standard pad","code_information":[{"code":"L8300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.28,"maximum":483.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":154.92,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":430.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":483.09,"additional_payer_notes":"APC"}]}]},{"description":"Truss double w/ standard pad","code_information":[{"code":"L8310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.05,"maximum":762.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":244.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":678.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":762.67,"additional_payer_notes":"APC"}]}]},{"description":"Truss addition to std pad wa","code_information":[{"code":"L8320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.1,"maximum":341.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109.65,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":304.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":341.93,"additional_payer_notes":"APC"}]}]},{"description":"Truss add to std pad scrotal","code_information":[{"code":"L8330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.44,"maximum":282.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.44,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":251.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":282.71,"additional_payer_notes":"APC"}]}]},{"description":"Sheath below knee","code_information":[{"code":"L8400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.27,"maximum":99.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":88.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99.49,"additional_payer_notes":"APC"}]}]},{"description":"Sheath above knee","code_information":[{"code":"L8410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.4,"maximum":132.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":118.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132.84,"additional_payer_notes":"APC"}]}]},{"description":"Sheath upper limb","code_information":[{"code":"L8415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.93,"maximum":130.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":116.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130.64,"additional_payer_notes":"APC"}]}]},{"description":"Pros sheath/sock w gel cushn","code_information":[{"code":"L8417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.32,"maximum":422.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.32,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":135.48,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":376.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":422.47,"additional_payer_notes":"APC"}]}]},{"description":"Prosthetic sock multi ply BK","code_information":[{"code":"L8420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.08,"maximum":117.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.08,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":104.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117.31,"additional_payer_notes":"APC"}]}]},{"description":"Prosthetic sock multi ply AK","code_information":[{"code":"L8430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.1,"maximum":126.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.65,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":112.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126.76,"additional_payer_notes":"APC"}]}]},{"description":"Pros sock multi ply upper lm","code_information":[{"code":"L8435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.74,"maximum":120.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.74,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38.61,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":107.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120.4,"additional_payer_notes":"APC"}]}]},{"description":"Shrinker below knee","code_information":[{"code":"L8440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.2,"maximum":239.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.2,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76.8,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":213.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":239.49,"additional_payer_notes":"APC"}]}]},{"description":"Shrinker above knee","code_information":[{"code":"L8460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.59,"maximum":381.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":122.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":339.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":381.64,"additional_payer_notes":"APC"}]}]},{"description":"Shrinker upper limb","code_information":[{"code":"L8465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.23,"maximum":337.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":108.34,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":300.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":337.86,"additional_payer_notes":"APC"}]}]},{"description":"Pros sock single ply BK","code_information":[{"code":"L8470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.17,"maximum":38.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":34.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38.22,"additional_payer_notes":"APC"}]}]},{"description":"Pros sock single ply AK","code_information":[{"code":"L8480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.27,"maximum":52.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":46.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52.72,"additional_payer_notes":"APC"}]}]},{"description":"Pros sock single ply upper l","code_information":[{"code":"L8485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.16,"maximum":66.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":58.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66.23,"additional_payer_notes":"APC"}]}]},{"description":"Artificial larynx","code_information":[{"code":"L8500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1077.27,"maximum":5038.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1077.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1615.9,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1098.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4485.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5038.93,"additional_payer_notes":"APC"}]}]},{"description":"Tracheostomy speaking valve","code_information":[{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":147.88,"maximum":691.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.88,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":615.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":691.71,"additional_payer_notes":"APC"}]}]},{"description":"Trach-esoph voice pros pt in","code_information":[{"code":"L8507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.34,"maximum":235.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":209.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":235.47,"additional_payer_notes":"APC"}]}]},{"description":"Trach-esoph voice pros md in","code_information":[{"code":"L8509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.24,"maximum":613.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":196.86,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":133.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":546.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":613.88,"additional_payer_notes":"APC"}]}]},{"description":"Voice amplifier","code_information":[{"code":"L8510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":303.69,"maximum":1420.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":303.69,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":455.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":309.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1264.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1420.51,"additional_payer_notes":"APC"}]}]},{"description":"Indwelling trach insert","code_information":[{"code":"L8511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.41,"maximum":408.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87.41,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":131.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":363.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":408.86,"additional_payer_notes":"APC"}]}]},{"description":"Gel cap for trach voice pros","code_information":[{"code":"L8512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.59,"maximum":12.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.59,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Trach pros cleaning device","code_information":[{"code":"L8513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.24,"maximum":29.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.24,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":25.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29.19,"additional_payer_notes":"APC"}]}]},{"description":"Repl trach puncture dilator","code_information":[{"code":"L8514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.31,"maximum":530.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.31,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":169.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":471.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":530.01,"additional_payer_notes":"APC"}]}]},{"description":"Gel cap app device for trach","code_information":[{"code":"L8515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.84,"maximum":354.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":113.76,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":315.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":354.74,"additional_payer_notes":"APC"}]}]},{"description":"Coch implant headset replace","code_information":[{"code":"L8615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.05,"maximum":2535.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":542.05,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":813.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":552.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2257.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2535.44,"additional_payer_notes":"APC"}]}]},{"description":"Coch implant microphone repl","code_information":[{"code":"L8616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.26,"maximum":590.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":126.26,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":189.39,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":525.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":590.58,"additional_payer_notes":"APC"}]}]},{"description":"Coch implant trans coil repl","code_information":[{"code":"L8617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.27,"maximum":515.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110.27,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":165.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":459.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":515.79,"additional_payer_notes":"APC"}]}]},{"description":"Coch implant tran cable repl","code_information":[{"code":"L8618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.5,"maximum":147.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.5,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47.25,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":131.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147.34,"additional_payer_notes":"APC"}]}]},{"description":"Coch imp ext proc/contr rplc","code_information":[{"code":"L8619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10248.4,"maximum":47936.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10248.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15372.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10453.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":42675.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47936.89,"additional_payer_notes":"APC"}]}]},{"description":"Repl zinc air battery","code_information":[{"code":"L8621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.75,"maximum":3.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1.12,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3.51,"additional_payer_notes":"APC"}]}]},{"description":"Repl alkaline battery","code_information":[{"code":"L8622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.39,"maximum":1.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":0.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1.82,"additional_payer_notes":"APC"}]}]},{"description":"Lith ion batt cid,non-earlvl","code_information":[{"code":"L8623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.75,"maximum":363.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":116.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":323.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":363.68,"additional_payer_notes":"APC"}]}]},{"description":"Lith ion batt cid, ear level","code_information":[{"code":"L8624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.82,"maximum":906.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.82,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":290.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":807.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":906.59,"additional_payer_notes":"APC"}]}]},{"description":"Charger coch impl/aoi battry","code_information":[{"code":"L8625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.97,"maximum":1061.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":226.97,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":340.46,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":945.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1061.65,"additional_payer_notes":"APC"}]}]},{"description":"CID ext speech process repl","code_information":[{"code":"L8627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8755.4,"maximum":40953.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8755.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13133.1,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8930.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":36458.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40953.38,"additional_payer_notes":"APC"}]}]},{"description":"CID ext controller repl","code_information":[{"code":"L8628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1492.93,"maximum":6983.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1492.93,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2239.4,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1522.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6216.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6983.18,"additional_payer_notes":"APC"}]}]},{"description":"CID transmit coil and cable","code_information":[{"code":"L8629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.18,"maximum":1006.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.18,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":322.77,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":896.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1006.5,"additional_payer_notes":"APC"}]}]},{"description":"Pt prgrm for implt neurostim","code_information":[{"code":"L8681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1320.72,"maximum":6177.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1320.72,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1981.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1347.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5499.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6177.67,"additional_payer_notes":"APC"}]}]},{"description":"Radiofq trsmtr for implt neu","code_information":[{"code":"L8683","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6333.04,"maximum":29622.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.04,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9499.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6459.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":26371.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29622.79,"additional_payer_notes":"APC"}]}]},{"description":"Radiof trsmtr implt scrl neu","code_information":[{"code":"L8684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":972.17,"maximum":4547.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":972.17,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1458.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":991.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4048.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4547.33,"additional_payer_notes":"APC"}]}]},{"description":"External recharg sys intern","code_information":[{"code":"L8689","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2073.11,"maximum":9696.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2073.11,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3109.66,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2114.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8632.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9696.97,"additional_payer_notes":"APC"}]}]},{"description":"Osseointegrated snd proc rpl","code_information":[{"code":"L8691","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2069.73,"maximum":9681.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2069.73,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3104.6,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2111.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":8618.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9681.16,"additional_payer_notes":"APC"}]}]},{"description":"Aoi transducer/actuator repl","code_information":[{"code":"L8694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1134.98,"maximum":5308.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1134.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1702.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1157.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4726.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5308.87,"additional_payer_notes":"APC"}]}]},{"description":"External recharg sys extern","code_information":[{"code":"L8695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.0,"maximum":93.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":83.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93.55,"additional_payer_notes":"APC"}]}]},{"description":"Pow ue rom dev ewh uprt cust","code_information":[{"code":"L8701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34970.13,"maximum":163572.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34970.13,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52455.19,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35669.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":145619.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163572.78,"additional_payer_notes":"APC"}]}]},{"description":"Pow ue rom dev ewhf uprt cus","code_information":[{"code":"L8702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68801.71,"maximum":321820.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68801.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103202.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70177.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":286497.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":321820.0,"additional_payer_notes":"APC"}]}]},{"description":"Pwr module pt cable lvad rpl","code_information":[{"code":"Q0477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":932.39,"maximum":4361.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":932.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1398.58,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":951.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3882.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4361.25,"additional_payer_notes":"APC"}]}]},{"description":"Power adapter, combo vad","code_information":[{"code":"Q0478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":220.87,"maximum":1033.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.87,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":331.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":919.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1033.12,"additional_payer_notes":"APC"}]}]},{"description":"Power module combo vad, rep","code_information":[{"code":"Q0479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14431.75,"maximum":67504.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14431.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21647.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14720.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":60095.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67504.51,"additional_payer_notes":"APC"}]}]},{"description":"driver pneumatic vad, rep","code_information":[{"code":"Q0480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108243.35,"maximum":506308.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":108243.35,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":162365.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110408.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":450736.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":506308.27,"additional_payer_notes":"APC"}]}]},{"description":"microprcsr cu elec vad, rep","code_information":[{"code":"Q0481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17463.78,"maximum":81686.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17463.78,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26195.67,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17813.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":72720.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81686.83,"additional_payer_notes":"APC"}]}]},{"description":"microprcsr cu combo vad, rep","code_information":[{"code":"Q0482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5469.98,"maximum":25585.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5469.98,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8204.97,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5579.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":22777.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25585.83,"additional_payer_notes":"APC"}]}]},{"description":"monitor elec vad, rep","code_information":[{"code":"Q0483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22533.92,"maximum":105402.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22533.92,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33800.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22984.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":93833.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105402.41,"additional_payer_notes":"APC"}]}]},{"description":"monitor elec or comb vad rep","code_information":[{"code":"Q0484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4376.02,"maximum":20468.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4376.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6564.03,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4463.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":18222.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20468.83,"additional_payer_notes":"APC"}]}]},{"description":"monitor cable elec vad, rep","code_information":[{"code":"Q0485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":422.47,"maximum":1976.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":422.47,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":633.71,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":430.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1759.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1976.1,"additional_payer_notes":"APC"}]}]},{"description":"mon cable elec/pneum vad rep","code_information":[{"code":"Q0486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":351.65,"maximum":1644.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":351.65,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":527.47,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":358.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1464.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1644.84,"additional_payer_notes":"APC"}]}]},{"description":"leads any type vad, rep only","code_information":[{"code":"Q0487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":410.25,"maximum":1918.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":410.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":615.38,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":418.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1708.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1918.94,"additional_payer_notes":"APC"}]}]},{"description":"pwr pck base combo vad, rep","code_information":[{"code":"Q0489","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19535.67,"maximum":91378.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19535.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29303.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19926.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":81348.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91378.1,"additional_payer_notes":"APC"}]}]},{"description":"emr pwr source elec vad, rep","code_information":[{"code":"Q0490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":845.03,"maximum":3952.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":845.03,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1267.54,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":861.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3518.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3952.63,"additional_payer_notes":"APC"}]}]},{"description":"emr pwr source combo vad rep","code_information":[{"code":"Q0491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1328.48,"maximum":6213.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1328.48,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1992.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1355.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":5531.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6213.97,"additional_payer_notes":"APC"}]}]},{"description":"emr pwr cbl elec vad, rep","code_information":[{"code":"Q0492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.01,"maximum":500.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":160.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":445.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":500.54,"additional_payer_notes":"APC"}]}]},{"description":"emr pwr cbl combo vad, rep","code_information":[{"code":"Q0493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.77,"maximum":1425.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":304.77,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":457.16,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1269.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1425.56,"additional_payer_notes":"APC"}]}]},{"description":"emr hd pmp elec/combo, rep","code_information":[{"code":"Q0494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.9,"maximum":1206.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.9,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":386.85,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":263.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1073.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1206.33,"additional_payer_notes":"APC"}]}]},{"description":"charger elec/combo vad, rep","code_information":[{"code":"Q0495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5020.16,"maximum":23481.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.16,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7530.24,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":20904.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23481.8,"additional_payer_notes":"APC"}]}]},{"description":"battery elec/combo vad, rep","code_information":[{"code":"Q0496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1801.82,"maximum":8428.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1801.82,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2702.73,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1837.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7502.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8428.01,"additional_payer_notes":"APC"}]}]},{"description":"bat clps elec/comb vad, rep","code_information":[{"code":"Q0497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":562.64,"maximum":2631.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":562.64,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":843.96,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":573.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2342.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2631.75,"additional_payer_notes":"APC"}]}]},{"description":"holster elec/combo vad, rep","code_information":[{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":617.36,"maximum":2887.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":617.36,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":926.04,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":629.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2570.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2887.7,"additional_payer_notes":"APC"}]}]},{"description":"belt/vest elec/combo vad rep","code_information":[{"code":"Q0499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.58,"maximum":938.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200.58,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":300.87,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":204.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":835.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":938.21,"additional_payer_notes":"APC"}]}]},{"description":"filters elec/combo vad, rep","code_information":[{"code":"Q0500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.71,"maximum":171.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.71,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":152.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171.71,"additional_payer_notes":"APC"}]}]},{"description":"shwr cov elec/combo vad, rep","code_information":[{"code":"Q0501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":613.75,"maximum":2870.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":613.75,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":920.62,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":626.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":2555.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2870.82,"additional_payer_notes":"APC"}]}]},{"description":"mobility cart pneum vad, rep","code_information":[{"code":"Q0502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":781.39,"maximum":3654.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":781.39,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1172.08,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":797.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3253.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3654.95,"additional_payer_notes":"APC"}]}]},{"description":"battery pneum vad replacemnt","code_information":[{"code":"Q0503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1562.84,"maximum":7310.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1562.84,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2344.26,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1594.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6507.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7310.18,"additional_payer_notes":"APC"}]}]},{"description":"pwr adpt pneum vad, rep veh","code_information":[{"code":"Q0504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":824.68,"maximum":3857.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":824.68,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1237.02,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":3434.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3857.44,"additional_payer_notes":"APC"}]}]},{"description":"Lith-ion batt elec/pneum VAD","code_information":[{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1026.54,"maximum":4801.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1026.54,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1539.81,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1047.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":4274.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4801.64,"additional_payer_notes":"APC"}]}]},{"description":"Biofeedback train any meth","code_information":[{"code":"90901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.37,"maximum":76.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":68.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76.57,"additional_payer_notes":"APC"}]}]},{"description":"Caregiver traing 1st 30 min","code_information":[{"code":"97550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.81,"maximum":186.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":165.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186.21,"additional_payer_notes":"APC"}]}]},{"description":"Caregiver traing ea addl 15","code_information":[{"code":"97551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.1,"maximum":98.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.65,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":87.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98.7,"additional_payer_notes":"APC"}]}]},{"description":"Group caregiver training","code_information":[{"code":"97552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.34,"maximum":43.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":38.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Qnhp ol dig e/m svc 5-10min","code_information":[{"code":"98970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.34,"maximum":48.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.34,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15.51,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":43.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48.37,"additional_payer_notes":"APC"}]}]},{"description":"Qnhp ol dig em svc 11-20min","code_information":[{"code":"98971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.0,"maximum":88.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":79.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88.87,"additional_payer_notes":"APC"}]}]},{"description":"Qnhp ol dig e/m svc 21+ min","code_information":[{"code":"98972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.01,"maximum":135.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43.52,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":120.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135.69,"additional_payer_notes":"APC"}]}]},{"description":"Rtm tx mgmt 1st 10 min","code_information":[{"code":"98979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.37,"maximum":53.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17.06,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":47.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53.18,"additional_payer_notes":"APC"}]}]},{"description":"Vag inser rectal control sys","code_information":[{"code":"A4563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1640.3,"maximum":7672.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1640.3,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2460.45,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1673.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":6830.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7672.5,"additional_payer_notes":"APC"}]}]},{"description":"Ed svc CKD ind per session","code_information":[{"code":"G0420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":113.02,"maximum":528.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":113.02,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":169.53,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":470.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":528.65,"additional_payer_notes":"APC"}]}]},{"description":"Ed svc CKD grp per session","code_information":[{"code":"G0421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.25,"maximum":127.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.25,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":113.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127.46,"additional_payer_notes":"APC"}]}]},{"description":"PPPS, initial visit","code_information":[{"code":"G0438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.23,"maximum":810.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.23,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":259.84,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":721.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":810.28,"additional_payer_notes":"APC"}]}]},{"description":"PPPS, subseq visit","code_information":[{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":136.66,"maximum":639.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136.66,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":204.99,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":569.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":639.23,"additional_payer_notes":"APC"}]}]},{"description":"Initial care training 30 m","code_information":[{"code":"G0539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.81,"maximum":186.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.81,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59.72,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":165.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186.21,"additional_payer_notes":"APC"}]}]},{"description":"Train for caregiver add 15","code_information":[{"code":"G0540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.1,"maximum":98.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.1,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31.65,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":87.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98.7,"additional_payer_notes":"APC"}]}]},{"description":"Safety plan interven","code_information":[{"code":"G0560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.53,"maximum":184.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.53,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59.3,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":164.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184.9,"additional_payer_notes":"APC"}]}]},{"description":"Remot img sub by pt, non e/m","code_information":[{"code":"G2250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.99,"maximum":37.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":33.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37.37,"additional_payer_notes":"APC"}]}]},{"description":"Brief chkin, 5-10, non-e/m","code_information":[{"code":"G2251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.67,"maximum":49.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.67,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":44.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49.91,"additional_payer_notes":"APC"}]}]},{"description":"Brief chkin by md/qhp, 11-20","code_information":[{"code":"G2252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.28,"maximum":104.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.28,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33.42,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":92.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104.21,"additional_payer_notes":"APC"}]}]},{"description":"Removable soft interface le","code_information":[{"code":"K0672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.7,"maximum":475.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.7,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":152.55,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":423.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":475.7,"additional_payer_notes":"APC"}]}]},{"description":"Aud osseo dev, abutment","code_information":[{"code":"L8693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1822.38,"maximum":8524.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1822.38,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2733.57,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":7588.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8524.18,"additional_payer_notes":"APC"}]}]},{"description":"Ext antenna phren nerve stim","code_information":[{"code":"L8696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.49,"maximum":1218.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.49,"additional_payer_notes":"APC"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":390.74,"additional_payer_notes":"Radiology"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":265.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Aca Exchange","methodology":"fee schedule","standard_charge_dollar":1084.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Highmark Non-Aca All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1218.44,"additional_payer_notes":"APC"}]}]}]}